Assessing Dietary Risk Among WIC Program Applicants

Summary

The Food and Nutrition Board of the Institute of Medicine (IOM),part of the National Academies, was asked to evaluate the use ofvarious dietary assessment tools and to make recommendations forthe assessment of inadequate or inappropriate dietary patterns. Theseassessments should accurately identify dietary risk of individualsand thus eligibility for participation in the Special SupplementalNutrition Program for Women, Infants, and Children (WIC). The Committeeon Dietary Risk Assessment in the WIC Program was appointed for the2-year study and directed to develop an interim report which wasto include (1) a framework for assessing inadequate diet or inappropriatedietary patterns, (2) a summary of a workshop on methods to assessdietary risk, and (3) the results of literature searches conductedto date.

This interim report includes these three components. Building onthe approach used in the 1996 IOM report, WIC Nutrition Risk Criteria, the framework proposed by the committee identifies characteristicsof dietary assessment tools that can identify dietary patterns orbehaviors for which there is scientific evidence of increased nutritionor health risk in either the short or long-term. The proposed frameworkconsists of eight characteristics that a food intake and/or behavior-basedtool should have when used to determine eligibility to participatein WIC programs. In order to be considered useful and effective,tools should:

  • use specific criteria that are related to health, growth, or disease

  • allow prioritization within the category of dietary risk

  • have acceptable performance characteristics

  • be suitable for the culture and language of the population served

  • be suitable for the skill level of the population served

  • be appropriate for age and physiological condition

  • be responsive to operational constraints

  • be standardized across states/agencies.



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Framework for Dietary Risk Assessment in the WIC Program: InterimReport Assessing Dietary Risk Among WIC Program Applicants Summary The Food and Nutrition Board of the Institute of Medicine (IOM),part of the National Academies, was asked to evaluate the use ofvarious dietary assessment tools and to make recommendations forthe assessment of inadequate or inappropriate dietary patterns. Theseassessments should accurately identify dietary risk of individualsand thus eligibility for participation in the Special SupplementalNutrition Program for Women, Infants, and Children (WIC). The Committeeon Dietary Risk Assessment in the WIC Program was appointed for the2-year study and directed to develop an interim report which wasto include (1) a framework for assessing inadequate diet or inappropriatedietary patterns, (2) a summary of a workshop on methods to assessdietary risk, and (3) the results of literature searches conductedto date. This interim report includes these three components. Building onthe approach used in the 1996 IOM report, WIC Nutrition Risk Criteria, the framework proposed by the committee identifies characteristicsof dietary assessment tools that can identify dietary patterns orbehaviors for which there is scientific evidence of increased nutritionor health risk in either the short or long-term. The proposed frameworkconsists of eight characteristics that a food intake and/or behavior-basedtool should have when used to determine eligibility to participatein WIC programs. In order to be considered useful and effective,tools should: use specific criteria that are related to health, growth, or disease allow prioritization within the category of dietary risk have acceptable performance characteristics be suitable for the culture and language of the population served be suitable for the skill level of the population served be appropriate for age and physiological condition be responsive to operational constraints be standardized across states/agencies.

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport This interim report also includes authored summaries of the presentationsat the workshop (Appendix A), along with the results of literature searches conducted in theinitial phase of the study (Appendix B). The committee's review of dietary assessment tools currently in use in WIC agencieshas not been exhaustive, but it did not find any tools that haveall eight characteristics. The committee's final report will providerecommendations for tools to assess dietary risk in potential WICparticipants and give the scientific basis for those recommendations.It will also address the remaining tasks requested by the Food andNutrition Service of the U.S. Department of Agriculture (see tasks2 through 6 in the box). BOX 1 Scope of Work for Assessing Inadequate Diets or Inappropriate Dietary Patterns to Ascertain Eligibility to Receive WIC Services Based on Dietary Risk Propose a framework for assessing dietary risk among WIC programapplicants, focusing on “Failure to Meet Dietary Guidelines” as a risk criterion; Identify and prioritize areas of greatest concern when the U.S.Dietary Guidelines are incorporated into WIC programs; Examine the use of food-based and behavior-based approaches in assessing“Failure to Meet Dietary Guidelines” requirements; Evaluate possible approaches for use specifically in the WIC setting; Provide specific cut-offs for establishing WIC eligibility usingthe identified approaches; and Identify needed research and tools necessary to implement the approachesidentified as having the greatest potential for identifying thoseat nutrition risk.