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9 Background and Approach to Considering Food Package Options
Pages 279-324

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From page 279...
... The infant formula regulatory and market landscape, 5. Choice and flexibility within food packages, and 6.
From page 280...
... The Role of the WIC Food Packages in Supporting Breastfeeding The primary way that the WIC program has endorsed and supported breastfeeding is through its "Loving Support" initiative (USDA/FNS, 2015a)
From page 281...
... Additional details about breastfeeding trends, barriers, and promotion in the WIC population were provided in Chapter 7. The Role of the WIC Food Packages in Preventing Food Insecurity The 2015 DGAC report identified food insecurity as one of three significant nutrition-related health issues facing the U.S.
From page 282...
... . Relationship Between WIC Participation and Food Insecurity Inasmuch as the WIC program is only one policy instrument used in the national effort to reduce or prevent food insecurity in the United States, it is challenging to evaluate its independent contribution to this effort.
From page 283...
... . The Role of the WIC Food Packages in Nutrition Education Nutrition education is key in supporting WIC participants' choices to purchase healthy foods, prepare those foods in a healthful manner, and consume them as part of a diet in alignment with the DGA.
From page 284...
... These studies suggest that the maximum intended health impact of the WIC food package and 2009 revisions is linked to staff training and participant education. DIETARY GUIDANCE AND FOOD PACKAGE OPTIONS Although recommended revisions in the WIC food packages for individuals ages 2 years and older will align with the 2015 DGA, those guidelines were not released during the committee's phase I deliberations.
From page 285...
... . Dietary Guidance for Specific Food Groups Applicable to the WIC Food Packages Here, food groups that are under-consumed based on the 2015 DGAC report are considered first (vegetables and whole grains for women and children and fruit and dairy for women)
From page 286...
... Added sugars Foods defined as added sugars: 1 tsp-eq of added sugars = 4 g honey, corn syrup, white sugar, of added sugars such as honey brown sugar, fructose (tsp-eq) or corn syrup NOTES: c-eq = cup equivalents; oz-eq = ounce equivalents; tsp-eq = teaspoon equivalents.
From page 287...
... The computation of intake of dry beans and peas was slightly different in the committee's analysis compared to that of the 2015 DGAC report.3 Vegetables in the WIC food packages  WIC participants can acquire vegetables from the WIC food package either by choosing 100% vegetable juice with the juice allowance or by purchasing vegetables with the cash value voucher (CVV)
From page 288...
... . Whole grains in the WIC food packages Whole grains in the WIC food packages may come from either the whole wheat bread or breakfast cereal food categories.
From page 289...
... Fruits (Including Fruit Juice) According to the 2015 DGAC report, fruit contributes substantial amounts of fiber and potassium, two nutrients of public health concern.
From page 290...
... , this equates to approximately 0.6 cup-equivalents of juice per day, which falls within the AAP recommended limit of 4 to 6 ounces per day. Fruit juice and health  Although the 2015 DGAC report did not review the effect of fruit juice on health, several groups have conducted evidence-based reviews to examine the impact of 100% juice consumption on health.
From page 291...
... reported that children who consume 100% fruit juice tend to consume more calcium and potassium and are therefore at lower risk of inadequacy for these nutrients. Fruit juice in the WIC food packages Fruit juice (100% only)
From page 292...
... . Dairy in the WIC food packages  In the WIC food packages, dairy foods include milk, cheese, and yogurt.
From page 293...
... This section summarizes the 2015 DGAC report's findings related to these three nutrients, the committee's findings for WIC and low-income populations (detailed in Chapter 4) , and the role of the WIC food packages in providing these nutrients (see Table 9-3)
From page 294...
... 71 3.1 1.6 8.9 0.0 0.0 Cereal, oat flakes with almonds, 118 5.1 0.2 1.3 5.4 16.8 1 oz-eqg Instant oats, 1 oz-eq 62 2.7 0.4 2.1 0.0 0.0 Whole wheat bread, 1 oz-eq 73 3.2 0.1 0.7 0.0 0.0 (1 slice) Canned light tuna, packed in water, 70*
From page 295...
... b The 2015 DGAC report recommendation is for total daily intake; therefore, the values should be interpreted in this context. "DGAC report daily recommendations" are based on a 2,200 kcal food pattern, which was the mean Estimated Energy Expenditure of WIC women in the NHANES analysis conducted for this report.
From page 296...
... . This topic was not covered by the 2015 DGAC report because these data were just appearing in the published literature at the close of DGAC deliberations (Personal communication, A
From page 297...
... . With few exceptions, foods with added sugars are generally not permitted in the WIC food package.
From page 298...
... , which, as previously mentioned, is considered a nutrient to limit. The WIC food packages provide 0.4 eggs per day in all packages, with the exception of the package for fully breastfeeding women, which provides approximately 0.8 eggs per day.
From page 299...
... summarizes results from the committee's analyses of food intakes for infants and children under the age of 2 years, which indicated concerns around early introduction of complementary foods including cow's milk and foods of poor nutritional value, as well as iron supplementation. The committee recognizes that the WIC food packages provide complementary foods only as early as 6 months of age (USDA/FNS, 2014)
From page 300...
... . Findings on Health Benefits Functional ingredients that have been systematically evaluated for outcomes within WIC's target population are listed in Table 9-4 (see Chapter 3 for a summary of how the functional ingredients and studies listed in this table were selected)
From page 301...
... benefit postpartum mothers and Menegozzo et al., their infants 2010 No benefit Mortality of supplemented Oliveira postpartum mothers and Menegozzo et al., their infants 2010 Hydrolyzed Inconclusive/ Reducing risk of atopic FDA, 2011 protein possible benefit dermatitis in healthy infants who are not exclusively breastfed and who have a family history of allergy Inconclusive Prevention of childhood allergy Osborn and Sinn, and infant cow milk allergy 2006 in high-risk infants not exclusively breastfed No benefit Prevention of allergy in Osborn and Sinn, formula-fed infants 2006 (compared to exclusive breastfeeding) continued
From page 302...
... PUFAS Inconclusive/ Symptoms of ADHD in Gillies et al., 2012 no benefit supplemented children and adolescents Insufficient Learning outcomes for children Tan et al., 2012 evidence with specific learning disorders Probiotics Benefit Prevention of antibiotic- Johnston, et al., associated diarrhea in 2011 children Inconclusive/ Treating persistent diarrhea in Bernaola Aponte possible benefit children et al., 2013 Reduce incidence of acute Hao et al., 2015 upper respiratory tract infections and reductions in mean episodic duration, antibiotic use, and cold related school absences No benefit/ Treatment for children with Boyle et al., 2008 potential harm eczema Lactose- Inconclusive/ Earlier resolution of acute MacGillivray et reduced or free possible benefit diarrhea in young children al., 2013 (< 5 years old) who are not predominantly breastfed
From page 303...
... their LDL cholesterol Inconclusive/ Treatment for patients with Bath-Hextall et al., no benefit established atomic eczema/ 2012 dermatitis Probiotics Benefit Shortening the duration and Allen et al., 2010 reducing the stool frequency in a cute infectious diarrhea Preventing Clostridium difficile- Goldenberg et al., associated diarrhea 2013 Inconclusive General safety AHRQ, 2011 Beta-carotene No benefit/ Mortality, adults with and Bjelakovic et al., potential harm without various diseases 2012 NOTE: DHA = docosahexaenoic acid; LCPUFA = long-chain polyunsaturated fatty acids; PUFA = polyunsaturated fatty acids.
From page 304...
... . USDA-FNS requested that the committee evaluate three specific aspects of infant formulas as a component of the food packages.
From page 305...
... Additionally, because the infant formula market is continually evolving and to ensure suitability of new or reformulated infant formulas, manufacturers are required to test and document that products are safe, support healthy growth when provided as the sole source of nutrition, and contain protein of biological quality (NARA, 2014c)
From page 306...
... As such, WIC does not function as a "supplemental nutrition program" in its provision of infant formula. The formulas provided by WIC must comply with the federal definition of and nutrient requirements for infant formulas.
From page 307...
... However, these compounds are not in every formula product. The AAP does not believe the available evidence demonstrates health benefits of probiotics in infant formulas at this time (Thomas and Greer, 2010; AAP, 2014)
From page 308...
... . These age-specific formulations must still comply with federal nutrient specification requirements for infant formulas (NARA, 2014c)
From page 309...
... . The AAP nutrition handbook does not have specific recommendations on the inclusion of carotenoids in infant formulas (AAP, 2014)
From page 310...
... The only type of infant formulas with a qualified health claim are those that are 100 percent whey-protein partially hydrolyzed, but the claim includes a statement of the relative dearth of data supporting it (e.g., "Little scientific evidence suggests that .
From page 311...
... review of WIC food packages recommended that the WIC program provide more flexibility to state agencies and more variety and choice for WIC participants. Accordingly, in the 2009 revision of the WIC food packages, new food options were added.
From page 312...
... A key theme emerging from these studies is that participants are especially satisfied with the flexibility allowed in the food packages (e.g., being able to choose canned beans instead of dried beans or corn tortillas instead of bread) and want as much food and brand variety as possible (Phillips et al., 2014; Personal communication, S
From page 313...
... does not exceed the cost of the current WIC food packages. Table 9-5 illustrates how costs were contained in the 2009 food package revisions.
From page 314...
... Changes That Decrease Cost Comments on Implementation No juice for infants less than 1 year Very popular change among WIC nutritionists.a,b of age Reduce quantity of eggs Initial dissatisfaction, no longer evident.a,b Reduce quantity of milk Initial dissatisfaction, no longer evident.a,b Reduce quantities of cheese Initial dissatisfaction, no longer evident.a,b Reduce infant formula for partially Initial dissatisfaction, no longer evident.a,b breastfed infants No cereal for infants 4–5 months Controversial. When to start complementary foods remains highly debated.a,b NOTE: CVV = cash value voucher.
From page 315...
... 2013. Effects of reduced juice allowances in food packages for the Women, Infants, and Children program.
From page 316...
... to breastfeeding mothers for improving child growth and development. Cochrane Database Systematic Review 12:Cd007901.
From page 317...
... 2011. The effects of changes in WIC food packages on redemp tions: Final report: Altarum Institute.
From page 318...
... 2006. WIC food packages: Time for a change.
From page 319...
... : Revisions in the WIC food packages; interim rule, 7 C.F.R.
From page 320...
... Cochrane Database Systematic Review 4:Cd006475. Osborn, D
From page 321...
... : Revisions in the WIC food packages; interim rule, 7 C.F.R.
From page 322...
... : Revisions in the WIC food packages; final rule, 7 C.F.R.
From page 323...
... 2014. Circulating biomarkers of dairy fat and risk of incident stroke in U.S.


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