Review of WIC Food Packages Improving Balance and Choice: Final Report (2017) / Chapter Skim
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3 Alignment of the Current Food Packages with Dietary Guidance, Special Dietary Needs, and Cultural Eating Practices or Food Preferences
3 Alignment of the Current Food Packages with Dietary Guidance, Special Dietary Needs, and Cultural Eating Practices or Food Preferences
Pages 109-156
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From page 109... ...
In this section, the contributions of the food packages to the DGA food patterns are evaluated, including the contribution of WIC-approved foods to intakes of sodium, added sugars, saturated fat, and "calories for other uses" (COU) (see Chapter 2 for a description of COU)
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From page 110... ...
Additionally, the data in these tables are based on an assumption that all foods in the packages are consumed by the intended beneficiaries. Alignment of the WIC Food Packages with Dietary Guidance for Intake of Fish The USDA's Food and Nutrition Service (USDA-FNS)
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From page 111... ...
The fish species for which the FDA advises limiting consumption are not included in the food packages. Alignment of the WIC Food Packages with Dietary Guidance for Nutrients to Limit The DGA recommend an upper sodium limit of 2,300 mg per day and upper limits of 10 percent of total calories from saturated fat and 10 percent of total calories from added sugars (USDA/HHS, 2016)
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From page 112... ...
112 TABLE 3-1 WIC Maximum Allowance Compared to the 2015–2020 DGA Food Pattern: Food Package V, Pregnant and Partially Breastfeeding Women, Up to 1 Year Postpartum WIC Maximum DGA 2,600-kcal % of 2,600-kcal DGA WIC Food Category DGA Food Group Units/d Allowance Food Pattern Recommendationa Total fruit Total fruit c-eq 1.0 2.0 52 Juice, 100%b Fruit, as juice c-eq 0.6 1.0 60 Fruit, 67% of CVVc Fruit, whole c-eq 0.4 1.0 45 Total vegetables Total vegetables c-eq 0.5 3.5 13 Vegetable, 33% of CVVd c-eq 0.2 3.5 6 Legumes (as a vegetable) e Beans and peas c-eq 0.3 0.4 71 Total dairy Total dairy c-eq 2.9 3.0 98 Milk c-eq 2.9 3.0 98 Total grains Total grains oz-eq 1.7 9.0 19 Breakfast cerealf Refined grains oz-eq 1.0 4.5 22 Breakfast cereal Whole grains oz-eq 0.2 4.5 17g Whole wheat bread Whole grains oz-eq 0.5
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From page 113... ...
In the current WIC food packages, pregnant women and partially breastfeeding women receive the same benefits. Percentages represent the proportion of the recommended food pattern amount in the corresponding row of the DGA food pattern column.
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From page 114... ...
114 TABLE 3-2 WIC Maximum Allowance Compared to the 2015–2020 DGA Food Pattern: Food Package VI, Women Up to 6 Months Postpartum WIC Maximum DGA 2,300-kcal % of 2,300-kcal DGA WIC Food Category DGA Food Group Units/d Allowance Food Pattern Recommendationa Total fruit Total fruit c-eq 0.8 2.0 42 Juice, 100%b Fruit, juice c-eq 0.4 1.0 40 Fruit, 67% of CVVc Fruit, whole c-eq 0.4 1.0 45 Total vegetables Total vegetables c-eq 0.3 3.0 12 Vegetable, 33% of CVVd c-eq 0.2 3.0 7 Legumes (as a vegetable) e,f Beans and peas c-eq 0.1 0.3 44 Total dairy Total dairy c-eq 2.1 3.0 71 Milk c-eq 2.1 3.0 71 Total grains Total grains oz-eq 1.2 7.5 16 Breakfast cerealg Refined grains oz-eq 1.0 3.8 26 Breakfast cereal Whole grains oz-eq 0.2 3.8 6 Total protein foods Total protein foods oz-eq 1.3 6.3 20 Peanut butterf Nuts, seeds, and soy oz-eq 0.6 0.7 84 Eggs Meat, poultry, and eggs oz-eq 0.4 4.2 10 Fish Seafood oz-eq 0.0 1.4 0
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From page 115... ...
. g In the current food packages, a ratio of 81 percent refined grains and 19 percent whole grains was applied, based on redemption data.
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From page 116... ...
116 TABLE 3-3 WIC Maximum Allowance Compared to the 2015–2020 DGA Food Pattern: Food Package VII, Fully Breastfeeding Women Up to 1 Year Postpartum WIC Maximum DGA 2,600-kcal % of 2,600-kcal DGA WIC Food Category DGA Food Group Units/d Allowance Food Pattern Recommendationa Total fruit Total fruit c-eq 1.0 2.0 52 Juice, 100%b Fruit, juice c-eq 0.6 1.0 60 Fruit, 67% of CVVc Fruit, whole c-eq 0.4 1.0 45 Total vegetables Total vegetables c-eq 0.5 3.5 13 Vegetable, 33% of CVVd c-eq 0.2 3.5 6 Legumes (as a vegetable) e Beans and peas c-eq 0.3 0.4 71 Total dairy Total dairy c-eq 3.6 3.0 119 Milk c-eq 3.2 3.0 107 Cheese c-eq 0.4 3.0 12 Total grains Total grains oz-eq 1.7 9.0 19 Breakfast cerealf Refined grains oz-eq 1.0 4.5 22 Breakfast cereal Whole grains oz-eq 0.2 4.5 17g Whole wheat bread Whole grains oz-eq 0.5 Total protein foods Total protein foods oz-eq 3.3 6.5 50 Peanut butter Nuts, seeds, and soy oz-eq 1.2 0.7 168 Eggs Meat, poultry, and eggs oz-eq 0.8 4.4 18 Fish Seafood oz-eq 1.0 1.4 70
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From page 117... ...
f In the current food packages, a ratio of 81 percent refined grains and 19 percent whole grains was applied, based on redemption data. g To compare the food package contribution to the DGA recommended amounts of whole grains, the whole grain portion of breakfast cereal was added to the whole grain contribution of bread.
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From page 118... ...
e,f Beans and peas c-eq 0.13 0.07 177 Total dairy Total dairy c-eq 2.1 2.5 85 Milk c-eq 2.1 2.5 85 Total grains Total grains oz-eq 2.3 4.5 50 Breakfast cerealg Refined grains oz-eq 1.0 2.3 43 Breakfast cereal Whole grains oz-eq 0.2 2.3 58i Whole wheat bread Whole grains oz-eq 1.1 Total protein foods Total protein foods oz-eq 1.0 3.5 29 Peanut butterf Nuts, seeds, and soy oz-eq 0.6 0.4 167 Eggs Meat, poultry, and eggs oz-eq 0.4 2.4 17 Fish Seafood oz-eq 0.0 0.6 0
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From page 119... ...
the 1,300-kcal pattern was applied in both the previous WIC food package review (IOM, 2006) and the Child and Adult Care Food Program (CACFP)
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From page 120... ...
. Similarly, the current WIC food packages allow only 1 percent or nonfat milk for individuals ages 2 years and older.
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From page 121... ...
. b Values based on the food label of a WIC-approved low-fat vanilla yogurt.
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From page 122... ...
. b Values based on the food label of a WIC-approved low fat vanilla yogurt.
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From page 123... ...
. b Added sugars were calculated by subtracting naturally occurring sugar from total sugar in the food option.
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From page 124... ...
The added sugars content of various WIC-allowable foods is presented in Table 3-8. Alignment of the Current WIC Food Packages with Dietary Guidance for "Calories for Other Uses" The concept of COU was introduced in the 2015–2020 DGA (replacing the 2010 DGA concept of "discretionary calories")
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From page 125... ...
, added sugars, refined carbohydrates, and alcohol; DGA = 2015–2020 Dietary Guidelines for Americans; FP = food package. Kcal patterns were selected based on the calculated Estimated Energy Requirement for WIC participants, using NHANES 2011–2012 (children)
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From page 126... ...
Given that the current food packages are relatively limited in added sugars and saturated fat, these results indicate there is little room for additional COU in foods and beverages outside the WIC food packages. These results also suggest that it is a challenge for many WIC participants, especially children, to ensure that their overall diets fall within the recommended limits for COU.
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From page 127... ...
Therefore, it was not possible to estimate the contribution of the food packages to the needs of partially breastfeeding women in reference to a DRI value as no appropriate DRI is available. 6 To develop the food package nutrient profiles, the nutrient contribution of each WIC food category (i.e., "milk" or "bread")
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From page 128... ...
Complementary Feeding Complementary foods should be gradually introduced to infants at AAP, 2014 approximately 6 months of life. Complementary food rich in iron and zinc (fortified cereals and AAP Committee on meats)
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From page 129... ...
; avoid Injury, Violence, eating peanut butter from a spoon. and Poison Prevention, 2010; AAP, 2014 Developing Healthy Eating Patterns Allow lower-fat milks for children 1 year of age and older for whom AAP Committee on obesity or overweight is a concern.
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From page 130... ...
130 TABLE 3-11 Nutrients Provided per Day in the Current Food Packages Compared to Dietary Reference Intakes: Pregnant, Breastfeeding, and Postpartum Women FP V, Pregnant FP VII, Breastfeeding FP VI, Postpartum* EAR/AI EAR/AI EAR/AI Nutrient Pregnant Breastfeeding Postpartum Amount % DRI Amount % DRI Amount % DRI Energy (kcal)
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From page 131... ...
29e 29e 26e 8.5 29 13 44 6.4 25 Sodium (mg) 1,500c 1,500c 1,500c 727 48 1,007 67 527 35 NOTES: AI = adequate intake; DGA = Dietary Guidelines for Americans; EAR = Estimated Average Requirement; FP = food package; RAE = retinol activity equivalents; RDA = Recommended Dietary Allowance; Nutrient profiles were developed by applying the assumptions outlined in Appendix R
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From page 132... ...
132 TABLE 3-12 Nutrients Provided per Day in the Current Food Packages for Infants Less Than 12 Months of Age* AI, Infants EAR/AI, Infants BF/FF Less Than 6 to Less Than FF 0–3 FF 4–5 BF/FF BF/FF FF 6–11 6–11 BF 6–11 Nutrient 6 Months 12 Months mo mo 0–1 mo 1–3 mo 4–5 mo mo mo mo Energy (kcal)
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From page 133... ...
NA NA 13.4 14.6 1.6 6.6 7.8 10.7 5.9 1.4 Sodium (mg) 120 370 178 194 21 88 104 156 93 64 NOTES: AI unless otherwise noted; AI = adequate intake; BF = breastfed; BF/FF = partially breastfed; DFE = dietary folate equivalents; DGA = Dietary Guidelines for Americans; EAR = Estimated Average Requirement; FF = formula fed; RAE = retinol activity equivalents; RDA = Recommended Dietary Allowance.
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From page 134... ...
134 TABLE 3-13 Nutrients Provided per Day in the Current Food Packages Compared to Dietary Reference Intakes: Children Ages 1 to Less Than 5 Years of Age* Children 1 to Less Than 2 Years Children 2 to Less Than 5 Years EAR/AI, EAR/AI, % DRI, % DRI, Nutrient 1–3 y 4–8 y Amount % DRI Amount 1–3 y 4–5 y Energy (kcal)
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From page 135... ...
1,000c 1,200c 587 59 639 64 53 NOTES: AI = adequate intake; DFE = dietary folate equivalents; DGA = Dietary Guidelines for Americans; EAR = Estimated Average Requirement; NA = not applicable; RAE = retinol activity equivalents. Nutrient profiles were developed by applying the assumptions outlined in Appendix R.*
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From page 136... ...
. Food Package VII for Fully Breastfeeding Women Food package VII for women who are fully breastfeeding (up to 12 months)
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From page 137... ...
Table 3-14 lists the current WIC foods that are authorized across food packages and the dietary guidance related to food types and food composition. In nearly all cases, the foods provided are consistent with this guidance.
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From page 138... ...
Cheese, starting at 1 year NR Appropriate intake depends of age upon the total dairy intake recommendations as well as the amount of saturated fat and sodium in the overall diet; one strategy to reduce saturated fat intake is to replace regular cheese with low-fat cheese (USDA/HHS, 2016) Eggs, starting at 1 year of Eggs may be introduced No specific age along with other recommendations related complementary foods to eggs (PAHO/WHO, 2003; WHO, 2005; AAP, 2014)
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From page 139... ...
Legumes and/or peanut NR No specific butter, starting at 1 year recommendations on types of age or composition of legumes or peanut butter Iron-fortified infant formula For infants that are not NA breastfeeding, iron-fortified formula is the recommended alternative for feeding the baby during the first year of life (AAP, 2014) Infant food meat, Complementary foods NA single-ingredient should be introduced gradually to infants after 6 months of life; 1–2 ounces of meat or 1–2 small jars of commercially prepared meat per day (AAP Committee on Nutrition, 2010b; AAP, 2012, 2014)
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From page 140... ...
and their prescribed amounts, as well as the length of time the participant requires the supplemental foods. Participants receiving food package III may be issued 455 ounces of WIC formula per month in addition to the maximum allowance of all other foods in the package appropriate for their life stage.
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From page 141... ...
.9 In some cases, participants under the care of a health care provider may be prescribed foods atypical for the participant's age category, such as when jarred infant foods are issued to individuals over 1 year of age. Under current regulations, participants must be prescribed a WIC formula to be issued food package III, whether or not it is included in the health care provider prescription and whether or not this required issuance suits the participant's condition (i.e., a participant 2 years of age or older who is prescribed whole milk is unlikely to also be in need of a WIC formula)
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From page 142... ...
. Here, the ways that the current food packages accommodate individuals with these conditions and potential gaps are highlighted.
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From page 143... ...
The major allergens shellfish and tree nuts were excluded from the table because no WIC foods are provided in these categories. Soy is excluded as a major allergen because the baseline food packages do not contain soy products.
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From page 144... ...
The Final Rule for the WIC food packages does not require that states provide a gluten-free option for cereals, although the provision allows state agencies to offer oat, corn, or rice-based cereals that may be appropriate for participants who must avoid gluten (USDA/FNS, 2014)
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From page 145... ...
Although there is no substitution for cheese for fully breastfeeding women, most individuals with lactose intolerance are able to consume cheese in small quantities. Alignment of Foods with Specific Preferences and Dietary Practices The committee considered how WIC food packages accommodate preferences for vegetarian and vegan diets and food-related religious practices (e.g., Kosher and Halal diets)
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From page 146... ...
Soy formula is an option in all WIC packages for formula-fed infants. The WIC food packages include several foods that by nature are compliant with vegetarian and vegan diets, including fruits, vegetables, legumes, peanut butter, and grains.
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From page 147... ...
. Cultural variations in infant and child feeding practices may also affect the use of specific WIC foods.
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From page 148... ...
• Dry breakfast cereals are popular and often seen as status symbols, but people from porridge-based cultures may prefer hot cereals or boiled root vegetables. FINDINGS AND CONCLUSIONS: POTENTIAL AREAS FOR FOOD PACKAGE MODIFICATIONS In this chapter, the alignment of the current food packages with the most recent dietary guidance and the suitability of WIC foods for particular medical conditions and to meet dietary preferences and practices are reviewed.
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From page 149... ...
forms of foods • Fish high in omega-3 fatty acids is provided only to fully breastfeeding women, although it is considered beneficial during all stages of growth and development. Consideration of the addition of seafood to food packages for other women and children is warranted.
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From page 150... ...
This requirement merits re-evaluation. Foods for allergies, The current food packages generally provide substitution lactose intolerance, or options for individuals with the most common allergies, lactose celiac disease intolerance, and celiac disease, with a few exceptions.
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From page 151... ...
2016. Differences in fruit and vegetable intake by race/ethnicity and by Hispanic origin and nativity among women in the Special Supplemental Nutrition Program for Women, In fants, and Children.
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From page 152... ...
2015. Diagnosis of gluten related disorders: Celiac disease, wheat al lergy and non-celiac gluten sensitivity.
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From page 153... ...
2016. Review of WIC food packages: Proposed framework for revisions: Interim report.
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From page 154... ...
: Revisions in the WIC food packages; final rule, 7 C.F.R.
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From page 155... ...
2015a. WIC food packages policy options II, final report.
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