Summary

The Dietary Guidelines for Americans (DGA) are the cornerstone of federal nutrition guidance. The policy document, revised every 5 years, underpins the dietary goals of federal nutrition assistance programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Given that the previous Institute of Medicine (IOM) review of WIC food packages applied the 2005 DGA as a benchmark, and that the 2010 DGA are currently undergoing reevaluation and update, the U.S. Department of Agriculture (USDA) requested that the IOM undertake a review of the WIC food packages to bring the program into alignment with current dietary guidance. This letter report is the first in a series of reports by the IOM Committee to Review WIC Food Packages in response to that request. For this report, the committee was tasked with assessing the impact of the 2009 regulation to allow the purchase of vegetables and fruits, excluding white potatoes, with a cash value voucher (CVV) on food and nutrient intakes of the WIC population and to consider whether white potatoes should be permitted for purchase with the voucher. The recommendations were to consider the effects on diet quality, the health and cultural needs of the WIC population, and allow for effective and efficient administration nationwide in a cost-effective manner. Following this report, phases I and II of the Review of WIC Food Packages study will update the findings presented here, evaluate the current WIC food packages as outlined in the statement of task, and recommend updates, in the context of the 2015 DGA.

Although the available data did not permit a direct comparison between

food and nutrient intakes before and after CVV implementation, data from the National Health and Nutrition Examination Survey (NHANES) (2007–2010) indicated that intakes of starchy vegetables (which includes white potatoes) among WIC participants are 64 and 56 percent of the 2010 DGA goals for children and women, respectively. For children, intakes of several nutrients of concern (vitamin D, calcium, potassium, and fiber) fall short of current Dietary Reference Intakes (DRIs). Women’s intakes of all nutrients of concern (vitamin C for iron absorption, folate, vitamin D, calcium, potassium, iron, and fiber) are in need of substantial improvement. Although there is some evidence that attention to glycemic index (GI) is important for individuals with type 2 diabetes or gestational diabetes, the GI value of white potatoes depends on the method of preparation. Other evidence indicates that consumption of vegetables and fruits may have long-term health benefits. The committee assessed the effect of various cost-neutral shifts in the intake of categories of vegetables and fruits to accommodate higher consumption of potentially WIC-eligible white potatoes, applying ad hoc assumptions. The scenarios tested included doubling at-home intake of white potatoes or doubling total intake of white potatoes. For children, this resulted in a 2 to 5 percent increase in potassium intake with intakes of other nutrients of concern changing from 0 to 3.3 percent. For women, potassium intakes increased from 2.7 to 6.7 percent and intakes of other nutrients of concern changed from 0 to 4.6 percent. Energy intake increased by less than 2 percent across all scenarios. Apart from the subscore for total vegetable intake (which increases by default), individual subscores of the Healthy Eating Index (a measure of diet quality) change by no more than 5 percent for either women or children under the tested scenarios. The projected changes are small across scenarios because the CVV covers approximately 5 percent of monthly food costs for women 19–50 years of age-based 2014 Thrifty Food Plan estimates. Information related to participant satisfaction and use of the CVV including the influence of culture, as well as on vendor response to CVV implementation, was limited. The committee makes the following recommendations (see the Recommendations section of the report for supporting rationale):

1. The committee recommends that the U.S. Department of Agriculture allow white potatoes as a WIC-eligible vegetable, in forms currently permitted for other vegetables, in the cash value voucher pending changes to starchy vegetable intake recommendations in the 2015 Dietary Guidelines for Americans (DGA). If there are relevant changes in the 2015 DGA, the committee should reevaluate this recommendation.

2. The committee recommends that the U.S. Department of Agriculture and the U.S. Department of Health and Human Services collaborate to achieve expansion of data collection on dietary intakes for pregnant, breastfeeding, and postpartum women in the National Health and Nutrition Examination Survey.
3. The committee recommends that the U.S. Department of Agriculture undertake a separate, comprehensive examination of currently available data to assess the effectiveness of the current cash value voucher in meeting participants’ food pattern and dietary intake goals as recommended by the Dietary Guidelines for Americans, including use of white potatoes in the context of cultural diversity among WIC participants.
4. The committee recommends that the U.S. Department of Agriculture allocate resources to support studies related to (1) participant satisfaction with the cash value voucher (CVV); (2) the strategies participants use to decide how much of the CVV to spend; (3) the strategies participants use to decide how to apportion this benefit among the vegetables and fruits, between vegetables and fruits, and between the CVV and other food purchases; (4) how vendors have changed the WIC-eligible vegetables and fruits they stock because of the implementation of the CVV; and (5) how the CVV and its implementation have affected vendors.

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