WIC Nutrition Risk Criteria A Scientific Assessment (1996) / Chapter Skim
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3 PRINCIPLES UNDERLYING THE NUTRITION RISK CRITERIA FOR WIC ELIGIBILITY
3 PRINCIPLES UNDERLYING THE NUTRITION RISK CRITERIA FOR WIC ELIGIBILITY
Pages 53-66
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From page 53... ...
The WIC program's nutrition risk criteria are intended to target its limited resources to low-income individuals who either already have poor outcomes or are at the greatest risk of poor outcomes. This chapter presents the committee's underlying principles concerning the use of nutrition risk criteria for eligibility for participation in the WIC program, a description of current WIC nutrition risk criteria, a discussion of the current WIC priority system, and the framework adopted by the committee as the basis for its recommendations for the use of specific nutrition risk criteria.
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From page 54... ...
Moreover, nutrition risk criteria should select those most likely to benefit from the WIC program from among potential participants who are at risk of poor outcomes. In other words, the nutrition risk criteria used in the WIC program should serve both as indicators of nutrition and health risk and as indicators of nutrition and health benefit.
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From page 55... ...
Examination of causal pathways and possible interventions is a key step in identifying risk indicators that predict nutrition and health risk. In the example given above, one such indicator is maternal thinness.
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From page 56... ...
Setting Cutoff Points for Nutrition Risk Indicators Once a risk indicator is chosen as a predictor of nutrition and health benefit, a cutoff point for the indicator is set at the level below (or above, depending upon the indicator) which individuals are eligible for participation in the WIC program.
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From page 57... ...
Increasing the yield of nutrition risk criteria helps target scarce resources. A perfect yield occurs at any cutoff point at which all of those selected for participation in the WIC program can benefit and nobody who cannot benefit is selected.
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From page 58... ...
It is therefore important to monitor the prevalence of changing risk conditions, including medical conditions and social conditions such as homelessness, and to make changes in the WIC program nutrition risk criteria as appropriate. Possible changes in response to the changing prevalence of risks include adding new risk indicators, for example, homelessness, or changing cutoff points, for example, moving the cutoff point for height-for-age below the 5th percentile as the prevalence of poor growth declines.
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From page 59... ...
In evaluating the use of nutrition risk criteria in the WIC program, it is important to note that the yield of a risk criterion refers to the yield of benefit and is actually the product of the yield of risk and the efficacy of the WIC program for individuals with that risk: Yield of benefit = [Yield of risk] x [The proportion of individuals truly at risk who will benefit from the WIC program]
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From page 60... ...
WIC NUTRITION RISK CRITERIA According to federal regulation, each participant in the WIC program must be determined to be at nutrition risk on the basis of a medical and/or nutrition assessment by a competent professional authority. At a minimum, federal regulations require that the following nutrition and health data be collected on each potential participant: height or length, weight, and a hematologic test for anemia (hematocrit, hemoglobin, or free erythrocyte protoporphyrin concentration)
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From page 61... ...
congenital malformations in infants or children infants born to women with alcohol or drug abuse histories or mental retardation Dietary Nutrition Risk Criteria: inadequate dietary patterns assessed by a 24-hour dietary recall, dietary history, or food frequency checklist Predisposing Nutrition Risk Criteria: homelessness or migrancy SOURCE: 7 CRF Subpart C, Section 246.7 (e)
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From page 62... ...
Pregnant and breastfeeding women and infants at nutrition risk as demonstrated by inadequate dietary pattem. At the state's option, this priority can also include high-risk postpartum women or pregnant or breastfeeding women and infants who are at nutrition risk solely because of homelessness or migrancy.
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From page 63... ...
It is likely that some of the predisposing nutrition risk indicators at current low priority levels-e.g., homelessness-may have higher overall yields than some medical risk indicators in PriorityI for example, asymptomatic bacteriuria as a renal medical risk for pregnant woman. With the current priority system, an overweight child who may not actually benefit would be served in preference to a homeless child who would be more likely to benefit from participation in the WIC program.
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From page 64... ...
For nutrition risk criteria for which the risk indicator is a predictor of both nutrition and health risk and benefit from the WIC program but for which cutoffs have been set so that many individuals selected are not truly at risk, the committee recommends using the risk indicator with more stringent cutoff values. For risk criteria for which there is strong evidence of nutrition and health risk but uncertain evidence of benefit, the committee recommends using the nutrition risk criteria and conducting further research on the benefit from the WIC program.
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From page 65... ...
it is difficult to justify the provision of a monthly food package worth approximately $30 per WIC participant unless there is evidence that the individual can benefit from the food package or the nutrition education that accompanies the provision of food; and (3) the WIC program is designed to be only an adjunct to good health care and is not itself a health program.
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