Review of WIC Food Packages An Evaluation of White Potatoes in the Cash Value Voucher: Letter Report (2015) / Chapter Skim
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Letter Report
Letter Report
Pages 5-38
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From page 5... ...
. In 2003, USDA-FNS asked the IOM to conduct a two-phase evaluation of the WIC food packages, including in phase I reviewing the nutritional needs of WIC participants and proposing priority nutrients and nutrition recommendations.
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Following this report, phases I and II of the Review of WIC Food Packages study will update the findings presented here, evaluate the current WIC food packages as outlined in the statement of task, and recommend updates, in the context of the 2015 DGA. A component of the committee's task, which is the subject of this report, was to evaluate the exclusion of white potatoes from purchase with the cash value voucher (CVV)
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Public Data Gathering, Sponsor, and Public Comment Sessions A data-gathering workshop, public comment session,2 and sponsor session were held October 14–15, 2014, in Washington, DC. Workshop presentations included information on national trends in the production and consumption of white potatoes; WIC voucher purchase patterns; nutrient content of white potatoes; nutrient bioavailability and relationships to health outcomes; and white potato products and processing.
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Alternatively, the committee opted to conduct a comprehensive review of peer-reviewed published evidence, as well as of non-peer-reviewed evidence to identify relevant scientific and government reports. The committee also reviewed commissioned data collection and analyses of the response to the 2009 WIC food package implementation describing changes in food consumption of WIC participants, white potato consumption patterns, program administration issues related to exclusion of white potatoes from the CVV, health impacts related to white potato intake, and vendor and stocking issues linked to use of the CVV (see Appendix D for the search strategy)
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To assess nutrient and energy intakes among WIC participants, WICeligible, and low-income but noneligible population groups, the committee examined the 2007–2008, 2009–2010, and 2011–2012 NHANES data sets. Although the 2011–2012 dataset had been released as this report was in preparation, two critical components were not yet publicly available5: 3 PC Software for Intake Distribution Estimation (PC-SIDE)
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Women ages 14 to 18 years were not included in the analysis because the data were not consistently available in NHANES to identify those among them who were WIC participants.6 Additionally, the subgroups of pregnant, breastfeeding, and postpartum WIC participants were too few in number for separate analyses. Therefore, the data were grouped as follows: (1)
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The current intake of potentially WICeligible white potatoes was used as a baseline when estimating plausible scenarios for changes in intake in the sensitivity analyses. Assessment of diet quality The diet quality of WIC participants and WICeligible nonparticipants was evaluated using the 2010 HEI (Guenther et al., 2013)
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Costs for each vegetable subgroup and for fruit were estimated in two ways: assuming all fresh items, and assuming a mix of fresh and canned vegetable items based on those reported to be commonly consumed by WIC participants and other low-income populations. Further details of these analyses are described in Appendix F
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Task 1: Compare white potato consumption among the population subgroups of interest before and after the enactment of regulations in 2009, finalized in 2014, to exclude white potatoes from the WIC food packages. Purchasing Patterns for White Potatoes In reviewing the literature, the committee identified studies indicating that changes in vegetable and fruit purchase patterns after the CVV implementation may vary geographically.
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There is some evidence that provision of fruit and vegetable benefits in the revised WIC food packages increased overall purchases of vegetables and fruits among households participating in WIC in New England. The committee did not find sufficient evidence on purchasing behavior of WIC participants to determine whether white potatoes would displace currently available vegetables and fruits or white potatoes currently purchased with other funds if permitted for purchase with the CVV.
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per capita, beginning well before the 2009 WIC food package changes, the committee was not able to identify changes in the availability of white potatoes in potentially WIC-eligible forms (i.e., fresh, canned, or frozen without added fat or added sugars) , compared to non-WIC-eligible forms (e.g., chips, fries)
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. A relatively large share of the white potatoes consumed by WIC participants (32 percent for children and 46 percent for women)
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The committee was unable to determine if the exclusion of white potatoes from purchase with the CVV had any effect on the consumption of potentially WIC-eligible forms of white potatoes by WIC participants or low-income nonparticipants. This was because the complete data from 2011–2012 NHANES survey needed for the most direct assessment of the impact of the 2009 exclusion were not available.
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Nutritional Value of White Potatoes White potatoes in potentially WIC-eligible forms do not contain any of the "food components to reduce" identified in the 2010 DGA. They do contain two "nutrients to increase," namely potassium and dietary fiber
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Starchy Vegetables in the Dietary Guidelines for Americans The 2005 Committee to Review the WIC Food Packages (IOM, 2006) based its recommendation to exclude white potatoes from purchase on a
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. Daily recommendations for total vegetables are currently as follows: 0.2 cups dark green vegetables, 0.2 cups of beans and peas, 0.8 cups of red and orange vegetables, 0.6 cups of "other" vegetables, and 0.7 cups of starchy vegetables, for a total consumption of 2.5 cups of vegetables daily (at a daily intake of 2,000 kcal)
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Finding WIC participants' intakes of all of the vegetable subgroups were below recommendations, as were intakes of fruit for women par ticipants. Intakes of starchy vegetables were closer to recommendations than intakes of the other vegetable subgroups, but were still consider ably below the 2010 DGA recommendations.
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. By aligning the WIC food packages with the 2005 DGA, the revised food package in general, and the CVV in particular, were intended to contribute to the nutritional health of WIC participants consistent with the evidence available at the time.
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The DGAC also noted a significant and consistently protective relationship between intake of nonstarchy vegetables and fruits and risk of all cancers, but evidence was insufficient for a relationship between starchy vegetables and site-specific cancers. In addition, the 2010 DGAC concluded that there were significant and positive associations with health outcomes linked to a minimum of five daily servings of vegetables and fruits, with additional benefits linked to more than five servings per day.
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Yet, few studies have examined cultural differences in white potato consumption or purchases among WIC participants by race/ethnic or cultural/geographic differences in use of the CVV. The committee therefore examined evidence for a relationship between the current WIC food package and increases in the purchase and consumption of both vegetables and fruits.
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, and (2) changes in dietary quality when fresh12 white potatoes are included in the WIC Food Package.
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However, these sensitivity analyses rely on several ad hoc assumptions about how the purchases with the CVV would be redistributed if white potatoes were to be allowed. Owing to a lack of behavioral data on the response of WIC participants to changes in allowable vegetables and fruits with the CVV, the quality of these assumptions is unknown.
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Conclusion Various cost-neutral shifts in the intake of categories of fruits and/or vegetables to accommodate higher consumption of fresh white potatoes would not appreciably impact nutrient or food group intake, or the HEI scores, for women or children. Further, if potato consumption increases, then intakes of starchy vegetables would move closer to the 2010 DGA recommendations, although small declines in meeting recommendations for other vegetable subgroups may be seen.
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. Additionally, the fact that at least three food companies created a one-pound size loaf of 100 percent whole wheat bread to match the revised WIC food package guidelines indicates that market adaptations to the WIC program have occurred in the past.
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Rationale The WIC food package must align with the current DGA, which means that the CVV must be aligned with recommended intakes of categories of vegetables and fruits. The recommendation of the report WIC Food Packages: Time for a Change (IOM, 2006)
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Rationale The committee's ability to respond to the USDA's request for specific analyses was compromised by a lack of data on dietary intake for adequate numbers of pregnant, breastfeeding, or postpartum women at any income and, especially, for low-income women in general and WIC participants in particular. These data are critical to future evaluations of changes in the WIC food packages.
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Moreover, the committee's ability to understand the satisfaction of either WIC participants or vendors with the CVV or understand how either WIC participants or vendors thought about how to use the CVV was also hampered by a lack of information.
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Percent of Percent of Mean Recommended Mean Recommended Food Group Recommendation Intake Intake Recommendation Intake Intake Starchy Vegetables (c-eq/d) 0.5 0.3 64 0.7 0.4 56 Dark Green Vegetables 0.1 0.02 17 0.2 0.06 29 (c-eq/d)
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; nutrient intakes were compared to the RDA/AI for children 1–3 years of age and 4–8 years of age as listed in Table E-1. Food group recommendations are weighted in a 1:3 ratio using 1,000 and 1,300 (averaged from 1,200 and 1,400)
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; nutrient intakes were compared to the RDA/AI for women 19–50 years of age as listed in Table E-1. Nutrient profiles of the food subgroups are presented in Table L-1b.
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2011. The effects of changes in WIC food packages on redemptions.
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2006. WIC food packages: Time for a change.
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2011. WIC food packages policy options study, final report.
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