Review of WIC Food Packages Improving Balance and Choice: Final Report (2017) / Chapter Skim
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9 How the Revised Food Packages Meet the Criteria Specified
9 How the Revised Food Packages Meet the Criteria Specified
Pages 371-394
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From page 371... ...
Several of the proposed food package revisions align with more than one criterion. Consistent with the study task, for each criterion, revisions were made in consideration of the 2015–2020 Dietary Guidelines for Americans (DGA)
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From page 372... ...
A comparison of all current and revised food packages as the 1 As noted in Chapter 8, only food package IV-B is used for assessment of the effects of the revised package on intake. In this chapter, the assessments include the nutrient gap analysis, the food group gap analysis, and the change in Healthy Eating Index–2010 (HEI–2010)
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From page 373... ...
CRITERION 2 Criterion 2 states: "The packages contribute to reduction of the prevalence of inadequate nutrient intakes and of excessive nutrient intakes." Nutrient Levels in the Current, Compared to the Revised Food Packages, as Redeemed The committee's analyses show that the proposed revisions to the food packages provide a better balance of the availability of most of the priority nutrients (see Appendix T)
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From page 374... ...
Diet Aligned with for Low- Availability, Agency Recommended Food Package Supplement Nutrient Aligned Guidance for Income and Cultural or Vendor Change to the Diet Intakes with DGA Children <2 y Persons Suitability Burden Total fruits Increase CVV ü ü ü ü ü ü Reduce fruit juice ü ü ü ü Reduce jarred infant food fruits ü Substitute CVV for juice or ü ü ü ü jarred infant fruits Total vegetables Increase CVV ü ü ü ü ü Reduce legumes ü ü Offer canned beans ü ü ü Vendors stock three varieties ü Reduce jarred infant food ü vegetables Substitute CVV for jarred ü ü infant foods
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From page 375... ...
Increase substitution options ü ü ü Offer a range of yogurt ü amounts Retain only low-fat or fat-free ü forms for 2 y or older Remove "dangling quart"* ü Whole grains Require whole grain-rich ü ü ü ü breakfast cereals Retain RTE breakfast cereal ü form Offer additional whole grain ü ü forms Offer range of sizes for whole ü ü ü wheat bread and grains Reduce infant cereal ü ü continued 375
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From page 376... ...
Diet Aligned with for Low- Availability, Agency Recommended Food Package Supplement Nutrient Aligned Guidance for Income and Cultural or Vendor Change to the Diet Intakes with DGA Children <2 y Persons Suitability Burden Total protein Offer seafood ü ü ü ü ü Reduce peanut butter ü ü ü Reduce jarred infant food meat ü ü Substitute fish for jarred infant ü ü ü food meat Calories for other uses Reduce total sugars ü ü ü ü ü limit in yogurt Limit added sugars in milk ü ü ü ü ü alternatives Reduce saturated fat by reducing ü ü ü dairy NOTES: CVV = cash value voucher; DGA = Dietary Guidelines for Americans; FP = food package; RTE = ready-to-eat.
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From page 377... ...
TD: Total dairy TG: Total grains 40 RG: Refined grains WG: Whole grains FW TP: Total protein foods WG NSS: Nuts, seeds, soy TG MPE: Meat, poultry, eggs RG SEA: Seafood 20 TP MPE TV VEG SEA 0 Current Revised Food package (IV-B) FIGURE 9-1 Proportion of the Dietary Guidelines for Americans (DGA)
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From page 378... ...
c See Appendix L for details on calculation of the gap. d Based on the difference between redeemed amounts of the current and revised food packages.
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From page 379... ...
Changes in Sodium, Saturated Fat, and Added Sugars The revised food packages provide less sodium and saturated fat. Reductions in the amounts of dairy foods were the primary drivers of reducing saturated fat and sodium in all revised food packages (see Appendix T)
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From page 380... ...
• Fish is available in all WIC food packages. The revised food pack ages provide fish to all WIC participants,5 no longer only to exclu sively breastfeeding women.
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From page 381... ...
The new intake values were then used to calculate the HEI–2010 score for the revised food packages. As shown in Table 9-5, the revised food package IV-B is predicted to increase several HEI–2010 subscores (e.g., total vegetables, whole grains, and total protein foods, refined grains, and sodium with increases of at least 0.1 points)
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From page 382... ...
b 1.50 0.6 0.12 0.18 0.89 0.84 −0.06 Small narrowing Legumes (beans and 0.07 0.05 0.06 0.04 0.02 0.04 +0.02 Moderate widening peas) Total dairy 2.50 1.9 1.51 1.48 0.56 0.59 +0.03 Small widening Total grains 4.50 4.7 1.29 1.13 0 0 NA No effect Whole grains 2.25 0.6 0.70 0.81 1.67 1.56 −0.11 Small narrowing Total protein foods 3.50 2.9 0.62 0.86 0.57 0.34 −0.23 Small narrowing Nuts, seeds, and soy 0.36 0.2 0.31 0.21 0.16 0.25 +0.09 Moderate widening Meat, poultry, eggs 2.36 2.5 0.32 0.32 0 0 NA No effect Seafood 0.57 0.1 0.00 0.08 0.47 0.39 −0.08 Moderate narrowing NOTES: CVV = cash value voucher; DGA = Dietary Guidelines for Americans; NA = not applicable.
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From page 383... ...
Table 9-7 presents a side-by-side comparison of how the revised food packages align with these recommendations. The revised food packages account for the nutritional needs of exclusively breastfed, partially breastfed, and formula-fed infants in the first few months of life, the developmental and nutritional needs during the first 2 years of life, the promotion of healthy eating patterns, and the safety of foods consumed.
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From page 384... ...
384 TABLE 9-5 Estimated Effect of the Revised Food Packages on the Healthy Eating Index–2010 of Children Ages 2 to Less Than 5 Years: Food Package IV-B Based on Redemption Serving-Equivalents per Daya HEI– Estimated Estimated Median Change in Current New Food 2010 Density Density Current New Food HEI–2010 Food Group Food Group Food Group Group Max for Min for Max Food Group Group Component Intake Intake Densityb Densityb Scorec Score Score Score Score Adequacy Total fruit 1.4 −0.05 0.91 0.88 5.00 0.00 0.80 5.00 5.00 Fruit, whole 0.7 0.11 0.47 0.55 5.00 0.00 0.40 5.00 5.00 Total vegetables 0.6 0.05 0.41 0.44 5.00 0.00 1.10 1.84 1.98 Greens and 0.1 −0.01 0.04 0.04 5.00 0.00 0.20 1.10 0.92 beansd Whole grains 0.6 0.11 0.39 0.46 10.00 0.00 1.50 2.59 3.06 Total dairy 1.9 −0.03 1.29 1.27 10.00 0.00 1.30 9.95 9.79 Total protein 2.9 0.19 1.95 2.08 5.00 0.00 2.50 3.90 4.16 foods Seafood and 0.3 −0.06 0.20 0.16 5.00 0.00 0.80 1.25 1.00 plant proteins Fatty acids (ratio 34.7 −1.26 1.95 1.90 10.00 <1.2 >2.5 5.79 5.41 to SFA)
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From page 385... ...
Because the energy in the current and revised food packages differ by only 8 kcal as redeemed, 1,500 kcals is used for all density calculations. c The minimum score for each HEI–2010 component is always zero.
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From page 386... ...
* Consume less than 10% of energy • Reduce dairy, which reduces saturated fat from saturated fats Consume less than 10% of energy • Reduce total sugars limits specifications for yogurt from added sugars • Propose total sugars limit for soy beverages • Retained total sugars limit for cereals Stay within the limits for • Revised packages V-A, V-B and VII fall within the "calories for other uses" for limits of COUs relative to the energy content of the specific food-pattern energy levels food packages and the appropriate food pattern
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From page 387... ...
CRITERION 6 Criterion 6 states: "The foods in the packages are readily acceptable, commonly consumed, widely available, take into the account cultural eating patterns and food preferences, and provide incentives for families to participate in the WIC program." The 2009 food package changes also included several additional options to improve alignment with cultural eating patterns and food preferences, as reviewed in Chapter 3. In particular, the increase of the CVV with very few restrictions on choice provides participants with the flexibility to choose
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From page 388... ...
(current policy is unchanged) Complementary Feeding Complementary foods should be gradually • Provide only infant formula in food introduced to infants at approximately packages for infants under 6 months of 6 months of life.
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From page 389... ...
Avoid mixed varying textures using a CVV in place of textures, such as broth with vegetables. jarred infant food vegetables and fruits Promoting Healthy Eating Patterns Allow lower fat milks for children age • Issue, at state agency option, fat-reduced 1 year and older for whom obesity or milks to children under 2 years of age for overweight is a concern.
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From page 390... ...
. The revised food packages increase the value of the CVV further, to the maximum extent possible, while balancing other nutrient and food group priorities and maintaining cost neutrality.
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From page 391... ...
suitable for various storage conditions (current policy is unchanged) • Require at least one form of canned, frozen, or dried fruit and one form of canned, frozen, or dried vegetable, which may be in nonperishable forms Food forms and • Allow for ready-to-feed infant formulas, full-strength juices, amounts available for and jarred infant foods (current policy is unchanged)
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From page 392... ...
Market research reviewed by the committee indicate that yogurts containing 30 g of total sugars or less and the number of whole grain cereals are likely to be widely available to meet participant preferences Culturally suitable • Include additional options for grains to align with cultural foods and foods and eating patterns preferred foods • Increase CVV and option to substitute a CVV for fruit juice and/or jarred infant food vegetables and fruits provides participants with increased flexibility • Retain yogurt, tofu, and soy beverage as culturally suitable options (current policy is unchanged) • Add a yogurt substitution option to suit individuals who prefer this product over fluid milk • Add soy-based cheese and soy-based yogurt substitute options • Allow participants following a vegan diet to select legumes in place of eggs Foods that provide • Enhance the food packages for fully and partially incentive for breastfeeding women participation in the WIC • Increase the value of the CVV in all food packages; program mandate for canned, frozen, or dried options may increase the purchasing power of the CVV; additional options to substitute a CVV for juice and jarred infant food vegetables and fruits provide additional flexibility • Add canned fish to nearly all food packages NOTES: CVV = cash value voucher.
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From page 393... ...
The FNS Infant Nutrition and Feeding • Allow a CVV in place of jarred infant Guide indicates that around 9 months of food vegetables and fruits age most infants are developmentally ready to consume foods of increased texture and consistency. Additional culturally-suitable options are • See "culturally suitable foods" in needed.
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From page 394... ...
Overall, the revised packages are not different enough from the current packages to change the likely effect of the food packages on participants' health. It is noteworthy that if participants were to use the CVV to consume a higher proportion of vegetables (relative to fruits)
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