Review of WIC Food Packages Improving Balance and Choice: Final Report (2017) / Chapter Skim
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5 Nutrient and Food Group Priorities for the WIC Food Packages
5 Nutrient and Food Group Priorities for the WIC Food Packages
Pages 215-260
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From page 215... ...
Collectively, this process led to development of a decision tree (see Figure 5-1) for determining potential revisions to the WIC food packages (see Tables 5-2 through 5-10)
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. Similarly, despite the very high prevalence of inadequacy across the WIC-participating population, vitamin E was not considered a priority in the food package revisions and was not carried through the decision tree.
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g Although the DGA apply only to individuals ages 2 years and older, sodium intakes exceed ing the Tolerable Upper Intake Level (UL) were also considered of concern for young children.
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Saturated Fat and Added Sugars Saturated fat and added sugars were evaluated along with other nutrients, not food groups, because they may occur in several different foods. The current food packages already provide foods that are limited in saturated fat (e.g., only low-fat or nonfat milk and yogurt are allowed in packages for participants over 2 years of age)
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Although intake of oils fell below recommended amounts in more than 50 percent of some subgroups, this food group was not evaluated because oils do not contain nutrients of public health concern for the WIC-participating population. IDENTIFYING POTENTIAL ACTIONS FOR FOOD PACKAGE REVISIONS Nutrients with a high proportion of inadequate intakes and food groups (or subgroups)
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STOP: No change in Yes food package Is this food available in acceptable forms? Yes ACTIONc: Consider adding this food or using it as an alternative to current foods FIGURE 5-1 Decision tree for determining potential food package changes given the prevalence of nutrient inadequacy or food group intake below recommended amounts among WIC-participating women and children.
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In cases where an appropriate (i.e., supplemental) amount is already included in the food packages and preferred and appropriate forms of the food could not be identified, the committee proposed either enhancing nutrition education or applying behavioral approaches to increase consumption of the currently available foods.
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The committee considered all of these factors in aggregate when translating the decision tree outcomes into final food package changes. Nutrition Education as a Potential Action The nutrition education tools developed by states are one strategy to improve the balance between what is provided in the food packages and participants' nutrient and food intake.
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. RESULTS FROM USE OF THE DECISION TREE The committee's final proposed revisions to the food packages, which are presented in Chapter 6, are based on information in Chapters 1 through 4; considerations described above in the section titled "Challenges with Translating the Decision Tree Outcomes into Potential Actions"; and outcomes of this chapter's decision tree process, as detailed in Tables 5-2 through 5-10.
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(62%) cereal, whole because iron requirements is associated with health wheat bread, for this group are higher risks in pregnancy and whole wheat than can be met by diet development; heme iron pasta, legumes, alone; foods outside of the is especially important for peanut food package or dietary women who are capable of butter supplements are required becoming pregnant or who are pregnant (as noted in the DGA)
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, Consider reducing the key fata DGA limit in 75% of the energy (29%) cheese sources of saturated fat or subgroup (DGA)
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(68%) RTE breakfast cereals; consider additional for WIC population cereal, CVV options and nutrition education or behavioral interventions to promote intake of milk, legumes, breakfast cereal, and vegetables and fruits already provided Vitamin A Inadequacy was 20%; no 550 µg 124 µg RAE 646 µg RAE Milk, RTE Consider reducing sources known health consequence RAE (117%)
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(103%) because nutrient amount in for WIC population the food package is more than supplemental Vitamin B6 Inadequacy was 12%; no 1.6 mg 0.2 mg 1.3 mg RTE breakfast Retain RTE breakfast known health consequence (EAR)
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d Translation of potential actions into the final food packages depended upon cost and other practical and administrative considerations.
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(38%) legumes, CVV CVV; canned legumes to AI; potassium promote intake; nutrition is a 2015 DGA education or behavioral nutrient of interventions to promote public health consumption of dairy concern that is already provided in the food package Fiber Mean intakes 29 g 13 g 8.0 g 8.0 g Bread (and Consider increasing fell below the (AI)
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(10%) beverage, maximum allowable in 24% of peanut butter, amounts of added subgroups RTE breakfast sugars in yogurt or cereal cereals; propose a maximum for soy beverage and milk Middle Priority Folate Inadequacy was 450 µg DFE 127 µg 473 µg 489 µg DFE RTE breakfast Consider reducing 27%; folate is (EAR)
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combination with WIC vitamin D is a foods may be required DGA nutrient to improve status of public health concern Calcium Inadequacy was 800 mg 136 mg 1,029 mg 1,232 mg (154%) Milk, yogurt, Consider reducing 16%; calcium (EAR)
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(72%) CVV known health consequence for WIC population Vitamin B6 Inadequacy 1.7 mg 0.5 mg 1.3 mg 1.4 mg RTE breakfast Retain RTE breakfast was 30%; no (EAR)
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(78%) cereal cereals known health consequence for WIC population NOTES: AI = Adequate Intake level; CVV = cash value voucher; DFE = dietary folate equivalent; DGA = 2015–2020 Dietary Guidelines for Americans; EAR = Estimated Average Requirement; IU = international units; RAE = retinol activity equivalents; RTE = ready-to-eat; UL = Tolerable Upper Intake Level.
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(92%) soy beverage, because nutrient amount in calcium is a DGA nutrient cheese, RTE the food package is more of public health concern breakfast than supplemental cereals Potassium Mean intakes fell below 4,700 mg 2,802 mg 1,302 mg Milk, cheese, Consider increasing the the AI; potassium is a DGA (AI)
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(152%) cereal, whole because nutrient amount in public health concern for wheat bread, the food package is more premenopausal females whole wheat than supplemental pasta, legumes, peanut butter Middle Priority Nutrient to Limit Saturated Intakes exceeded the <10% of 8g 6.4 g Milk, cheese Consider reducing the key fata DGA limit in 49% of the energy (25%)
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(50%–52%) RTE breakfast options; nutrition for WIC population cereal, CVV education or behavioral interventions to promote intake of milk, legumes, breakfast cereal, and vegetables and fruits already provided in the food package Vitamin A Inadequacy was 69%; no 500 µg 355 µg RAE 522 µg RAE Milk, RTE Consider reducing sources known health consequence RAE (104%)
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(97%) cereal because nutrient amount in for WIC population the food package is more than supplemental Vitamin Inadequacy was 14%; no 2.0 µg 0.6 µg 3.6 µg RTE breakfast Consider reducing sources B12 known health consequence (EAR)
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From page 238... ...
(72%) cereal cereals for WIC population NOTES: AI = Adequate Intake level; CVV = cash value voucher; DFE = dietary folate equivalent; DGA = 2015–2020 Dietary Guidelines for Americans; EAR = Estimated Average Requirement; IU = international units; RAE = retinol activity equivalents; RTE = ready-to-eat; UL = Tolerable Upper Intake Level.
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, promote intake of legumes by nutrient of public health legumes, CVV providing a canned option concern Potassium Mean intakes fell below 3,000/ 929/1,729 mg 1,267/ Milk, cheese, Consider increasing the CVV; the AI; potassium is a 3,800 mg 1,357 mg CVV, legumes promote intake of legumes by DGA nutrient of public (AI)
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Excess to 5%b limit) c This Nutrient Potential Actiond Saturated Intakes exceeded the <10% of 15 g 6.6 g 1% milk, Consider reducing the key fata DGA limit in 70% of the energy (DGA)
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c The percent values assume that the food package is fully consumed. d Translation of potential actions into the final food packages depended upon cost and other practical and administrative considerations.
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. However, because the amounts of these nutrients in the food package exceeded 100 percent of recommendations, the committee considered the need to decrease amounts of foods provided in the current infant packages and provide a more preferred form to promote intake.
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The percent values assume that the food package is fully consumed. c Translation of potential actions into the final food packages depended upon cost and other practical and administrative considerations.
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The committee considered increasing the value of the CVV as a possible approach to addressing intakes of vegetables, including subgroups of vegetables.3 Inasmuch as legumes and peanut butter are already provided in greater-than-supplemental amounts in most food packages, the quantities of these foods were a target for reduction along with nutrition education or behavioral approaches to improve intakes. The committee also considered increasing the amounts or types of whole grains and adding fish to food packages where it is not currently provided as possible approaches to addressing lower-than-recommended intakes of these food groups.
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b Group Potential Actiond Higher Priority Whole grains Subgroup 100 4.5 oz-eq/d 17 Bread and Consider increasing whole alternatives, grain allowance or adding breakfast grain options cereal Total Group 99 3.5 c-eq/d 13 CVV Consider increasing the CVV vegetables Dark green Subgroup 97 2.5 c-eq/wk -- c CVV Consider increasing the CVV vegetables Total red and Subgroup 97 7 c-eq/wk -- c CVV Consider increasing the CVV orange vegetables Nuts, seeds, Subgroup 87 5 oz-eq/wk 168 Peanut butter Consider reducing amount in and soy the food package because it is more than supplemental Other Subgroup 83 5.5 c-eq/wk -- c CVV Consider increasing the CVV vegetables continued 245
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b Group Potential Actiond Total dairy Group 82 3 c-eq/d 98 Milk, cheese, Consider additional yogurt yogurt substitution; amount in the food package is more than supplemental and could be reduced Seafood Subgroup 82; authoritative 10 oz-eq/wk 0 None Consider adding canned fish bodies recommend intake of fish varieties high in omega-3 and low in mercury during all life stages that affect development Beans and peas Subgroup NA 2.5 c-eq/wk 71 Legumes Consider providing canned computed as options to promote intake of vegetables legumes
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c The quantity of vegetable subgroups provided by the CVV depends upon the participants' selection. d Translation of potential actions into the final food packages depended upon cost and other practical and administrative considerations.
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b mendation (%) c Group Potential Actione Higher Priority Whole Subgroup 100 4.5 oz-eq/d 19 19 Bread and Consider increasing grains alternatives, whole grain allowance breakfast or adding grain options cereal Total red Subgroup 97 7 c-eq/wk -- d -- d CVV Consider increasing the and orange CVV vegetables Other Subgroup 92 5.5 c-eq/wk -- d -- d CVV Consider increasing the vegetables CVV Total grains Group 88 9 oz-eq/d 19 19 Bread and Consider increasing alternatives, whole grain allowance breakfast or adding grain options cereal
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Total starchy Subgroup 84 7 c-eq/wk -- d -- d CVV Consider increasing the vegetables CVV Total fruit Group 79 2 c-eq/d 52 52 CVV Consider increasing the CVV Total Protein Group 76 6.5 oz-eq/d 28 50 Milk and Consider additional foods alternatives, options; nutrition cheese, eggs, intervention or legumes and behavioral interventions peanut butter to promote intake of foods already provided Dark green Subgroup NA 2.5 c-eq/wk -- d -- d CVV Consider increasing the vegetables CVV Beans Subgroup NA 2.5 c-eq/wk 71 71 Legumes Consider providing and peas a canned option to computed as promote intake of vegetables legumes Seafood Subgroup NA 10 oz-eq/ 0 70 None Enhance nutrition wk education or use behavioral approaches Nuts, seeds, Subgroup NA 5 oz-eq/wk 168 168 Peanut butter Consider reducing and soy amount in the food package because it is more than supplemental continued 249
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b mendation (%) c Group Potential Actione Lower Priority Whole fruit Subgroup 79 1–2 c-eq/d 45 45 CVV Consider increasing the CVV Total dairy Group 73 3 c-eq/d 98 119 Milk, cheese, Consider additional yogurt yogurt substitution; amount in the food package is more than supplemental and could be reduced Total Group 50 3.5 c-eq/d 13 13 CVV Consider increasing the vegetables CVV NOTES: c-eq = cup-equivalents; CVV = cash value voucher; DGA = Dietary Guidelines for Americans; NA = data not available because too few survey respondents reported intake of the food group or subgroup to generate estimates of intake; oz-eq = ounce-equivalents.
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b Food Group Potential Actiond Higher Priority Whole grains Subgroup 100 3.75 oz-eq/d 6 Bread and Consider increasing whole alternatives, grain allowance or adding grain breakfast cereal options Total Subgroup 100 3 c-eq/d 12 CVV Consider increasing the CVV vegetables Total starchy Subgroup 99 6 c-eq/wk -- c CVV Consider increasing the CVV vegetables Total dairy Group 96 3 c-eq/d 71 Milk, cheese, Consider additional yogurt yogurt substitution; amount in the food package is more than supplemental and could be reduced Whole fruit Subgroup 96 1–2 c-eq/d 45 CVV Consider increasing the CVV Total red and Subgroup 94 6 c-eq/wk -- c CVV Consider increasing the CVV orange vegetables continued 251
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b Food Group Potential Actiond Nuts, seeds, Subgroup 91 5 oz-eq/wk 84 Peanut butter Consider reducing amount in and soy the food package because it is more than supplemental Total fruit Group 90 2 c-eq/d 42 CVV Consider increasing the CVV Dark green Subgroup 89 2 c-eq/wk -- c CVV Consider increasing the CVV vegetables Other Subgroup 85 5 c-eq/wk -- c CVV Consider increasing the CVV vegetables Beans and peas Subgroup NA 2 c-eq/wk 44 Legumes Consider providing canned computed as option to promote intake of vegetables legumes Seafood Subgroup NA 9.5 oz-eq/wk 0 None Consider adding canned fish
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d Translation of potential actions into the final food packages depended upon cost and other practical and administrative considerations.
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SUMMARY This chapter describes the committee's decision tree (see Figure 5-1) and how it was used to identify potential changes to and actions for WIC food package revisions based on the committee's findings related to nutritionrelated health risks, food safety, and nutrient and food intake among WIC participants.
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c Group Potential Actione Higher Priority Seafood Subgroup 100 5 oz-eq/wk 0 None Consider adding canned fish Total Group 99 1.5 c-eq/d 19 CVV Consider increasing the vegetables CVV Dark green Subgroup 94 1 c-eq/wk -- d CVV Consider increasing the vegetables CVV Whole grains Subgroup 93 2.25 oz-eq/d 58 Bread and Consider increasing whole alternatives, grain allowance or adding breakfast cereal grain options Total red and Subgroup 90 3 c-eq/wk -- d CVV Consider increasing the orange CVV vegetables Nuts, seeds, Subgroup 77 2.5 oz-eq/wk 167 Peanut butter Consider reducing and soy amount in the food package because it is more than supplemental 255 continued
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c Group Potential Actione Lower Priority Total starchy Subgroup 73 3.5 c-eq/wk -- d CVV Consider increasing the vegetables CVV Other Subgroup 73 2.5 c-eq/wk -- d CVV Consider increasing the vegetables CVV Total dairy Group 73 2.5 c-eq/d 85 Milk, cheese, Consider increasing the yogurt yogurt substitution; enhance nutrition education or use behavioral approaches to promote intake of milk already provided in the food package Total protein Group 68 3.5 oz-eq/d 29 Milk and Consider adding canned foods alternatives, fish cheese, eggs, legumes and peanut butter
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d The quantity of vegetable subgroups provided by the CVV depends upon the participants' selection. e Translation of potential actions into the final food packages depended upon cost and other practical and administrative considerations.
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For this reason, not all of the proposed actions identified in this chapter resulted in a corresponding change to a food package. In the next chapter, the committee used the potential actions outlined in Tables 5-2 through 5-10 to develop its recommended revisions to the WIC food packages.
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2016. Review of WIC food packages: Proposed framework for revisions: Interim report.
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