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6 Nutrition-Related Health Risks in the WIC Population
Pages 195-234

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From page 195...
... . This chapter begins with a summary of the WIC specification of these risks and the most commonly reported risks for WIC participants.
From page 196...
... report Weight Gain During Pregnancy: Reexamining the Guidelines (IOM, 2009) was also considered because of its extensive review of several health concerns applicable to the WIC population.
From page 197...
... As a result of the multiple risk reporting and the use of multiple approaches for nutritional risk assessment, interpretation of the frequency of reported risks is challenging. Therefore, the committee cites only the five most frequently reported nutritional risks for WIC participants in 2012 (see Table 6-2)
From page 198...
... Inappropriate Pregnant Gestational weight gain < or > IOM growth or Women Weight Gain Guidelines (2009) or weight gain weight loss pattern Infants Low birth weight (< 2,500 g)
From page 199...
... Infants and Feeding practices that compromise Children appropriate infant growth, health, or safety (CDPH, 2015) ; 4–23 months dietary risk associated with complementary feeding (age introduced, intake, quantity, etc.)
From page 200...
... . This section summarizes maternal nutrition-related health risks before pregnancy, during pregnancy, and after pregnancy and the effects of these risks on both maternal and infant health outcomes.
From page 201...
... TABLE 6-2  Reported Nutritional Risks for WIC Participants from Most Common to Fifth Most Common in 2012 WIC Participant Category Women Infants Children Rank Pregnant Breastfeeding Postpartum 0 to < 12 months 1 to < 5 years 1 High weight for height High weight for height High weight for height Inappropriate nutrition Inappropriate nutrition practices practices 2 Inappropriate weight Low hematocrit or Inappropriate weight Low birth weight or High weight for height/ gain hemoglobin gain premature birth length 3 Inappropriate Inappropriate weight Low hematocrit or Short stature Failure to meet the Dietary nutritional practices gain hemoglobin Guidelines for Americans 4 General obstetrical Inappropriate Inappropriate nutritional Low weight for length Low hematocrit or risk nutritional practices practices hemoglobin 5 Low hematocrit or General obstetrical General obstetrical risk   Low hematocrit or   Low weight for height/ hemoglobin risk hemoglobin length SOURCE: USDA/FNS, 2013.
From page 202...
... 2011 PNSS Nutrition-Related Health Risk/Outcome (WIC Women) a Pregnant All Before Pregnancy Overweight 26.0 NA 23.9b Obese 27.6 NA 31.9b Combined overweight and obese 53.6 NA 55.8b Underweight 4.5 NA 2.5c Low folate status NA NA 0.9d During Pregnancy: Maternal Risks and Outcomes Inappropriate gestational weight gain < IOM 2009 Guidelines 21.0 NA NA > IOM 2009 Guidelines 48.0 NA NA Gestational diabetes 5.7 NA NA Pregnancy-induced hypertension 6.7 NA NA Anemia NA 5.4e NA 1st trimester 7.3 NA NA 2nd trimester 11.6 NA NA 3rd trimester 33.8 NA NA Iron deficiency NA 18.0e NA 1st trimester NA 6.9e NA 2nd trimester NA 14.3e NA 3rd trimester NA 29.7e NA During Pregnancy: Fetal Risks and Outcomes Low birth weight 7.9 NA NA SGA (full-term low birth weight)
From page 203...
... 2011 PNSS Nutrition-Related Health Risk/Outcome (WIC Women) a Pregnant All Breastfeeding Overweight and obese NA NA NA Anemia NA   NA   NA NOTES: IOM = Institute of Medicine; NA = Data not available; NHANES = National Health and Nutrition Examination Survey; PNSS = Pregnancy Nutrition Surveillance System; SGA = small for gestational age.
From page 204...
... , for which folic acid fortification is not required. Subsequently, the 2009 changes in the WIC food packages included introduction of whole wheat bread (or allowable substitutions from other whole grain options)
From page 205...
... . Nutrition-Related Health Risks During Pregnancy Nutrition-related health risks during pregnancy include inappropriate gestational weight gain, type 2 and gestational diabetes, pregnancy-induced hypertension and preeclampsia, maternal iron deficiency and anemia, low maternal vitamin D, and low maternal choline intake (IOM, 2009)
From page 206...
... . The committee was not able to find data specific to the prevalence of gestational diabetes in the WIC population on a national level.
From page 207...
... , with neonatal outcomes, including lower iron stores, impaired neurocognitive development, developmental programming, low birth weight, and preterm birth (Cao and O'Brien, 2013; AHRQ, 2015)
From page 208...
... . Fetal Outcomes Related to Nutrition-Related Health Risks During Pregnancy This section summarizes evidence associating low and high birth weight with nutrition-related conditions in women.
From page 209...
... . Of this, 10.5 percent of infants were born preterm and 3.4 percent were born small for gestational age (full-term, low birth weight)
From page 210...
... Excessive postpartum weight retention, however, could contribute to such interconceptional nutritional risk and adverse birth outcomes or longterm maternal health. Gestational weight gain above the recommended amounts (IOM, 2009; Endres et al., 2015)
From page 211...
... . K NUTRITION-RELATED HEALTH RISKS IN INFANTS This section summarizes evidence for health outcomes associated with nutrition related-risks for infants.
From page 212...
... . Emerging evidence, though controversial, has similarly associated rapid catch-up growth in infants with low birth weight and being small for gestational age, particularly excess weight-for-length gain (Belfort and Gillman, 2013)
From page 213...
... . Being small for gestational age, but not low birth weight, was found in a systematic review to be modestly associated with childhood, but not adult, morbidity (Malin et al., 2015)
From page 214...
... . In a systematic review, Weng et al.
From page 215...
... who were fully breastfed for 4 months or more had lower percent body fat at 2 years persisting to 5 years. Further, those with rapid weight gain as infants who had low fat intakes at 12 and 18 to 24 months had lower percent body fat than similar infants with rapid weight gain who had high fat intakes.
From page 216...
... noted that, despite some evidence for improvement of hematological values following iron supplementation, evidence for improved clinical health outcomes was lacking. Low birth weight infants may be at greater risk for iron deficiency because of lower iron stores and more rapid catchup growth, but the evidence to support iron supplementation specifically in infants with low birth weight is limited (Long et al., 2012)
From page 217...
... . S No evidence could be identified on the status of omega-3 fatty acids or the visual acuity of the WIC population.
From page 218...
... populations based on nationally representative samples (see Table 6-4) , or smaller s ­ tudies of WIC participants in specific states or regions.
From page 219...
... . Although consumption of sugar-sweetened beverages is often cited as a factor in child and adult obesity, a recent systematic review concluded that evidence supporting this relationship, after adjustment for energy intake and physical activity, was inconsistent for children as well as for adolescents and adults (Trumbo and Rivers, 2014)
From page 220...
... Therefore, the committee examined national and regional evidence on iron deficiency in WIC and U.S. children aged 1 to 3 years available from two studies, which assessed iron deficiency using multiple ­ iomarkers, as b required.
From page 221...
... . Relevant to the WIC food packages, a recent evaluation of NHANES 1999–2004 data found no association between ECC and consumption of 100% fruit juice in children 2 to 5 years of age (Vargas et al., 2014)
From page 222...
... FOOD SAFETY CONSIDERATIONS The committee considered potential nutrition-related health risks arising from foods themselves that may be of concern to the WIC population, with an understanding that the safety of the U.S. food supply is ensured by the U.S.
From page 223...
... . The FDA has not identified drug r ­esidues in other non-dairy foods included in the WIC food packages as contaminants of concern.
From page 224...
... Further, there is a high level of uncertainty in determining health risks from exposure because of the vari
From page 225...
... The fish species for which the FDA advises limiting consumption are not included in the food packages. Fish is not provided to other WIC participants.
From page 226...
... 2015. Routine iron supplementation and screening for iron deficiency anemia in pregnant women: A systematic review to update the U.S.
From page 227...
... 2012. Omega-3 fatty acids on child growth, visual acuity and neurodevelopment.
From page 228...
... 2014. Preconception care: Nutritional risks and interventions.
From page 229...
... 2014. Allostatic load in women with a history of low birth weight infants: The National Health and Nutrition Examination Survey.
From page 230...
... 2007. How early dietary factors modify the effect of rapid weight gain in infancy on subsequent body-composition development in term children whose birth weight was appropriate for gestational age.
From page 231...
... 2012. Benefits of iron supplementation for low birth weight infants: A systematic review.
From page 232...
... 2014. Prepregnancy body mass index is an independent risk factor for gestational hypertension, gestational diabetes, preterm labor, and small- and large-for gestational-age infants.
From page 233...
... 2002. Infant weight gain and childhood overweight status in a multicenter, cohort study.
From page 234...
... 2012. Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy.


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