WIC Nutrition Risk Criteria A Scientific Assessment (1996) / Chapter Skim
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SUMMARY
SUMMARY
Pages 1-22
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All WIC program participants must be determined to be at nutrition risk on the basis of a medical or nutrition assessment by a physician,. nutritionist, dietitian, nurse, or some other competent professional authority.
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Since the federal WIC program does not have a uniform set of nutrition risk criteria (where a risk criterion is defined as a risk indicator and its cutoff point) , the committee obtained a list of nutrition risk criteria used by WIC state agencies in 1992.
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In addition, the nutrition risk assessments are used to tailor the WIC intervention and, in some cases, to monitor the health and nutrition status of program participants. This report is a scientific assessment of the WIC nutrition risk criteria as they are currently used to establish WIC eligibility and the priority of the WIC eligible individuals.
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. The committee agreed that 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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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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GENERAL CONCLUSIONS The committee reached seven general conclusions about the WIC nutrition risk criteria and priority system: A body of scientific evidence supports a majority of the nutrition risk criteria used by the WIC program. For some of the risk criteria, however, there are serious gaps in the evidence.
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Such loosely defined nutrition risk criteria include endocrine disorders, renal disease, chronic and recurrent infections, food allergies, and genetic and congenital disorders. · There is some inconsistency between the WIC program's goals, design, and implementation.
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. Risk criteria for which there was very little evidence of nutrition risk or benefit from WIC participation include maternal short stature, abnormal postpartum weight change, and infants large for gestational age.
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The committee recommends that most of these nutrition risk criteria continue to be used in the WIC program, using cutoff points that generally are documentation or diagnosis of the disease or disorder. Maternal cigarette, alcohol, and illegal drug use among pregnant and lactating women pose significant health risks but uncertain benefit from participation in the WIC program.
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The committee recommends that these nutrition risk criteria no longer be used in the WIC program. Dietary Risk Criteria Three major categories of dietary risk criteria are reviewed: inappropriate dietary patterns, inadequate diets, and food insecurity.
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Because of the lack of evidence that nutrition will benefit those exposed to passive smoking, the committee recommends that this risk criterion no longer be used in the WIC program. RECOMMENDATIONS FOR FUTURE RESEARCH AND ACTION Research Recommendations Regarding the nutrition risk criteria reviewed in the report, the committee recommends the following areas for future research: Develop anthropometric standards (including weight change velocity)
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Department of Agriculture, to provide guidance to state WIC agencies in the development of nutrition risk criteria: Adopt scientifically justified cutoff values for anemia and for anthropometric criteria among women, infants, and children, realizing that they may be different across populations as prevalences change. Define preterm consistently as delivery before the end of the 37th postmenstrual week for both mothers and their infants.
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Consider changing the current WIC priority system to give higher priority to those nutrition risk criteria identified in this report as having strong relationships to risk and potential to benefit and lower priority to nutrition risk criteria with weaker relationships to risk and potential to benefit.
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