Dietary risk assessment in the WIC program : Committee on Dietary Risk Assessment in the WIC Program

EXECUTIVE SUMMARY ..................................................................................1 1 INTRODUCTION.......................................................................................13 The WIC Program, 14 Nutrition Risk Criteria, 15 Dietary Risk, 19 The Charge to the Committee and the Study Process, 22 Organization of the Report, 24 2 DIETARY ASSESSMENT TOOLS IN WIC..............................................27 Purposes of Dietary Data Collection, 27 Dietary Assessment Tools Currently Used by WIC Programs, 29 Eligibility Criteria in Use, 32 Summary, 33 3 USING THE DIETARY GUIDELINES AS THE BASIS OF DIETARY RISK CRITERIA......................................................................35 The Dietary Guidelines, WIC, and National Goals, 35 Which Dietary Guidelines Should be Targeted, 36 4 FRAMEWORK FOR EVALUATING TOOLS TO ASSESS DIETARY RISK..........................................................................................49 Desirable Characteristics of an Assessment Tool, 49 Summary, 55 xii CONTENTS 5 FOOD-BASED ASSESSMENT OF DIETARY INTAKE .........................57 A Focus on Usual Intake, 58 Overview of Research-Quality Dietary Methods for Estimating Food or Nutrient Intake, 60 Methods to Compare Food Intakes with the Dietary Guidelines, 79 Conclusions Regarding Food-Based Dietary Assessment Methods for Eligibility Determination, 83 6 ASSESSMENT OF PHYSICAL ACTIVITY ............................................ 85 Challenges in Assessing Physical Activity, 85 Methods to Assess Physical Activity, 88 Conclusions Regarding the Role of Physical Activity Assessment for Eligibility Determination, 90 Recommendations for Future Research, 92 7 BEHAVIORAL INDICATORS OF DIET AND PHYSICAL ACTIVITY..................................................................................................93 The Concept of Behavioral Indicators, 94 Behavioral Indicators of Diet, 96 Behavioral Indicators of Physical Activity, 112 Conclusions Regarding the Use of Behavioral Indicators for Eligibility Determination, 114 8 EVIDENCE OF DIETARY RISK AMONG LOW-INCOME WOMEN AND CHILDREN.....................................................................115 Nutritional Vulnerability of Groups Served by WIC, 115 Results from Relevant Dietary Intake Studies, 120 Associations of Food Intake with Income, 124 Summary of Evidence Suggesting Dietary Risk, 126 9 FINDINGS AND RECOMMENDATIONS..............................................129 Findings, 129 Recommendation, 133 Concluding Remark, 135 10 REFERENCES..........................................................................................137 APPENDIXES A Allowed Nutrition Risk Criteria, 159 C Workshop Agenda and Presentations, 163 B Biographical Sketches, 165