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Proposed Criteria for Selecting the
WIC Food Packages
A Preliminary Report of the Committee to Review the WIC Food Packages
Food and Nutrition Board
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of
the National Research Council, whose members are drawn from the councils of the National
Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The
members of the committee responsible for the report were chosen for their special competences
and with regard for appropriate balance.
This study was supported by contract number 43-3198-03-0127 between the National Academy
of Sciences and the U.S. Department of Agriculture. Any opinions, findings, conclusions, or
recommendations expressed in this publication are those of the authors and do not necessarily
reflect the views of the sponsoring agency that provided support for the project.
International Standard Book Number: 0-309-0XXXX-X (book)
International Standard Book Number: 0-309-0XXXX-X (PDF)
Additional copies of this report are available from the National Academies Press, 500 Fifth
Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the
Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at:
www.iom.edu.
Copyright 2004 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient
Greece, now held by the Staatliche Museen in Berlin.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon the authority
of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it
to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is
president of the National Academy of Sciences.
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National Academy of Sciences, as a parallel organization of outstanding engineers. It is
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Academy of Sciences the responsibility for advising the federal government. The National
Academy of Engineering also sponsors engineering programs aimed at meeting national needs,
encourages education and research, and recognizes the superior achievements of engineers. Dr.
Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to
secure the services of eminent members of appropriate professions in the examination of policy
matters pertaining to the health of the public. The Institute acts under the responsibility given to
the National Academy of Sciences by its congressional charter to be an adviser to the federal
government and, upon its own initiative, to identify issues of medical care, research, and
education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to
associate the broad community of science and technology with the Academy's purposes of
furthering knowledge and advising the federal government. Functioning in accordance with
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providing services to the government, the public, and the scientific and engineering
communities. The Council is administered jointly by both Academies and the Institute of
Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of
the National Research Council.
www.national-academies.org
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COMMITTEE TO REVIEW THE WIC FOOD PACKAGES
SUZANNE P. MURPHY, Chair, Cancer Research Center of Hawaii, University of Hawaii,
Honolulu
BARBARA L. DEVANEY, Mathematica Policy Research, Inc., Princeton, NJ
GEORGE M. GRAY, Department of Health Policy and Management, School of Public Health,
Harvard University, Boston, MA
GAIL G. HARRISON*, Department of Community Health Sciences, School of Public Health,
University of California--Los Angeles
HELEN H. JENSEN, Department of Economics and Center for Agricultural and Rural
Development, College of Agriculture, Iowa State University, Ames
LUCIA L. KAISER, Department of Nutrition, College of Agriculture and Environmental
Sciences, University of California--Davis
JEAN D. KINSEY, Department of Applied Economics and The Food Industry Center, College of
Agricultural, Food and Environmental Sciences, University of Minnesota, St. Paul
ANGELA M. ODOMS-YOUNG, School of Allied Health Professions, College of Health and
Human Sciences, Northern Illinois University, Dekalb
KAREN E. PETERSON, Department of Society, Human Development and Health and
Department of Nutrition, and Public Health Nutrition Program, School of Public Health,
Harvard University, Boston, MA
ANNA MARIA SIEGA-RIZ, Department of Maternal and Child Health and Department of
Nutrition, Carolina Population Center, and Nutrition Epidemiology Core for the Clinical
Nutrition Research Center, School of Public Health, University of North Carolina--Chapel
Hill
VIRGINIA A. STALLINGS, Nutrition Center, Division of Gastroenterology and Nutrition,
Joseph Stokes Jr. Research Institute, Children's Hospital of Philadelphia, Department of
Pediatrics, University of Pennsylvania School of Medicine, Philadelphia
CAROL WEST SUITOR, Nutrition Consultant, Northfield, VT
______________________________
*Member, Institute of Medicine
Staff
JANICE RICE OKITA, Senior Program Officer
TAZIMA A. DAVIS, Research Associate
JON Q. SANDERS, Senior Program Assistant
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FOOD AND NUTRITION BOARD
CATHERINE E. WOTEKI, Chair, Department of Food Science and Human Nutrition, Iowa
State University, Ames
ROBERT M. RUSSELL, Vice-Chair, U.S. Department of Agriculture's Jean Mayer Human
Nutrition Research Center on Aging, Tufts University, Boston, MA
LARRY R. BEUCHAT, Center for Food Safety, University of Georgia, Griffin
SUSAN FERENC, SAF*Risk, L.C., Madison, WI
NANCY F. KREBS, Department of Pediatrics, University of Colorado Health Sciences Center,
Denver
SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania School of Medicine, Philadelphia
REYNOLDO MARTORELL, Rollins School of Public Health, Emory University, Atlanta
LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Research and Action
Center, Washington, DC
NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism Research Laboratory,
University of California--San Diego
JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin, Madison
STEVE L. TAYLOR, Department of Food Science and Technology and Food Processing
Center, University of Nebraska--Lincoln
BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology,
Pennsylvania State University, University Park
IOM Council Liaison
DONNA E. SHALALA, University of Miami, Florida
Staff
LINDA D. MEYERS, Director
GERALDINE KENNEDO, Administrative Assistant
ELIZABETH RIMAUD, Financial Associate
vi
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Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse
perspectives and technical expertise, in accordance with procedures approved by the NRC's
Report Review Committee. The purpose of this independent review is to provide candid and
critical comments that will assist the institution in making its published report as sound as
possible and to ensure that the report meets institutional standards for objectivity, evidence, and
responsiveness to the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the deliberative process. We wish to thank the following
individuals for their review of this report:
Steven A. Abrams, Baylor College of Medicine and Texas Children's Hospital; Lindsay H.
Allen, University of California--Davis; Susan S. Baker, Children's Hospital of Buffalo; George
H. Beaton, Professor Emeritus, University of Toronto; Mary Kay Fox, Independent Nutrition
Consultant, Reading, MA; Philip M. Gleason, Mathematica Policy Research, Inc., Geneva, NY;
Geraldine Henchy, Food Research and Action Center, Washington, DC; Anne Looker, National
Center for Health Statistics, Centers for Disease Control and Prevention; Edward R. B. McCabe,
Mattel Children's Hospital and David Geffen School of Medicine, University of California--Los
Angeles; Roy M. Pitkin, Professor Emeritus, University of California--Los Angeles; Kathleen
M. Rasmussen, Cornell University.
Although the reviewers listed above have provided many constructive comments and
suggestions, they were not asked to endorse the conclusions or recommendations nor did they
see the final draft of the report before its release. The review of this report was overseen by
Johanna T. Dwyer, Tufts-New England Medical Center and Office of Dietary Supplements at the
National Institutes of Health. Appointed by the National Research Council and the Institute of
Medicine, she was responsible for making certain that an independent examination of this report
was carried out in accordance with institutional procedures and that all review comments were
carefully considered. Responsibility for the final content of this report rests entirely with the
authoring committee and the institution.
vii
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Contents
Executive Summary ES-1
Chapter 1 Introduction and Background 1-1
The WIC Program, 1-1
The WIC Population Has Changed Since the Inception of the WIC Program, 1-4
The Food Supply and Dietary Patterns Have Changed Since the Inception of
the WIC Program, 1-6
The Health Risks of the WIC-Eligible Population Have Changed Since the Inception
of the WIC Program, 1-7
Dietary Guidance and Recommendations Have Changed Since the Inception
of the WIC Program, 1-9
The Committee's Task, 1-10
Chapter 2 Challenges to Selecting an Effective Set of WIC Food Packages 2-1
Introduction, 2-1
Addressing Both Overnutrition and Undernutrition, 2-1
Participant Diversity, 2-1
Employment, 2-3
Food Availability, 2-4
Limitations in Transportation, Storage, or Cooking Facilities, 2-4
Food Safety Considerations, 2-5
Administrative Impacts, 2-5
Incentives, 2-6
Summary, 2-6
Chapter 3 Nutrient Intake of WIC-Eligible Populations 3-1
Introduction, 3-1
Dietary Reference Intakes (IOM, 1997-2004), 3-1
Using the DRI to Assess Nutrient Adequacy, 3-5
Results and Discussion, 3-11
Summary, 3-22
Chapter 4 Food Intake of WIC-Eligible Populations 4-1
Introduction, 4-1
Dietary Intakes of Children Ages 2 through 4 Years and of Women, 4-1
Findings for Young Children and Women, 4-4
Dietary Intakes of Infants and Children Younger Than Two Years, 4-8
Summary, 4-11
viii
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Chapter 5 Nutrition-Related Health Risks and Outcomes of
WIC-Eligible Populations 5-1
Introduction, 5-1
Maternal Nutrition-Related Health Risks and Outcomes, 5-1
Nutrition-Related Health Risks and Outcomes in Infants and Children, 5-4
Food Allergies, 5-7
Environmental Risks in the WIC Population, 5-7
Summary, 5-9
Chapter 6 Proposed Approach for Selecting the WIC Food Packages 6-1
Introduction, 6-1
Implications of a Supplemental Food Program, 6-1
Proposed Criteria for the WIC Food Packages, 6-2
Process for Translating the Criteria into Food Packages, 6-4
Evaluating Cost Neutrality, 6-6
Proposed Methods for Evaluating Benefits and Risks of Alternative WIC
Food Packages, 6-6
Summary, 6-8
Chapter 7 References 7-1
Appendix A Tables A-1
Appendix B Biographical Sketches of Committee Members B-1
Appendix C Acronyms and Abbreviations C-1
ix
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