Review of WIC Food Packages Proposed Framework for Revisions: Interim Report (2016) / Chapter Skim
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3 Approach to the Task
3 Approach to the Task
Pages 79-118
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From page 79... ...
The approach included • Convening public workshops; • Conducting literature searches; • Analyzing food and nutrient intakes and diet quality of WIC and WIC-eligible (low-income and for women, also pregnant, breast feeding, or postpartum) populations; • Developing an approach to WIC food package food, nutrient, and cost profiles; • Conducting a food expenditure analysis; • Developing approaches to sensitivity and regulatory impact analy ses to be conducted during phase II; • Visiting WIC sites and shopping for WIC foods; and • Reviewing public comments.
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From page 80... ...
The role of WIC food packages in preventing food insecurity; 5. Racial or ethnic differences in infant/child feeding practices and personal food intake patterns; 6.
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From page 81... ...
The MEDLINE database was searched using a combination of search terms relating to Medicaid, poverty, and low income, plus search terms relating to firstly, culture or race/ethnicity and diet or feeding behavior or, secondly, food access or accessibility, food environment, food costs, store, and vendor. Furthermore, another Medline search strategy was developed for identifying interventional breastfeeding studies conducted among lowincome populations living in the United States using the combinations of the low-income search with additional MeSH terms for culture and continental population groups and a broad search for breastfeeding, infant nutrition, and human milk.
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From page 82... ...
As a result, nearly all studies reviewed for this report compare WIC participants to a group of nonparticipants or use a pre-post design (relative to a change in the food package) . These study designs are not sufficient for causal inference.
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From page 83... ...
. Evaluation of WIC participant outcomes before and after the 2009 adoption of the new food package is complicated by the fact that adoption of the new package took place at the tail end of a recession and at a time when families were facing the worst labor market since the deep recession of the early 1980s.
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From page 84... ...
A unique search was conducted to address this task. The functional ingredients investigated were those currently added to infant formula, because this is the item in the WIC food packages of primary interest to USDA-FNS with respect to these ingredients.
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From page 85... ...
This section describes the methods used to assess the prevalence of inadequate and excess nutrient intake in the WIC subpopulations and, for this phase I report, compare food intakes to the recommended food patterns in the Scientific Report of the 2015 Dietary Guidelines Advisory Committee (2015 DGAC report) (for the phase II report, they will be compared to the 2015 DGA)
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From page 86... ...
These reference points are identical to those applied in the previous review of WIC food packages (IOM, 2006)
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From page 87... ...
Although the IOM (2002/2005) report recommended limiting the amounts of saturated fat and cholesterol for all individuals more than 2 years of age, analyses of these macronutrients in this report are based on updated recommendations in the 2015 DGAC report (USDA/HHS, 2015)
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From page 88... ...
Nutrients analyzed for this report are listed in Appendix J, Table J-2. Estimating Usual Intake Distributions Assessing nutrient adequacy involves, first, estimating usual distributions of intake.
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From page 89... ...
were used to estimate standard errors of estimated percentiles. Usual nutrient intake distributions were estimated using methods that account for the statistical properties of the data (intra-individual variation and reported data that are not normally distributed [Nusser et al., 1996; IOM, 2000b]
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From page 90... ...
Note that only AIs are available for infants 0 to less than 6 months of age, therefore the prevalence of inadequacy of any nutrient could not be calculated for this age group. Assessing the Prevalence of Excessive Intakes Excessive intakes of micronutrients were assessed by comparing observed nutrient intake to the UL for that nutrient, as described in IOM (2006)
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From page 91... ...
. Food package content of vitamin D will be determined in phase II, primarily to serve as a reference point for food package changes (i.e., if, during phase II, the committee determines that foods containing vitamin D should be added to the WIC packages, the potential difference from baseline dietary intake can be estimated)
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From page 92... ...
Table 1-5 in Chapter 1 illustrates the food patterns recommended in the 2015 DGAC report for various energy intake levels. To evaluate the diets of all children 1 to less than 5 years of age, the committee applied a weighted food pattern (a 1,000 kcal pattern weighted 1:3 with the average of 1,200- and 1,400-kcal patterns [IOM, 2011b]
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From page 93... ...
TABLE 3-1 Dietary Guidance for Infants and Children Less Than 2 Years of Age Feeding Mode Reference Breastfeeding Exclusive breastfeeding for about 6 months, followed WHO, 2009; IOM, 2011c; by continued breastfeeding as complementary foods are AAP, 2014; AND, 2015 introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.a At 4 months of age exclusively breastfed infants should AAP, 2010 be supplemented with iron. All breastfed infants should receive an oral supplement AAP, 2012 of vitamin D, 400 IU per day, beginning at hospital discharge.
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From page 94... ...
. a There is some controversy regarding whether exclusive breastfeeding meets energy require ments of infants at 6 months of age in developed countries (Fewtrell et al., 2007)
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From page 95... ...
NUTRIENT AND FOOD INTAKE IN THE WIC POPULATION Nutrient and food intakes in the WIC-eligible population were estimated using NHANES 2005–2008 and 2011–2012. The intent of these analyses was to identify priority nutrient and food group needs that could be addressed by making additional changes to the food packages.
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From page 96... ...
food package changes by October 2009, and most states implemented the changes at 6 At the request of the study sponsor, USDA-FNS, dietary supplement intake was excluded from the analysis. The purpose of the WIC food packages is to improve nutrient intakes from foods alone.
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From page 97... ...
The WIC identifier for the NHANES 2011–2012 dataset was not available at the time of this analysis. Therefore, a comparison of nutrient or food intakes among WIC participants before the 2009 food package changes to those after the changes could not be conducted.
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From page 98... ...
income could change within the certification period, but the individual remains in the program at the new income level, and (2) the objective is primarily to evaluate the effect of the food package, not the effect of income.
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From page 99... ...
D status estimated Same action as for the available for 2005–2006 for this survey period and current report survey years only and for subgroups ages 1 year and individuals ages 1 year and older only older NOTES: non-WIC = WIC-eligible nonparticipants; WIC = individuals participating in WIC. a NHANES (National Health and Nutrition Examination Survey)
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From page 100... ...
To generate more robust nutrient intake estimates of the ratio of the within- to the between-person variance in intake, the method of Jahns et al.
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From page 101... ...
Consequently, with the small sample sizes that were available for women, and the large proportion of zero intakes observed for many of the food subgroups, estimates of the proportion of usual intakes of foods below recommendations are less reliable. Estimates of mean food intake are, however, adequately precise and only these are presented for women (Dekkers et al., 2014)
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From page 102... ...
A second index was developed, as detailed in the Letter Report (IOM, 2015) : Options for a second index were considered by the committee, based on its evaluation of the literature on existing diet quality indexes other than the Healthy Eating Index (HEI)
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From page 103... ...
and the commit tee's assessment of the nutrient intakes of WIC-eligible populations. The committee developed an adapted nutrient-based diet quality index to be scored by comparison to DRI values.
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From page 104... ...
In all cases, pairwise t-tests were applied with estimated standard errors that account for the complex design of the NHANES surveys. Tests were implemented for differences in means of the usual intake distributions of nutrients and foods, for the prevalence of inadequate intakes, and for overall mean HEI scores.
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From page 105... ...
APPROACH TO DEVELOPMENT OF THE BASELINE FOOD PACKAGE: NUTRIENTS AND COST Several of the committee's tasks related to dietary intake estimation and food package costs required an evaluation of baseline packages representative of the foods acquired through the WIC food packages. Accurately representing baseline package composition is fundamental to subsequent (phase II)
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From page 106... ...
The protocol for estimating these nutrient profiles will be similar to that used in the previous evaluation of WIC food packages (IOM, 2006)
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From page 107... ...
The average price of each food category in the WIC food package will be determined by assessing prices for qualifying foods (USDA/FNS, 2013b)
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From page 108... ...
The sensitivity analysis will determine the effect of any change on nutrient intake, food intake, and cost. For all WIC food categories within the baseline food packages, the committee plans to evaluate options to add/eliminate/increase/decrease/alter the baseline composition.
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From page 109... ...
Variations from Cost Neutral While the committee was tasked with ensuring overall cost neutrality for recommended changes to the WIC food packages, they were also asked to offer prioritized recommendations in the event that USDA-FNS's WIC funding is either above or below the cost-neutral level. These priorities will appear in the phase II report.
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From page 110... ...
The household panel scanner data provide information on the purchases of a large number of households and can be used to assess expenditures and quantities of detailed products that may be evaluated in determining likely costs of baseline and alternative package foods. Sample weights will be applied to derive nationally representative estimates of retail food purchases and unit values (prices)
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From page 111... ...
Particularly, all of the specific changes recommended for the WIC food packages should be based on consideration of whether it is feasible to make the recommended foods available, from both the perspective of federal/state administration in allowing local agencies to make substitutions (i.e., select combinations from among the WIC-approved foods) and the perspective of vendors that directly provide the foods included in the packages.
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From page 112... ...
update, USDA-CNPP NOTE: FoodAPS = National Household Food Acquisition and Purchasing Survey; IRI = Information Resources Incorporated; TFP = Thrifty Food Plan; USDA-CNPP = U.S. Department of Agriculture-Center for Nutrition Policy and Promotion; USDA-ERS = U.S.
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From page 113... ...
Alterna tively, observe a WIC certification appointment from start to finish. TABLE 3-6 WIC Sites Visited by the Committee to Review WIC Food Packages State City Connecticut Hartford Illinois Chicago Iowa Ames Kentucky Newport Massachusetts Sommerville Michigan Detroit Nevada Las Vegas New York Kenmore Oklahoma Chickasaw Nation Texas McAllen Vermont Burlington Virginia Alexandria West Virginia Charleston Wyoming Cheyenne
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From page 114... ...
• Obtain an EBT card or voucher to complete the shopping experience. • Visit a local WIC authorized vendor to locate and purchase WIC foods.
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From page 115... ...
2000b. Dietary reference intakes: Applications in dietary assessment.
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From page 116... ...
2015. Review of WIC Food Packages: An evaluation of white potatoes in the cash value voucher: Letter report.
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2011. WIC food packages policy options study, final report.
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From page 118... ...
2012. Evaluation of a diet quality index based on the probability of adequate nutrient intake (PANDIET)
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