Review of WIC Food Packages Improving Balance and Choice: Final Report (2017) / Chapter Skim
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6 The Revised Food Packages
6 The Revised Food Packages
Pages 261-314
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From page 261... ...
Finally, proposed changes to specifications for WIC-eligible foods are reviewed. The revised food packages based on all proposed changes are presented in Tables 6-1 and 6-2,1 and specifications for WIC foods are presented in Table 6-4.
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Within this process, the committee also recognized a number of other factors relevant to the revisions. The factors included the following: • The value of the food packages to the mother–infant dyad • The flexibility of the cash value voucher (CVV)
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From page 263... ...
Given this observation, the committee developed the following guidance for designing food packages that supplement the diet: • Inasmuch as WIC participants (other than formula-fed infants in the first 6 months of life for whom 100 percent of needs is provided) consume foods and beverages not supplied by the WIC food packages that meet some portion of their nutrient needs or recommended amounts of food groups, the amounts of nutrients and food groups in the WIC packages should provide a moderate proportion of an individual's requirement for a particular nutrient or recommended amount of a food group.
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From page 264... ...
(FP II or IIIb) For Infants Formulac -- -- 0 to 3 months: up Up to 312 fl ozd,e 0 to 3 months: up Up to 624 fl ozd,e to 364 fl ozd,e to 806 fl ozd,e 4 to 5 months: up 4 to 5 months: up to 442 fl ozd,e to 884 fl ozd,e Infant cereal -- 16 oz -- 8 oz -- 8 oz Infant food -- 128 oz or -- 128 oz or -- 128 oz or vegetables and 64 oz and $10 64 oz and $10 64 oz and $10 fruits CVV or CVV or CVV or 0 oz and $20 0 oz and $20 0 oz and $20 CVVf CVVf CVVf Infant food -- 40 ozg -- -- -- -- meats For Women Fully Breastfeeding Women (FP VII)
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From page 265... ...
In food package III, medical documentation is required for issuance of infant formula, exempt infant formula, WIC-eligible nutritionals, and other foods. Numbers indicate the full nutrition benefit, defined as the minimum amount of reconstituted fluid ounces of liquid concentrate infant formula as specified for each infant food package category and feeding variation.
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From page 266... ...
g Participants may substitute 10 oz of jarred infant food meat with 10 oz of canned fish meeting WIC specifications for this food category. h Food package VII is issued to three categories of WIC participants: fully breastfeeding women whose infants do not receive formula from the WIC program; women partially (mostly)
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SOURCE: Modified to reflect the revised food packages from 7 C.F.R.
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From page 268... ...
c WIC formula -- -- -- Up to 455 fl oz of liquid concentrate, if appropriate Vegetables and fruitsd $12.00 CVV $12.00 CVV $15.00 CVV Other foods in food packages Legumese,f 1 lb every 3 months 1 lb every 3 months 2 lb every 3 months IV and V-A are provided as Juice 64 fl ozg 64 fl ozg 64 fl ozg appropriate Dairy (milk) 12 qth,i,j,k,l 14 qti,k,l,m 16 qtk,m,n,o Breakfast cerealp 36 oz 36 oz 36 oz Whole grainsq 16–24 oz 16–24 oz 16–24 oz Peanut butterf 16–18 oz every 3 months 16–18 oz every 3 months 16–18 oz every 3 months Eggsr 1 dozen 1 dozen 1 dozen Fish 10 oz every 3 months 10 oz every 3 months 10 oz every 3 months NOTES: -- = the food is not authorized in the corresponding food package; CVV = cash value voucher; FP = food package.
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From page 269... ...
The need for reduced fat milks for 1-year-old children must be based on an individual nutritional assessment and consultation with the child's health care provider if necessary, as established by state agency policy. i Children receiving food package IV-A or IV-B may substitute 1 lb of cheese and 1 qt of yogurt (30–32 oz are allowed at the discretion of the state agency)
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From page 270... ...
for each 1 dozen eggs is permitted for individuals with an egg allergy or who consume a vegan diet. SOURCE: Modified to reflect the revised food packages from 7 C.F.R.
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From page 271... ...
, as prescribed and as redeemed, in the current packages as well as in the revised packages. Overall, the structure of the revised food packages is essentially the same, except that currently food package V is now divided to provide foods specifically for pregnant (food package V-A)
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From page 272... ...
, but it is also the component of the food packages that offers participants the most flexibility to meet their cultural needs. Evidence indicates that preferences for vegetables and fruits vary among WIC participants depending upon race, ethnicity, and geographic region of origin (Di Noia et al., 2016)
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From page 273... ...
In the revised food packages, peanut butter and beans are provided to all participants in a 3-month rotation.5 The intention of the rotation is to provide a better balance of food groups within cost-constraints. The committee envisions that states would decide on the best way to program the rotation, given the flexibility of their individual Management Information Systems.
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From page 274... ...
should facilitate state efforts to meet requirements to stock canned legumes. Peanut Butter The amount of peanut butter in the current food packages provides approximately 84 to 168 percent of recommended amounts of nuts, seeds, and soy (a protein food subgroup)
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From page 275... ...
Juice in the Revised Food Packages Based on these considerations, the amount of juice offered in the revised food packages was reduced by approximately half.7 Juice now provides approximately 50 percent of the AAP recommendation for juice intake for children and 27 percent of the DGA limit for fruit intake from juice for women. The funds saved by the reduction in juice were reallocated to the CVV, a priority component of the revised food packages.
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From page 276... ...
Additional Milk Substitutions Inasmuch as dairy intakes are below recommended amounts across participant subgroups, milk, or the substitution options currently permitted, may not be preferred forms of dairy. The revised food packages allow more substitution options for milk in food packages IV, V-A, V-B, VI, and VII as follows: (1)
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.10 The amount of milk in the revised food packages provides 71 percent of the recommended amount of dairy for women. Milk Amounts in the Food Packages for Children The current food package for children ages 2 to less than 5 years (IV-B)
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. Increasing the focus on whole grains in the WIC food packages may help to increase whole grain intake and improve acceptability of whole grains for the longer term.11 For women, the current food packages provide between 6 and 17 percent of the recommended amounts of whole grains, but 58 percent of recommended amounts of whole grains for children.
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From page 279... ...
The lower price per ounce allows for delivery of 50 percent more whole grains to participants at an increased cost of only $0.17 per loaf.12 Additional Whole Grain Options Are Allowed A greater degree of flexibility in size, as described above, is one way that the revised packages will allow states to offer a greater number of grain options. The committee further recommends that the WIC food category of whole grains also include fortified corn masa flour (which is not a whole grain, see further description below)
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From page 280... ...
. The revised food packages include the additional option of ground corn masa flour, even though this option is not whole grain.
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, fish was reduced from 30 to 20 ounces per month in the revised food package VII for fully breastfeeding women to allow partially breastfeeding women to receive 10 ounces per month. The other revised food packages contain a smaller amount (10 ounces, or two 5-ounce cans every 3 months)
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Although peanut butter and legumes are no longer considered interchangeable in the revised food packages, participants with a peanut allergy may be issued 1 pound of dry legumes or four 15- to 16-ounce cans of legumes in place of peanut butter.
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should increase the dollar amount of the cash value voucher, add fish, and reduce the amounts of juice, milk, legumes, and peanut butter in all food packages for women and children (IV, V-A, V-B, and VII) , to improve the balance of food groups in alignment with the 2015–2020 Dietary Guidelines for Ameri cans.
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• Require states to offer a choice of 1 pound of dry legumes or 64 ounces (four 15- to 16-ounce cans) of canned legumes in all food packages offering legumes.
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The Committee's Vision for Breastfeeding Support in WIC The first Institute of Medicine (IOM) committee to review the WIC food packages made an important recommendation that attempted to b olster support of breastfeeding in the first 30 days postpartum by limiting the issuance of formula to breastfeeding women (IOM, 2006)
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From page 286... ...
"Up to" Amounts of Formula Although formula amounts to infants are largely unchanged from the current packages, the committee found it important to include language clarifying that, across all infant food packages, formula amounts should be considered up to amounts to emphasize the importance of assessing the actual need for formula and reducing the possibility of interfering with the successful establishment of the mother's desired breastfeeding behavior. This language is well aligned with the USDA-FNS guidance for issuance of formula through the WIC program (USDA/FNS, 2016b)
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. Consistent with the modification allowing up to amounts in all infant packages that include infant formula, the revised food package for partially breastfed infants 0 to less than 1 month of age (food package I-A)
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Therefore, the revised food package II provides more infant cereal to fully breastfed infants per month: 16 ounces, which is 100 percent of the AAP-recommended amount. As described below, fully breastfed infants also receive jarred infant food meats, which are another good source of iron and zinc.
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From page 289... ...
CVV in place of half of the jarred infant food vegetables and fruits. In the revised food packages, the proposed CVV substitution is $10 plus half of the jarred infant foods or $20 and no jarred infant foods for all infants ages 6 to 11 months.
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. The current WIC food packages provide 130 percent of the maximum of this range, which may be one factor in the low redemption of jarred infant food meat (generally 40 percent or less)
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, the revised food package for fully breastfed infants still provides 130 percent of the EAR for iron and 72 percent of the EAR for zinc. Fish May Be Substituted for a Portion of Jarred Infant Food Meat Given that redemption of jarred infant food meat is poor and jarred infant food meat is not a preferred infant food, coupled with the importance of providing a bioavailable source of iron as infants begin complementary feeding (AAP, 2014)
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From page 292... ...
even if these products do not suit the participant's specific medical need. For example, in the current food packages, a participant who is issued food package III because of a need for jarred infant food vegetables and fruits although the participant is over 1 year of age is also required to be issued a WIC formula.
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From page 293... ...
The committee recommends one change to the amounts of jarred infant food fruits and vegetables provided to children and women in food package III. In the current packages, children may receive 128 ounces and women may receive 160 ounces jarred infant food vegetables and fruits in place of the CVV.
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From page 294... ...
Providing food package V-B to women pregnant with multiple fetuses increases the CVV by $10 per month and adds more fish compared to food package V-A for pregnant women with singletons. Issuance of food package VII to women partially breastfeeding multiples provides an additional 1 dozen eggs, $10 in CVV, and 10 ounces of fish per month compared to the revised food package V-B for women who are partially breastfeeding singletons.
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The contribution of WIC food packages to the intake of nutrients to limit, including added sugars, was of particular concern to the committee because of this guidance and also because of excessive intakes of added sugars across subgroups of WIC participants (see Chapter 5)
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and 2,000 IU added sugars in the WIC food of vitamin A per quart (500 IU packages per cup) May be flavored or unflavored.
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Soy-based IV, V-A, V-B, VI, Must be fortified to meet the In addition, the total sugar Soy-based beverages are beverage VII following nutrient levels: content of soy-based beverages available in the marketplace Women and 276 mg calcium per cup, 8 g should be as low as possible, that contain 12 g or less of children protein per cup, 500 IU vitamin not to exceed 12 g per 8 oz total sugars per serving; sugars A per cup, 100 IU vitamin D serving in soy-based beverages are 100 per cup, 24 mg magnesium per percent added; intakes of added cup, 222 mg phosphorus per sugars are excessive in the cup, 349 mg potassium per cup, WIC population, therefore it is 0.44 mg riboflavin per cup, and appropriate to apply a limit that 1.1 µg vitamin B12 per cup, in considers nationwide availability accordance with fortification of these products guidelines issued by FDA Tofu IV, V-A, V-B, VI, Calcium-set tofu prepared with Must contain a minimum of Tofu in the food packages serves VII calcium salts (e.g., calcium 200 mg of calcium per 100 g of as a milk substitution; as such, Women and sulfate) ; may not contain added tofu (calcium-set is no longer the revised specification ensures children fats, sugars, oils, or sodium part of the specification)
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; may be plain or flavored must contain at least 250 mg of amount is more closely aligned with ≤40 grams of total sugars calcium and 6.5 g of protein per with the DGA; soy products per 1 cup of yogurt 8 oz servingc meet the needs of individuals with a milk allergy or who consume a vegan diet Cheese IV, V-A, V-B, VI, Domestic cheese made from 100 In addition, soy-based cheese Soy products meet the needs of VII percent pasteurized milk. Must substitute (not soy curd cheese)
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for CACFP, the National grain as the primary ingredient School Lunch Program, and the by weight and meet labeling National Breakfast Program requirements for making a (USDA/FNS, 2016d) health claim as a "whole grain food with moderate fat content": (1)
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is challenging; restricting moderate fat content," as to 100 percent whole wheat outlined above bread aligns with most current state WIC authorized food lists and promotes intake of whole grains by WIC participants Other whole Other whole unprocessed In addition, teff or buckwheat Additional options provide grain grains: may be offered; cornmeal culturally suitable alternatives; options Brown rice, bulgur (cracked (including blue) ; and corn masa participants and WIC staff wheat)
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to current options Corn masa flour Not yet permitted Add corn masa flour. Once Allowing this flour aligns available in the marketplace, with the allowance of tortillas states are encouraged to offer made with corn masa flour; folic acid–fortified corn masa participants expressed an flour interest continued 301
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d It is anticipated that changes to the whole grain-rich criteria in alignment with the FDA proposed changes to the RACCs used for food labeling would be applied to the WIC food packages. SOURCE: For current specifications, see USDA/FNS, 2014.
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SOURCE: Based on data available in USDA/ARS, 2016. specifications in light of not only the contribution of the current food packages to the DGA limit on COU, but also products now available in the marketplace, the role of added sugars in improving the palatability of nutritious foods, and the preferences of WIC participants.
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From page 304... ...
Not only is the added sugars content of yogurts in the marketplace declining, but the committee's proposed reduction of added sugars in yogurt is aligned with the USDA-FNS Final Rule that requires all yogurt provided in the Child and Adult Care Food Program (CACFP) to contain no more than 23 grams of total sugars per 6 ounces (or 30 grams per 8 ounces)
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. To align the WIC food packages with CACFP regulations and to limit added sugars in the food packages, only unflavored milk is authorized in the revised WIC food packages.
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TABLE 6-6 Folate Content of Commonly Redeemed Selected Cereals in WIC Food Packages Categorization on Example Folate in 1 oz-eq State WIC Food Lists Ready-to-Eat Cereal Type (µg DFE)
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. The committee proposes that this specification be revised such that all bread in the WIC food packages be 100 percent whole wheat and that whole grain bread no longer be permitted.
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Specifications for New Substitution Options Specifications for New Grain Options The revised food packages offer additional grain options to accommodate cultural eating patterns and other food preferences. Cornmeal (including blue)
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. These specifications ensure that these substitutes supplement the diets of WIC participants with key nutrients that the WIC food packages are intended to provide.
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A description of these topics and the rationale for retaining the status quo is presented in Appendix Q SUMMARY The recommended revisions to the WIC food packages outlined in this chapter are based on the committee's considerations of the health of the WIC-participating population, food safety risks relevant to the WICparticipating population, current dietary guidance (i.e., the DGA and dietary guidance for individuals less than 2 years of age)
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2006. WIC food packages: Time for a change.
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: Revisions in the WIC food packages. Final Rule, 7 C.F.R.
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2015. Formula supplementation of breastfed infants: Helpful or hazardous?
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