Technical papers review of WIC food packages

              W 2 8 19
United States
Department of
Agriculture
Food and
Nutrition
Service
6 tfrOJ
Technical Papers
Review of WIC Food Packages
/
COMPLETED
J
This set of Technical Papers on the "Review of WIC Food Packages"
represents the final deliverable submitted in November 1991 to
the U.S. Department of Agriculture, Food and Nutrition Service,
by Pennsylvania State University, College of Health and Human
Development, Department of Nutrition, under Cooperative Agreement
#58-3198-1-006. The papers were prepared by Principal
Investigator Mary Frances Picciano, PhD; and Co-Investigators
Helen A. Guthrie, PhD; Shiriki K. Kumanyika, PhD; Jeannie
McKenzie, PhD; and Helen Smiciklas-Wright, PhD.
November 1991
J
PREFACE
The Child Nutrition and wic Reauthorization Act of 1989 (Public
Law 101-147) required the U.S. Department of Agriculture to
conduct a review of the appropriateness of foods made available
to participants in the Special Supplemental Food Program for
Women, Infants and Children (WIC). The legislation specifically
directed the Department to consider the nutrient density of such
foods and how effectively nutrients for which WIC participants
are most vulnerable to deficiencies of, such as protein, calcium,
iron, zinc, and vitamin A, are provided to participants.
In designing the procedure for completion of the legislatively
mandated review, the Department was convinced that its
consideration of these important and complex issues would benefit
greatly from public participation. Therefore, a Notice was
published in the Federal Register on October 24, 1990 which
identified the major issues to be addressed by the review and
solicited public input on these issues. A copy of the Notice is
included with the attached technical papers as background
material.
The second phase of the review process involved enlisting
independent technical experts to review the comments submitted to
USDA in response to the Notice and then to conduct a
comprehensive search of the scientific literature available on
the issue topics to determine whether a consensus or majority
opinion could be established on each one.
The attached technical papers were then developed by a team of
faculty members of The Pennsylvania State University, The
Department of Nutrition, College of Health and Human Development,
under a Cooperative Agreement with the U.S. Department of
Agriculture's Food and Nutrition Service during the spring and
summer of 1991. Drafts of the papers were provided to the
National Advisory Council on Maternal, Infant and Fetal Nutrition
for discussion at an ail hoc meeting of 12 Council volunteers in
June 1991. The papers were then revised, resubmitted to the
Department, and used to form the agenda of a full Council meeting
in September 1991, along with similar papers developed as part of
a separate review addressing the nutritional risk criteria used
in determining eligibility for the WIC Program, which was also
mandated by Pub. L. 101-147.
The Council's recommendations are included in its 1992 Report to
Congress and the President. Copies of the Report are available
upon request from the U.S. Department of Agriculture, Food and
Nutrition Service, Supplemental Food Programs Division, 3101 Park
Center Drive, Room 540, Alexandria, Virginia 22302,
(703) 305-2730.
#58-3198-1-006
TABLE OF CONTENTS
FOREWORD
NIC FOOD PACKAGE TECHNICAL PAPERS
Technical Butt fl
What evidence exists to support or contraindlcate the continuance of the
five current target nutrients (high quality protein, Iron, calcium and
vitamins A and C) In the NIC food packages?
Technical Paper II
What, If any, changes In or additions (e.g., thiamin, riboflavin or
zinc) to the NIC target nutrients should be considered and why?
Technical Paper f?
What evidence exists to support or contraindlcate the current WIC food
packages as nutrient dense and bioavailable sources of the recommended
WIC target nutrients?
Technical Paper *4
What, If any, foods should be Introduced as nutrient-dense and
bioavailable sources of the recommended WIC target nutrients and why?
Technical Paper *$
Do the current maximum monthly allowances of WIC foods appropriately
address the nutritional needs of the six different participant groups
for whoa they were designed?
Technical Paper f$
Are there valid reasons for limiting the dietary Intakes of total fat,
saturated fat (SFA) and cholesterol by the WIC target population and
why?
Technical Paper 17
Are there valid reasons for limiting the dietary Intakes of sodium by
the WIC target population and why?
Technical Paper #8
Are there valid reasons for limiting the dietary Intakes of artificial
colors and flavors by the WIC target population and why?
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Technical Paper #9
Are there valid reasons for limiting the dietary Intakes of artificial
sweeteners and natural sugars by the ML target population and why?
Technical Piper IIP.
Are there valid reasons to recommend that dietary fiber be targeted In
the MIC food packages?
Technical Paper #11
To what extent IS lactose Intolerance a significant problem among
different ethnic groups, e.g., Asians, Hlspanlcs, American Indians and
Alaskan Natives?
LIST OF TABLES
TjcJttlCj] Paper fj
Table 1.1. Prevalence of Short Stature In the U.S. 1n 1988 according
to population subgroup and age of low-Income children
aged 5 and younger (taken from Healthy People 2000, U.S.
Department of Health and Human Services, Publication #
017-001-00474, 1990)
Table 1.2. Prevalence of Iron deficiency and anemia among children
aged 1 to 4 and women of chlldbearlng age (taken from
Healthy People 2000, U.S. Department of Health and Human
Services, Publication #017-001-00474, 1990)
Table I.3a. Mean percentage protein from different food groups within
the WIC food packages for women
Table I.3b. Mean percentage protein from different food groups within
the WIC food packages for Infants and children
Table 1.4. Mean percentage RDA of WIC target nutrients supplied from
legumes and eggs In the pregnant women's food packages
Table 1.5. Mean percentage RDA of WIC target nutrients supplied from
eggs In the postpartum teen and women food packages
Table 1.6. Mean percentage RDA of WIC target nutrients supplied from
legumes and eggs In the breastfeeding women's food
packages (first 6 mo)
Table 1.7. Mean percentage RDA of WIC target nutrients supplied from
legumes .and eggs In the breastfeeding women's food
packages (second 6 mo)
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Table 1.8.
Table 1.9.
Mean percentage RDA of WIC target nutrients supplied from
legumes and eggs In ths children's (1-5 years) food
packages
Summary and schematic representation of findings from the
review of published reports on dietary Intakes of current
target nutrients for pregnant and dictating women,
Infants and children
Technical Paper
Table II.1.
SI
Comparison of nutrient composition of human milk, Iron
fortified formula and whole cow milk
Technical EMM f?
Table III.l.
Table III.la.
Table III.1-2.
Table III.la-2.
Table III.2.
Index of Nutrient Quality (INQ) for current target
nutrients In approved NIC Packages for Infants and
Children
Index of Nutrient Quality (INQ) for current target
nutrients In approved WIC packages for Pregnant,
Breastfeeding, and Postpartum (non-breastfeeding) Women
Percent RDA of target nutrients provided by current
approved packages for Infants and children
Percent RDA of target nutrients provided by current
approved packages for pregnant, breastfeeding and
postpartum women
Factors Influencing the bloavallability of nutrients
targeted in WIC Food Packages
Technical Paper #4
Table IV.la.
Table IV.lb.
Table IV.2a.
Table IV.2b.
Table IV.3.
Index of Nutrient Quality (INQ) for proposed additional
target nutrients In WIC packages for Infants and children
Index of Nutrient Quality (INQ) for proposed additional
target nutrients In WIC packages for pregnant,
breastfeeding, and postpartum (non-breastfeeding) women
Percent RDA of proposed target nutrients provided by
current approved packages for Infants and children
Percent RDA of proposed target nutrients provided by
current approved packages for pregnant, breastfeeding and
postpartum women
INQ of foods proposed as additions to current WIC package
for proposed target nutrients
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158-3198-1-006
Table IV.4.
Table IV.S.
Table IV.6.
Percent RI)A provided by 'standard' servings of foods
proposed for addition to WIC package
Factors affecting the bloavallability of nutrients
proposed is targeted nutrients for WIC food packages
INQ for current target nutrient for foods proposed as
additions to WIC packages
Technical PlP?r *$
Table V.l.
Table V.2.
Table V.3.
Table V.4.
Table V.5.
Table V.6.
Table V.7.
Table V.8.
Table V.9.
Table V.10.
Table V.ll.
Table V.12.
Table V.13.
Percent )f RDA provided per day In Food Package I (for
Infants 0-3 aos. of age)
Percent of RDA provided per day In Food Package II (for
Infants 4-12 BOS. of age)
Mean percent of RDA provided per day In Food Package IV
(for children 1-5 yrs,)
Percent of RDA provided per day In Food Package V with a
highly fortified cereal for pregnant women (12-50 yrs.)
Percent of RDA provided per day In Food Package I for
pregnant women (12-50 yrs) not Including a highly
fortified cereal
Mean percent of RDA provided per day In Food Package V
(for breastfeeding women during the first 6 aos.)
Mean percent of RDA provided per day In Food Package V
(for breastfeeding women during the second 6 aos.)
Mean percent of RDA provided per day In Food Package VI
(for postpartum non-breastfeeding women 19-24 yrs.)
Mean percent of RDA provided per day In Food Package VI
(for post parti* non-breastfeeding teens 11-14 yrs.)
Vitamin C, B6 and folate contents of fruit juices allowed
by the WIC Program
Percentage Increases In recommended Intakes for women
during pregnancy and lactation
Incremental Increase In nutrient density (per 1000 kcal)
of additional foods needed to furnish recommended levels
of nutrients for pregnant and lactatlng women at
recommended energy Intakes
Indices of nutritional quality of Food Package IV with
various food Items for children aged 1 to 3 years
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Table V.14.
Technical Paper
Table VI.1.
Table VI.2.
Table VI.3.
Table Vi.4.
Table VI.5.
Indices of nutritional quality of Food Package IV with
various food Items for children aged 4 to 5 years
IS
Technical Paper
Table VII.1.
Table VII.2.
Table VII.3.
Table VII.4.
Table VII.5.
WIC Food Packages: Contribution to energy, percent
calories froa fat and cholesterol
Estimated dally nutrient content of WIC Food Packages
with 2 dozen eggs, with 1 dozen eggs and with no eggs
Nutrient content of cheese In WIC Food Packages
Nutrient content of brand name low fat/low cholesterol
cheese
Nutrient content per ounce of reduced fat cheese and
processed cheese food
*1
Technical Paper
No tables
Technical Paper
Table IX.1.
Estimated sodium minimum requirements of health persons
In the 10th revision of the Recommended Dietary
Allowances
Estimates of sodium Intake In U.S. Infants and children
and reproductive-aged women
Urinary sodium excretion (mean) data for women 20-49
years old, from the 6 U.S. INTERSALT Centers
Caloric (% of RDA) and Sodium (X of estimated minimum
requirement (ENR))contributed by typical NIC food
packages
Proportionate contributions of commodity groups to sodium
Intake In Infants, toddlers, and adult males, estimated
from the FDA Total Diet Study, 1981/82.
Jfi
IS
Total sugars and sweets Intake by women and children:
Mean Intakes per Individual per day, 4 nonconsecutlve
days
Technical Paper fio
Table X.l. Soluble and Insoluble fiber components In total dietary
fiber
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Table X.2. Primary sources of fiber In the UIC food packages
Technical Paper »11
Table XI.1. Estimates of the prevalence of lactose Intolerance and
symptoms In U.S. populations (adapted from Scrimshaw and
Hurray, American Journal of Clinical Nutrition 1988;1086-
1098)
Table XI.2a.
Table XI.2b.
Table XI.2c.
Energy, protein, carbohydrate, fat, cholesterol and
dietary fiber* and sodium content of possible
alternatives to dairy sources of calcium
Calcium, iron, magnesium, and zinc content of possible
alternatives to dairy sources of calcium
Vitamin content of possible alternatives to dairy sources
of calcium
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FOREWORD
Special Supplemental Food Program for Women, Infants and Children (WIC):
Review of Food Packages (Cooperative Agreement #58-3198-1-006)
The Special Supplemental Food Program for Women, Infants and Children,
also known as MIC, provides eligible Individuals during vulnerable periods In
the life cycle with supplemental foods, nutrition education and referral to
adjunct health services. In 1986, It was estimated that over 7 million
Individuals in the U.S. were eligible based on health, Income and nutritional
risk criteria. The WIC eligible population consists of 64% children aged 1 to
5 years, 16% Infants aged birth to 1 year, 10% pregnant women and 10%
breastfeeding and postpartum women combined. In 1986, the WIC program served
approximately 46% of the eligible population: greater than 90% of Infants, 48%
of all women and 35% of children (Batten et al, 1990).
Currently, the WIC Program provides six different monthly packages: two
for Infants, one for children 1 to 5 years, one for pregnant and breast-feeding
women, one for nonbreastfeedlng postpartum women, and one for women
and children with special dietary needs. The six packages were designed on
the basis of knowledge available In 1980 on developmental needs and special
nutritional requirements of vulnerable groups to provide those nutrients
likely to be limiting In the diets of the eligible population. The nutrients
currently targeted are protein, Iron, calcium and vitamins A I C. With
advances In knowledge of the nutritional needs of the targeted population and
with changing dietary patterns, an assessment of how well current WIC food
packages are meeting program objectives was needed and accordingly, Congress
mandated In section 123(C) of Public Law 101-147 (The Child Nutrition and WIC
13
#58-3198-1-006
Reauthorlzatlon Act of 1989), that the USDA conduct a review of the
appropriateness of MIC food packages and that a final report be provided to
Congress by June, 1992.
This package of documents (Foreword and 11 Technical Papers) were
written as part of the review and analysis conducted by Penn State
nutritionists In response to RFA number FNS 91-006JMP, a request from USDA to
evaluate the appropriateness of current WIC food packages In meeting the
nutritional needs of the eligible population [Federal Register Vol. 55, No.
206, Wednesday, October 24, 1990, pp. 42856-42860 (Appendix A)]. From the
start of this review (February 15, 1991) It was recognized that there were
many complex and interrelated factors that Influence food and nutrient Intakes
and nutritional and health status, so we assembled a team of experienced
professionals with diverse expertise. An evaluation strategy was developed
for a critical and scholarly evaluation of current Food Package and was
designed to address the multlfaceted nature of the Issues within the narrow
tlmeframe available for such an evaluation. The professional review team
consisted of Drs. H.A. Guthrle, S.K. Kumanylka, M.F. Plcclano and H.S. Wright.
Brief biographical sketches of the review team are provided in Appendix B.
In designing this review that ultimately culminated In the development
of 11 technical papers, written by four different nutrition professionals,
presenting current knowledge on diverse Issues related to the nutritional
Impact of WIC Food Packages, an operational scheme was formulated to Insure
consistency of presentation and to capitalize on the wide expertise of the
review team (Appendix B). Each member of the team held primary responsibility
for several Issues. The Issue leader first reviewed the relevant literature.
In most cases computerized literature searches were done on Hedllne. using
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both the 1983 to present data base (containing over 2.4 million references)
and the 1966 to present (containing over 6.5 aliiIon references). In a few
cases AGRZCOLA, 1979 to present also was searched. This data base contains
over 1.5 milIon references. Relevant literature was secured, analyzed and
evaluated and used to develop technical papers. The tew as a whole then
discussed the content of each review for completeness and balance prior to the
first draft of each technical paper. Issue leaders summarized their findings
according to the kinds of evidence, the quality and strength of the evidence
and 1f Indicated, a risk-benefit analysis of Implementing possible changes.
This approach Is described in detail elsewhere (Ahrens, 1979) and Is designed
to maintain objectivity In review of Issues.
Seven Issues were Initially Identified In the October 24, 1990 Federal
Register and a technical paper on each was Initially proposed (January 9,
1991). These follow:
ISSUE
1. Evidence to support or contradict the continuance of
the five current target nutrients
2. Evidence to support or contradict the current NIC
packages as nutrient-dense and bloavallable sources of
target nutrients
3. Evidence to support six participant groups or the need
for revision of these groups
4. Evidence to support categorical tailoring of MIC food
packages for subgroups of participants
111
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158-3198-1-006
5. Evidence to support need and sufficient flexibility 1n
current MIC food packages to permit 1 dividual
tailoring for participants
€. Evidence to support or refute the need to Halt the
contents of specific food components In food packages
7. Evidence to support or refute the need to revise
current criteria for food substitutions to accommodate
cultural 1eating patterns
DEVELOPMENT OF TECHNICAL PAPERS
Following the review and analysis (Comment Analysis Is presented 1n
Appendix C) of consents submitted In reply to the Federal Register VOIUM 55
No. 206, Wednesday, October 24, 1990 the Cooperator proposed the following
topics for technical papers on March 29, 1991.
1. What evidence exists to support or contralndlcate the continuance
of the five current target nutrients (high quality protein, Iron,
calcium, and vitamins A and C) In the WIC food packages?
2. What, if any, changes In or additions (e.g. thlaaln, rlboflavln,
or zinc) to the WIC target nutrients should be considered and why?
3. What evidence supports or contralndlcates current WIC food
packages as nutrient dense and bloavallable sources of nutrients?
4. What, If any, foods should be Introduced as nutrient-dense and
bloavallable sources of recommended nutrients?
5. Participants are currently divided Into six groups for the purpose
of prescribing food packages and maximum monthly allotments of
foods within each package has been established. What evidence
1v
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158-3198-1-006
exists to support these six groups, or to Indicate the need for
revisions of any of these groups?
6. What evidence exists to support the naxlMn Monthly allowances for
food within the food package for each of the six groups, or to
Indicate the need for revisions If any of these maximum
allowances?
7. What guidelines should the Department use In approving state
agency proposals for categorically tailored food packages?
8. HIthin the question, "What guidelines should the Department use In
approving state agency proposals for categorically tailored food
packages?" A secondary Issue Is the Identification of population
groups for categorical tailoring.
9. What evidence exists to Indicate that current WIC food packages
provide sufficient flexibility for such Individual tailoring, or
to Indicate that the design of any of the food packages should be
changed to more fully accommodate or restrict Individual
tailoring?
10. Is there any evidence to support or refute the need to establish
regulatory limits on the amount of sugar and other substances
(fat, sodium, cholesterol or artificial flavors, colors or
sweeteners) which may be contained In the WIC package?
11. State agencies have the authority, with Federal approval, to make
food substitutions In the WIC food packages to accommodate
cultural eating patterns. Currently, any cultural food substitute
must be comparable to the traditional WIC food counterpart In
cost, availability, and nutritional value (at least with respect
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to the WIC target nutrients). Whit, If any, revisions should be
made to the criteria to which State agencies must adhere In making
such substitutions, and why?
12. Issue number was not one of the Issues outlined In the Federal
Register. Rather, this Issue and any sub Issues derived will
cover points that emerge during detailed consideration of Federal
Register Issues (246.1 through 7). These points may be Issues
that are not clearly subsumed under those outlined In the Federal
Register or points of overlap or synthesis among the Federal
Register Issues. Although overlap with other Federal Register
Issues will be addressed when appropriate In Technical Papers 1
through 11, Technical Paper No. 12 will provide an opportunity to
look across all Issues at once and Identify any apparent conflicts
that would arrive from recommendations with a given area.
On April 10, 1991,the Cooperator received a revised list for the
proposed technical papers fro.ii FNS staff entitled, Guidelines for Minimum
Content of Proposed Technical Papers (see attached Appendix D). On June 4,
1991, the WIC Food Package Technical Papers List sent to the Ad Hoc Committee
of the National Advisory Council Indicated that the topics were revised once
■ore (see attached Appendix E). On June 18, 1991, after the meeting of this
Ad Hflc. Working Group (June 18, 1991) the final list of WIC Food Package
Technical Papers was developed (see attached Appendix F).
Our approach to evaluating whether there was scientific evidence to
support or refute continuance of the current target nutrients and if, and to
what extent, modifications were needed or Indicated In Food Packages was based
on the decision making process used by the Expert Panel On National
v1
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Nutritional Monitoring In categorizing food components by priority monitoring
status (LSRO, 1989). In this process, first nutrient Intake data are
evaluated and classified as being high or low relative to Recommended Dietary
Allowances for particular age and physiological groups. The Recommended
Dietary Allowances (RDA) have changed from 1980 (9th ed) to 1989 (10th ed) and
the majority of the dietary survey data cited In various review papers used
the 1980 edition of the RDAs. For purposes of comparison, 1980 and 1989 RDAs
are presented In Appendix G. In some cases the RDAs have decreased while in
others, they have Increased. Reevaluatlon of dietary survey data collected
after 1980 and prior to 1989 using the latest RDAs will not make the dietary
data more accurate nor more reliable (see Chapter 2 of LSRO report, 1989).
Furthermore, an Intake below any RDA merely Identifies a risk of inadequate
Intake and dietary data were not the only criteria used for assessing whether
or not nutrients should be targeted and/or If Intake levels of such nutrients
represented a problem for the physiological groups served by WIC. Thus In
review papers, various lines of scientific evidence (epldemlologlcal, animal
and human studies) also were evaluated for existence of linkages between low
or high nutrient Intakes and adverse or beneficial nutrition and/or health
consequences. The quality and strength of the scientific evidence was used to
confirm or deny whether potential problem nutrients Identified from dietary
studies should be targeted or whether modifications In current Food Packages
were Indicated.
v11
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References
Ahrens, E.H. 1979. Introduction to Symposium on The Evidence Relating Six
Dietary Factors to the Nation's Health. Consensus Statements. Am. J. Clln.
Nutr. 32:26, 27-31.
Institute of Ned1c1ne/Food and Nutrition Board. 1980 and 1989. Recommended
Dietary Allowances. 9th and 10th Eds. National Academy of Sciences,
Washington, DC.
LSRO, FASEB: Nutritional Monitoring In the United States - An update on
Nutrition Monitoring. 1989. Prepared for the USDA and USDHHS. DHHS
publication number (PHS) 89-1255. Public Health Service. U.S. Government
Printing Office, Washington, DC.
vlll
APPENDIX A
FEDERAL REGISTER
VOL. 55, No. 206
WEDNESDAY, OCTOBER 24, 1990
io
46285
Corrections Federal Register
Vol. 55. No. 213
Friday. November 2. 1990
This tadion of the FEDERAL REGISTER
contains editorial correction of provtouiiy
published Presidential, Rule, Proposed
Rule, and Notice document*. These
corrocliom are prepared by the Office of
the Federal Register. Agency prepared
corrections are issued as signed
documents and appear in the appropriate
documant categories elsewhere in the
DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
7CFR Part 246
Specie I Supplemental Food Program
for Womtn, Infants and Children
(WlCk Review of Food Packages
Correction
In proposed rule document 90-25129
beginning on page 42856. in the Issue of
Wednesday. October 24.199a make the
following corrections:
1. On page 42857, in the third column,
in the first full paragraph, in the second
line from the bottom, "instruction"
should read "introduction".
2. On page 42858. in the first column,
in the second full paragraph, in the first
line. "Specially" should read
"Specifically": and in the 10th line from
the bottom of the page, after "to" insert
"the".
3. On the same page*, in the second
column, in the second full paragraph, in
the fifth lino, after "or insert "a".
4. On the same page, in the third
column, in the paragraph numbered 2, in
the fifth and sixth lines, remove the r4j-.
phrase"(i.e.. high nutrient to calorie sate)
and bioavailable sources"; and the
paragraph numbered 3. in the third,
fourth and fifth lines, remove the phrase
"and maximum monthly allotments of
foods within each packages."
6 On page 42659, in footnote 2. in the
second line. "100 milligrams" should
read "10 milligrams".
EPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
No,tOF-OM7]
p\; Filing of Food Additive
190-24564 beginning
issue of Thursday.
the following
Correction
In notice d
on page 42272, in
October 16199a
correction:
On page 42273. in the. first column,
under "aumjatfWTAiryWoiiMATIOH:
in the 10th line, "to 265">should read
"to 2*4".
DEPARTMENT OF THE I
Bureau of Land Management
[il>M3-tO-4214-11?OMH2a03
Proposed Continuation of"
Idaho
Correction
In notice document 90-11464 beginning
on page 20537 in the issue/ofThursday.
May 17.1960, make the following
corrections:
1. On page 20537. fa/the second
column, in the 24th line. ~W*4WKE
W5V4" Should reaiTVVV4SWK
SEKSEVt"
2. On the saro/page, in the i
column, in theisth and 30th lines,
"Kiwanas" was misspelled.
3. On the/wine page, in the same
column, in .the 21st Una from the bottom.
"EttNEttSWKSEW should read
"EVaNEfcSWVfcSEW.
4. Or/the same page, in the same
column, in the fifth line from the bottom.
delete the second comma (.).
5/On the same page, in the third
column, in the 33rd line, "SturgU" was
sfusspelled.
DEPARTMENT OF THE INTERIOR
Bureau of Land Managi
[NV-930-00-4212-14; IMS
Realty Action; N
Public Lands In
Sato of
County. NV
Correction
In notice d
appearing on
Friday. Sep
following
On
in the
read
ent 90-21629
ige 3797a in the issue of
14.199a make the
oar
'. in the second column.
I line. "SEViNEVs" should
JKNEK".
7
»ARTMENT OF LABOR
' Employment and Training
Administration
Lsbor Surplus Ares Classifications
Under Executive Orders 12073 and
10582; Annual List of Labor Surplus
Arena
'ion
i notice document 90-24751 beginning
142509. in the issue of Friday.
• ia 199a make the following
1. Orhpage 42514. to the second
column, ha the 44th line after "Saginaw
City" insert "Saginaw Township".
2. On pagV.42515, in the fifth column,
in the 13thline, "Nobel" should read
"Noble".
6, On the sameNpege. in the sixth
column, in the l9uVJine. "Nobel" should
read "Noble".
4. On page 42517, irVthe third column,
in the 14th line from theJasL "Tutus"
should read "Titus".
5. On the seme page, brihe fifth
column, under "WASHINGTON", in the
third line. "Beton" should rasa
"Benton".
a On the seme page, in the sixt!
column, in the 27th Una from the bottom.
"Beton" should read "Benton".
n
42856
Proposed Rules Federal Register
Vol. 65. No. 206
Wednesday. October 24.1990
This section of the FEDERAL REGISTER
contains notK.es lo the public Of ttw
proposed issuance of rules and
regulations. The purpose of these notices
is to give interested persons on
opportunity to participate in the rule
making prior to the adoption of the final
rules.
DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
7CFRPart246
Special Supplemental Food Program
for Woman, Infante and ChNdron
(WIC); Review of Food Packages
AGENCY: Food and Nutrition Service,
USDA.
ACTION: Notice of intent to conduct a
review and solicit comments.
SUMMARY: In accordance with the
mandate of section 123(c) of the Child
Nutrition and WIC Reauthorization Act
of 1989 (Pub. L101-147). the Department
announces its intent to conduct a review
of the appropriateness of the foods
provided by the Special Supplemental
Food Program for Women. Infants and
Children (WIC). Directors of WIC Stale
and local agencies and other individuals
with expertise in the fields of nutrition
and public health, as well as other
interested parties, are encouraged to
comment on issues proposed for
consideration by the Department and to
suggest additional issues for
consideration within the scope of this
review.
DATES: TO be assured of consideration,
comments must be received on or before
December 24. MO,
ADDRESSU: Comments should be sent
to Ronald). Vogel. Director.
Supplemental Food Programs Division.
Food and Nutrition Service. USDA. 3101
Psrk Center Drive, room 1017,
Alexandria. Virginia 22302. (703) 756-
3746. Comments on this notice should be
clearly labeled "Food Packages Review
Notice" and should identify the specific
issue(s) addressed. All written
comments will be available for public
inspection during regular business hours
(8:30 a.m. to S pjn.. Monday through
Friday) at the office of the Food and
Nutrition Service. 3101 Park Canter
Drive. Alexandria. Virginia 22302.
FOR FURTHER INFORMATION CONTACT:
Philip K. Cohen. Supplemental Food
Programs Division. Food and Nutrition
Service. USDA. 3101 Park Center Drive,
room 1017. Alexandria. Virginia 22302,
(703) 756-3730.
SUPPLEMENTARY INFORMATION: This
Notice has been reviewed under
Executive Order 12201 and has been
classified not major. This Notice will not
have an annual effect on the economy of
$100 million or more, nor will it cause a
major increase in costs or prices for
consumers, individual industries.
Federal. State or local government
agencies, or geographic regions. This
action will not have significant adverse
effects on competition, employment,
investment, productivity, innovation, or
on the ability of U.S.-based enterprises
to compete with foreign-based
enterprises in domestic or export
markets.
The Notice imposes no new reporting
or recordkaeping provisions that are
subject to OMB review in accordance
with the Paperwork Reduction Act of
I960 (44 US.C 3507).
This action is not a rule as defined by
the Regulatory Flexibility Act (5 U.S.C
601-612) and thus is exempt from the
provisions of the Act
This program is listed in the Catalog
of Federal Domestic Assistance
Programs under No. 10.557 and is
subject to the provisions of Executive
Order 12372. which requires
intergovernmental consultation with
State and local officials (7 CFR part
3015. subpart V. and final rule-related
notice published June 24.1963 (48 FR
29114)).
Background
The authorizing legislation for the
WIC Program, section 17 of the Child
Nutrition Act (CNA) of 1966, as
amended, established the program to
provide supplemental foods and
nutrition education to low-income
pregnant breastfeeding and postpartum
women, infants and children up to age 5
who are at nutritional risk. The Program
also serves as an adjunct to health care
during critical times of growth and
development to prevent the occurrence
of health problems and to improve the
health status of participants.
The CNA clearly established the WIC
Program as "supplemental" in nature,
that is. the food packages issued to
various categories of participants are
not intended to provide a complete diet
but are designed to complement
additional wholesome foods needed for
a balanced diet. The Department
administers a variety of food assistance
programs which are designed to work
together to provide a more nutritious
diet to the Nation's low-income persons.
Low-income families can. and frequently
do. receive benefits from more than one
of these Programs. The lergest of these
programs, the Food Stamp Program,
provides general food assistance in the
form of coupons which are used to
increase the food-buying power of low-income
individuals and families. Other
programs are designed with a more
limited population in mind. For example,
the National School Lunch Program
provides meals to children in school and
the Child and Adult Care Food Program
provides meals to persons in child and
adult care centers and family day care
homes. WIC Program benefits are
intended to meet the special nutritional
needs of a very specific population. The
nutrition education provided by WIC
assists participants in choosing foods
which, together with the supplemental
foods contained in the packages, meet
their total dietary needs.
Section 17(b)(l4) of the CNA defines
"supplemental foods" as "those foods
containing nutrients determined by
nutritional research to be lacking in the
diets of pregnant breastfeeding, and
postpartum women, infants- and
children, as prescribed by the
Secretary." The legislation provides
substantial latitude to the Department in
designing WIC food packages and
places the obligation on the Department
to prescribe foods which successfully
target those nutrients critical to growth
and development and typically lacking
in the diets or the WIC-eligible
Eopulation. Historically, the Department
ss based its prescriptions of WIC foods
on sound nutritional research and input
from State and local agencies, the health
and scientific communities, industry end
the general public. Further, these
prescriptions have been developed with
regard to a set of fundamental principles
which are discussed below. Food
package requirements appear in the
WIC Program regulations at 1246.10(c).
The current food packages (Appendix)
were established through program
regulations in 1960 (45 FR 74854
(November 12. i960)). To better meet the
nutritional needs Mparticipants, the
1960 rulemaking created six different
monthly packs*m two for infants, one
l*
Federal Register / Vol. 65. No. 206 / Wednesday, October 24. 1890 / Proposed Rules 42657
for children and women with special
dietary needs, one for children 1 to 5
yeurs ofsge. one for pregnant and
breastfeeding women, and one for
nonbreastfesding postpartum women.
These packages were designed to follow
infants' developmental needs and
current pediatric feeding
recommendations, complement the
eating patterns of preschool children,
end supplement the special
requirements of pregnant and
breastfeeding women.
Most importantly, the packages were
developed to provide foods that are rich
sources of the nutrients that tend to be
lacking in the diets of the WIC-eligible
population. The original legislation for
the WIC Program specifically identified
protein, iron, calcium and vitamins A
and Cas the target nutrients (Section 0
of Pub. L 62-133. September 26.1972). ■
However, subsequent legislation deleted
the references to specific tarjet
nutrients and instead directed the
Department to prescribe the appropriate
nutrients (Section 3 of Pub. L 95-637,
November 10.1976). The Department
determined, through an examination of
nutritional research prior to the 1980
rulemaking. that the original target
nutrients continued to be lacking among
the WIC-eligible population. Thus
protein, iron, calcium and vitamins A
and C were again proposed for public
comment (44 FR 69254 (November 30.
1979)). and were retained in the final
rulemaking. Given the supplemental
nature of the WIC Program, the food
packages were not intended to supply
100 percent of the Recommended Daily
Allowances (RDA) of each specified
nutrient. Participants are expected to
obtain a portion of the RDA from other
food sources. However,lhe packages do
provide categories of foods which en
high in one or more of the target
nutrients and are capable of providing a
substantial portion, and in some
instances the entire amount, of the
RDAs for the targeted nutrients.
Section 17(f)(12) of the CNA directs
the Department to assure that to the
extent possible, the fat sugar and salt
content of WIC foods is appropriate.
Several changes made to the WIC food
packages in the 1980 rulemaking
responded specifically to this mandate.
For example, the Department
established a limit on the amount of
sugar permitted in WIC cereals and on
the amount of cheese that can be issued,
in part to moderate the salt content of
the packages. With regard to the issue of
fat content the packages are designed to
maintain a wide range of variability in
fat levels within the food packages,
depending on the particular foods
prescribed. Individual tailoring enables
Stdie and local agencies to adapt food
packages to the individual participant's
needs for higher or lower fat levels, as
well as to limit salt and sugar content as
eppropriate.
Aside from considerations which are
specifieu in legislation, a prime
consideration in food package design is
cost. The Department is committed to
serving as many eligible persons as
possible while maintaining the
nutritional integrity of the program.
Efficiency in providing nutrients is
important since increases in the total
cost of the food packages reduce the
number of participants served by the
program. Thus, cost is an important
consideration in the selection of WIC
foods, and the packages are designed to
encourage further cost control by
permitting State and local agencies the
flexibility to specify lower-cod food
brands, types and container sizes within
regulatory parameters.
State and local agencies are permitted
flexibility in other aspects of the food
packages as well. The quantities in the
[lockages are expressed as maximum
cvels which must be available to
participants as needed. However. State
and local agencies have the authority to
tailor quantities according to the needs
of individual participant or categories
of participants when based on a sound
nutritional rationale. These tailoring
provisions, established in program
regulations (fi 246.10) and supplemented
by FNS Instruction 604-1. are designed
to permit Slate agencies to implement
their own nutrition policies and
philosophies within the parameters of
the food packages. Section 17(0(13) of
the CNA and regulations at 1246.10(e)
also give the Department the authority
to approve substitution of foods by State
agencies to allow for different cultural
eating patterns under certain
circumstances. State agencies must
demonstrate that the substitute foods
are nutritionally equivalent to foods
prescribed by the Department Pursuant
to section 212(a) of the Hunger
Prevention Act of 1968 (Pub. L1C9-435).
which amended section 17(b) of the
CNA WIC regulations also give State
agencies even greater flexibility to adapt
food packages to the circumstances of
homeless persons (1248.10(e)(3)).
In addition, the food packages are
designed with regard to a numberof
practical considerations which reflect
participant and program needs. The
WIC foods should be readily available
commercially, offer variety and
versatility in preparation to participants.
and have broad appeal The foods
should also permit daily consumption by
an individual over a month's time. The
WIC food package la an individual food
prescription which, in order to have the
full effect in improving nutritional
status, must be consumed by the
participant and not other family
members. Further, the foods should
generally be of domestic origin with
minimal processing, since the WIC
Program, along with other food
assistance programs administered by
the Department participates in a
longstanding partnership with American
agriculture and endeavors to provide
foods which support the nation's
farming industry. Lastly, the packages
should be administratively manageable
for State and local agencies and
vendors. That is, they should be clearly
describable on food Instruments and
easily understood by both participants
and vendors.
The Department acknowledges die
continuing advances in nutritional
research since the current food packages
were established in 1980. Recommended
dietary practices are constantly evolving
in response to new knowledge and may
hold significant implications for the WIC
Program. Food technology has also
advanced substantially over the last
decade, resulting in a large number of
new products, forms and container
sizes. Many of these new products are
specially fortified or formulated to
address the needs of a special
population, such as persons with
allergies. The Department continues to
receive requests to modify the current
food packages and permit greater (
substitution of foods or thiijiit 'L^L.'^
of additional foods. >fVtrodu«*iOn
Mandated Food Package Review
The appropriateness of WIC foods
continues to be an issue of major
interest to the WIC community and to
other nutrition and health professionals
and representatives of the food industry.
Accordingly, Congress mandated, in
section 123(c) of Public Law 101-147. the
Child Nutrition and WIC
Reauthorization Act of 1969. that the
Department conduct a review of the
appropriateness of WIC food packages.
The legislation directs the Department
to examine the nu trient density of foods:
to consider how effectively protein,
calcium and iron are provided to WIC
Program participants; and to consider
the extent to which nutrients, for which
program participants are most
vulnerable to deficiencies, such as iron.
thiamln. riboflavin. vitamin A. and zinc
are effectively provided to participants.
The Act mandates that a final report be
provided to Congress by June 80.1992.
/?
42858 Federal Register / Vol. 55, No. 206 / Wednesday. October 24. 1990 / Proposed Rules
Review Procedure
The Department believes that the
consideration of such important and
complex issues will be best
accomplished through public
participation and is therefore soliciting
input from all segments of the WIC
community, as well as other informed,
concerned members of the public.
Further, the Department wishes to
ensure that its review provides for the
open and equitable consideration of
these issues. The procedure which the
Department has established for
conducting its review is designed to
provide the broadest possible base for
public input, to include access to
technical expertise from independent,
credible entities, and to permit
consideration of pertinent issues by a
knowledgeable forum which is broadly
,e ,* representative of the WIC community.
ywwgtpMlall^ the Department plans to
enlist independent, technical experts to
review comments submitted in response
to this Notice and to develop technical
papers summarizing and assessing this
input for the Department's
consideration. These papers will be
presented for consideration to the
National Advisory Council on Maternal.
Infant and Fetal Nutrition (NAC).
authorized by section 17(k) of the CNA.
to consider issues relevant to the WIC
Program and to make recommendations
to the President and Congress. The NAC
consists of 24 members (including State
and local health officials and WIC
Program administrators from a variety
of agencies, physicians, program
participants and a representative of the
food industry) who share a common
interest in and knowledge of the WIC
Program. The Council's consideration of
these issues will be included in the
Department's report to Congress. This
report, in turn", may influence future
legislative action by Congress with
regard to the WIC Program and/or
regulatory action by the Department.
Any program regulations issued by the
Department as a result of this review
would be published as proposals for
public comment prior to promulgation of
a final rulemaking.
Review Considerations/Parameters
Given the criticalimportance of food
package content ^nutritional impact of
the WIC Program, commenters should
carefully weigh the potential effects of
their recommendations on the overall
integrity of the packages. Responses to
this notice should be developed with
serious regard to the d'-tary needs of
the WIC-eligible popu: tion. the
supplemental nature of the program and
the critical impact of cost of program
services. In addition, the Department
encourages commenters to submit
suggestions with the following
considerations in mind: (1) Cultural and
ethnic food preferences; (2) commercial
availability, variety and appeal of foods;
(3) versatility in food preparation: (4)
feasibility of apportionment into daily
servings for an individual over a
month's time; (5) domestic origin of
foods: (6) State and local agency
flexibility; and (7) administrative
manageability.
The principler outlined above (and
discussed elsewhere in this Notice)
constitute a framework upon which WIC
food packages have been developed.
The Department encourages
commenters to present their
recommendations in the context of their
potential impact on.the affected food
package(s) and their responsiveness to
these principles or to alternate
principles which the commenter
believes should be considered.
Further, comments should include
Justification in terms of current
nutritional research. Simple expressions
of opinion or statements of position,
without benefits ojjclcarly stated
rationale based on scientific evidence,
would be of little use to the Department
in the consideration of such complex
issues.
Review Issues
The Department carefully considered
how best to present the issues in this
Notice. Attempts to provide background
information specific to each issue
inevitably resulted in issue descriptions
which could bias responses. The
Department believes that this review
will benefit from the broadest possible
scope of public input with minimal
Departmental direction. Therefore, the
following issues proposed for
consideration arc broadly stated
without Departmental comment. Within
the context of these broad issues,
commenters are encouraged to state
their responses as specifically as
possible. Commenters may address
additional issues which are within the
scope of this review. Each of the issues
presented below is numbered. In order
to ensure that comments receive full and
appropriate consideration, commenters
are asked to precede each comment
with the number of the issue to which it
pertains, and to clearly define issues
they have chosen to address which are
not listed in this Notice.
1. What evidence exists to support or
contraindicate the continuance of the
five current target nutrients (high-quality
protein, iron, calcium, and vitamins A
and C) in the WIC food packages? What
if any. changes in or additions (eg..
thiamin. ribofla vin. or zinc) to the WIC
target nutrients should be considered
and why?
2. What evidence exists to support or
contraindicate the current WIC food
packages as nutrient-dense (i.e., high
nutrient to calorie 'alichwOmfZmimkim
MM II 1 ill III I i
•wii) and bioavailable sources (i.e..
readily absorbed and utilized by the
body) of the recommended WIC target
nutrients? What if any. foods should be
introduced as nutrient-dense and
bioavailable sources of the
recommended WIC target nutrients and
why?
3. Participants are currently divided
into six groups for the purpose of
prescribing food packages, and
maximum monthly allotments of foods
i i iili tWtmmmmUmdt within each
package have been established. What
evidence exists to support these abt
groups, or to indicate the need for
revisions of any of these groups? What
evidence exists to support the maximum
monthly allowances for foods within the
food package for each of the six groups,
or to indicate the need for revisions of
any of these maximum allowances?
4. State agencies have the authority,
with Federal approval based on a
nutrition rationale, to categorically tailor
WIC food packages to better address
the nutritional needs of subgroups of
Srtidpants (e.g.. reduced quantities of
ids in WIC food packages prescribed
for 1 and 2 year old children compared
to their older counterparts). What
guidelines should the Department use in
approving State agency proposals for
categorically tailored food packages?
5. In addition. State agencies have the
authority to tailor WIC food packages to
better meet the nutritional needs of
individual participants. For example, the
amount of sugar, fat sodium, and
cholesterol provided to a specific
participant by the food package can be
modified through nutrition tailoring.
What evidence exists to indicate that
current WIC food packages provide
sufficient flexibility for such individual
tailoring, or to indicate that the design of
any of the food packages should be
changed to more fully accommodate or
restrict individual tailoring?
6. Current regulations limit the sugar
content of cereals which may be
prescribed to participants. Is there any
evidence to support or refute the need to
establish regulatory limits on the
amounts of sugar and other substances
(e.g.. fat sodium, cholesterol, or artificial
flavors, colors, or sweeteners) which
may be contained in WIC food
packages?
0,0
Federal Register / Vol. 55. No. 206 / Wednesday. October 24. 1990 / Proposed Rules 42859
7. Slate agencies have the authority,
wi«h Federal approval, to make food
substitutions in the W1C food packages
!u accommodate cultural eating
patterns. Currently, any cultural food
substitute must be comparable to the
traditional WIC food counterpart in
cost, availability, and nutritional value
(at least with respect to the WIC target
nutrients). What, if any, revisions should
be made to the criteria to which State
agencies must adhere in making such
substitutions and why?
Dated: October 18.1890.
Betty Jo Nel»en.
Administrator. Foodand Nutrition Service.
MAXIMUM MONTHLY ALLOWANCES FOR WIC FOOD PACKAGES
[Food package number* and vapot popuwtionol
Food package I Food package » Food package » Food package IV Food package v FoodpackagaVi
Food*
MM0-3 month* Man* 4-12 ironta
CMOfWt/WOfMfl tnmh
■pacaldatary Oaorenl-S years
Pregnant or breast*
toodatg woman tup
lo 1 veer poM-
{ mm)
wonoraaiviaaarg
poatpurtum woman
(up to • month*
poMparajm)
Formula: •
403 tot <03Sn <Mflf>
■add-on
*■ OP
■ ■> f %
ON
fHnK tfi linl •"•■OF
OtTFL
Fruit/Vegetable
MMC*
IMP*'
ON
AduBfcaoo*
164 Sot
OH** **h~ na rm <*» ON
06 II or fruit onry)
MM
144 •« .,.„ paean? .„,,. ?ajnor ,.,,,. 182 Bor
eosen
Cera*
want cereal • Slot
ON 0" , , ,
Caw*'(hot or
COW).
Mac*
2? -p ..,.,.
CMK* *-*^rfrrr f-t* sea
LeauoMK'*
Mature dry
teanaorpwk.
ON
NsanylfeuSMr •■if Mat
'The auppniwanw looda ■sssMssi oaww era wet euttottiod saWr tor— purpose ot ordartcag aunam aaass or saaajstsa boor wan el.
''Fomuf." Food PlK1mom ' "* "-rater* totan torbSed award tarmuto. amttt to a comma* tormua not roouxng ta eddaon of any toaedtords etar ttian
water prior to batng Mrvad m a
par gwnlaj»g» sjtsssasaa
Formuiaa «mch do not mat!
■SO el Mam tomato aa daaenbad at
d atato. and which contan* at laa«ru>. maw
» kitoertone* par Butf ounca ol tormtla M at
(dean perl
darddda
or tormuia at ST
ara bUBvattaJ when a phywean dotormmee dial Pa Want he* a medka
•.•a o. «uam mwi oa*M*j*u above, UJ—-***»* ttoorrmmuutoaa* ara not aauueawwrmtzaardj asowaaiyy ttoorr Heae ppuupsosoesa ol managongo aboodoyywwawgorer.t
NTF tormua a owy autawaod —an eta toapawrt protoaawnal eutiorty dotonarao and datawares jj Wmk B) an tatasidtory or teswetod —tor euppiy. tiara
aeaffiaoBjsBiSjBje'a^
formula in Food Helige B ntora ID product net ■ Wandad tor use as an em liiding era prasertoad by ■ pnyaaton tor a aanwaaw otaiwi madteal
COTdjaon wtw» proctudea a roatnea thauaa ot convanaonal to > end menaaiii Ha uee el a tonauto. Such miacat eorttbona eatvde. tx
metaoofac daordors. atoom jrrors at anuno at
swswaaissawais»aas<syasstaa<i
Tha adddan aj Bajl ounoao ol concaaatod aauW, 1 pound el powdered or 10* ■eta* ounces el NTF tjaneta may BO
ew need a domorabatod and documonad in ew paracpant ■ t caraacaaon Ha by too competent pretoeaona aafa»ay.
• vaoataoi* Moa • not eutioread tor beans due to tw rasher psHidJei tor tood ebergaa. lesuenos el race pner to tie tea amen tie intont een dnr* fiom a cup
■ dacouragod. The compatont atoSsas mil eueanty onad baMruci tie parbcipanra parom or auatdati to toed toe pace to Sjpj aaajsMaal bom a pup to pra»am law
but are net kmaad to:
Dacumawaaon ol Sw priyaoana
en en
* Want |uca wtieri eontaMa a m-wnum at 30 mAgrarm ol vltarmn C par 1001
* &ngto saonoti SM iwoo or ngiubii kaee. or boax ameh ccnttine a mMmum ol 33 mnorame el »*amm C par 100 itilbiin; or eoaan eoneamraiad bua or
vogcttMa MC9, or boax wften contama • mnmum ot 30 m*arama ol Mom C par 100 rMtoirt el raoorsMuwd (uca Coronation* ol Kngto *transtn and boron
concanuatod KKO may b* isauad a* long a* ma total vwuma doo* not *K»*d aw anuura apacakad tor angla *a*notr< iuca.
»OryaaawastasT«de»aaaiaM
not ogQorojod wtant f iraan
* Diy cereal aw or eotdl amlcr: contains a mnmum ol 2S pJsgaaaj el ban par 100 gram* of dry oaraal and net awto San *12 gram* el i
sugar* par 100 grama ol dry car** ,"« gram* par ounca)
• PaMounnd tkad vmoto nak wtactt a Savored or unbowed end which contains 400 btotrnaiionsl bras ol wumn 0 par quart (• L); or pawaaaad Sad skim or
towlat mk artieh a Sairorod or unfavored end when cotaana 400 fctkameaonal Unito ol «Namin 0 and 2000 totomesena Uraa el wtonan A per quart (• Lf. or
aastaatoed cubured butwrwak aSeaa eamana 4SJP imarneaoral Unas a atonai D and 2000 traomoaoral Mass el idanat A par euari (.S LL
EwjptMatod ameto aak which oeniara 400 totortabonel Unas el »tow 0 per PisaaatJjaaJ quart (.s L) or eiraporstod skJamed mm when certains 400
mtemaaor* Una ol atonan 0 end 2000 batrtaaoral Unas el taama A per wicsFeNulid cpen |.S U may be luQiMuua tor Sad whoto mto at ta njto at 13 Sad
ounca* (4 L) par quart (11) ot bad whrjta n* Dry whota m*k rhjch contoaa 400 kaarnaaoral Uta* ot vaarnm 0 par raooraatutod quart (J L) may be iJBB«Mr.d
tor Sad abeto adk at tie mto of 1 pound |4 ha) par 9 quarto (UII el tadwiatoa*.
01 towtot dry mto wtocti cortana 400 bmanaaewat Unas el trttomw 0 and 2000 bdarakoral Una* 1 i A per iiooraatuiid ejuert LS U aay be
tor Bad whoto a* et too raw ot 1 pound (.4 kg) par • «ara H-7 U el Putowrwto mBk.
DWttoJUC CftoMeM tP#t*eKptT2*d p>OCWe) A/nemCeW. MOe*llsjr%y atoKfc. COat*/. MMpTtf CHeMOsV. SmTtatoV aWsCV '
nay bo ad>ibaaad tor Su* whoto mm «ta raw of 1 pound M kg) ol etwees pa 3 quart* (2J L) el Bad amae m*X 4 pounds (IJ kg) a ta I
42880 Federal Renter / Vol. 55. No. 206 / Wednetday. October 24. 1990 / Pro- *ed Rules
chNM «Mch myM MbMMadeaJSMiMMMpiM is IW»gJglgWtMgggl Bjeoei
prov*)ad lha nasd a docurnaniad w Sia paYkOpanfa Na by tru cornpatarrl protasiorul authortf)
•DnMmmiriiyMwMtMMilMiitiot 1.5 pounds (7 kg) agg
rm pr 2 doza
* Ptanui bunar or mature dry bun or pass ndudng. but not fcmrtad K>. lanM*. black, m
r to touto on an IndMduN tosis in eaaaa o»
I aoa nw may to autotoAtd at in* rat* of i.S (.«• Peanut toons hdudng. tot kmaadto.
and Kack-ayad pass.
down trash eggs or 2 pounds (.9 kg) agg m
cfc, navy. Udnay. gartonzo. soy, pMo and mung
ms par 2Vb dozen trash oggs.
|FR Doc 90-25129 Filtd 10-23-40: MS am]
■ttuwt coot *m n m
APARTMENT OF TRANSPORTATION
Federal Aviation Administration
14CIU
Petition tor Rulemaklng; Summary of
Petitions Received; Dispositions of
Petitions lssuedN
AGENCY: Federal Aviation
Administration (FAA)>60T.
ACTION: Notice of petitiorts for
rulemaking received and ohdispositions
of prior petitions: correction.
SUMMARY: This action corrects a\em
with reference to the comment doi
date to a notice published on
Wednesday. October 10.1990. page
41200 and in the first column. The FAA
inadvertantly inserted October 29.1990.
Please change the comment close date
to read January 8.1991.
FOR FURTHER INFORMATION CONTACT:
The petition, any comments received,
and a copy of any final disposition are
filed in the assigned regulatory docket
and are available for examination in the
Rules Docket IACC-10). room 915C FAA
I icadquerters Building (FOB 10A). 800
Inependence Avenue SW.. Washington.'
DC 20591: telephone (202) 287-3132.
ACO10:—
DmiseD.ltaU.
n/anoftr. Program Manofttntnt Stoff.
|FR Doc 90-23139 Filed 10-23-90: M5 an)
DEPARTMENT OF THE TRI
Customs Service
19 CFR Part 101
Changes In the Custom* Service Field
Organization: Apalachicola, Carrabelle,
and Port St Jos, I
AGENCY: US. Customs Service.
Treasury.
ACTION: NqKce of proposed rulemaking.
f. This document proposes to
amen/'the Customs Regulations by
dosfng the ports of entry of
felachicolaand Carrabelle and
Sesignating Port 3t. Joe as a Customs
station. Civen the inactivity at these
ports, together with the necessity for -
providing full Customs service at such
inactive ports, closing Apalachicola and
Carrabelle as ports of entry end
converting Port St. Joe to a Customs
station are warranted by the
circumstances. These changes are
proposed in orderio obtain more
efficient use of Customs personnel,
facilitiesAnd resources, and to provide
better service to carriers, importers and
the public.'
DATES: Comments must be received on
or before December 24.1990.
ADDRESSES: Written comments
(preferably in triplicate) may be
addressed to the Regulations and
Disclosure Law Branch. U.S. Customs
Service. 1301 Constitution Avenue NW..
room 2119. Washington. DC 20229.
FOR nmTHSA INFORMATION CONTACT:
Joseph O'Gorman. Office of Inspection
and Control 202-566-9425.
SUPPLEMENTARY INFORMATION:
ickground
iMtoms ports of entry and/tat ions
are Ideations where Customs officers or
employees are assigned uraccept
entries onnerchandise/Ciear
pessengersvcollect dimes, and enforce
the various previsions of Customs and
related laws. Tmrsignificant difference
between DOrtSiffiotry and stations is '
that at stations, the Kfderal Government
is reimbursed foe
(1) TWsalartes and expenses of its
officetsior employees for services
rendered in connection withi^e entry or
snee of vessels: and
' (2) Except as otherwise providajl by
'the Customs Regulations, the <
(including any per diem allowed in I
of subsistence), but not the salaries of1
its officers or employees, for service
rendered in connection with the entry or
delivery of merchandise.
The list of designated Customs ports
of entry is set forth in 1101.3(b),
Customs Regulations (19 CFR 1013(b))
and Customs stations are listed in
1101.4(c). Customs Regulations (19 CFR
101.4(c)). The Customs organizational
structure consists of regions, districts,
ports of entry within districts, end
stations supervised by ports. This
change is proposed pursuant to the
authority vested in the President by
section 1 or the Act of August 1.1914/38
Stat. 823. as amended (19 U.S.C 2). and
delegated to the Secretary of the
Treasury by Executive Order No. 10289, •
September 17.1951 (3 CFR 1949-1953 ■
Comp.. Ch. II). and pursuant to authority.
provided by Treasury Department Ordc
No. 101-5 (47 FR 2449). as well as 5
U.S.C. 301.
As pert of a continuing progranrlo
obtain more efficient use of its.
personnel facilities, and resources, and
to continue to provide better service to
carrieis. importers. endlKe public
Customs proposes to close the
Apalachicola and Carrabelle ports of
entry located in tb* Florida panhandle
area, and at the/tame time convert Port
St. Joe to a Customs station. These ports
of entry have been inactive and not
manned\m a i.umber of years. Only
aomesrx vessels were entered at Port St.
Joe during the past three-year period.
Cdequate Customs service will
intinue to be provided to the
Panhandle region of Florida through the
ports of Panama City and Pensacola as
well as the proposed Port St. Joe station.
Pensacola. Panama City, and Port St. Joe
are located along the coast in s linear
pattern and are thus eble to provide
convenient service to importers in that
area. In addition, the Port of Mobile is
located in dose proximity to Pensacola
and importers/brokers had indicated
their preference for using this larger port
of entry to enter and dear merchandise,
which is reflected in low workload
figures for the Panhandle ports.
Since there generally appears to be no
immediate increase in international
activity in the Panhandle ana. closing
these ports of entry would have little if
any economic impact in this area,
especially in view of the total absence
of commercial activity at these ports,
except for the little business carried on
at Port St. Joe.
ifore adopting this proposal.
consideration will be given to any
written comments timely submitted to
Customs. Comments submitted will be
available fofpublic inspection in
accordance whb the Freedom of
Information ActVU.SC. 552111.4.
Treasury Department Regulations (31
CFR 1.4). and 1103.11(b). Customs
Regulations (19 CFR 10\l1(b)). on
regular business days befayuen the hours
of 9 a.m. and 4:30 p.m. at thVRegulaUons
and Disclosure Law Branch.-rbom 2119,
Custom* Headquarters, 1301
Constitution Avenue. NW., Wsi
DC 20229, . n.
APPENDIX B
PROFESSIONAL REVIEW TEAM
BIOGRAPHICAL SKETCHES
CL3
Professional Review Ton
1. Dr. Helen fiuthrle 1s an endowed Professor of Nutrition at The
Pennsylvania State University having served for forty years on the faculty,
fourteen years as Head of the Department of Nutrition and seven as Director of
the Graduate Program In Nutrition. Her research Interests in Infant
nutrition, nutrition education; dietary and nutritional assessment and
International nutrition funded by USDA, NIH and the Nutrition Foundation, have
resulted In close to 100 publications. She 1s Editor of Nutrition Today and
author of a college textbook, Introductory Nutrition, now In Its seventh
edition. Dr. Guthrie has been recognized for her professional accomplishments
by being awarded the Borden Award In Human Nutrition by the American Home
Economics Association, the Elvejhem Award for Public Services by the American
Institute of Nutrition and the Atwater Award from the U.S. Department of
Agriculture.
Dr. Guthrie has played an active role In the Society of Nutrition
Education and the American Institute of Nutrition having served as President
of both of these professional organizations. She Is on the Board of Trustees
of the International Life Sciences Institute Nutrition Foundation and has
served on advisory panels for several Industries and federal agencies
Including FTC, USDA, GAD and NIH. She served on the first Joint Nutrition
Monitoring and Evaluation Committee (1987).
2. Dr. Shlrlkl K. Kumanvlka 1s an Associate Professor of Nutritional
Epidemiology In the Colleges of Medicine and Health and Human Development at
the Pennsylvania State University. Dr. Kumanylka has formal training In
nutritional sciences (Ph.D., Cornell) and public health (N.P.H., Johns
Hopkins) and approximately 15 years experience 1n practice, teaching and/or
research activities related to various aspects of health and human services.
She Is currently co-Investigator on a NHLBI funded grant to analyze secular
trends 1n Cardiovascular risk factors using National Health Survey data and
was principal Investigator of a Center for Disease Control-sponsored nutrition
surveillance project In the District of Columbia. She was a visiting
scientist 1n the Division of Health Examination Statistics, NCHS, during a six
month period In 1989. She has co-authored analysis of NHANES data and Is
senior author of a comprehensive paper, for Secretary Heckler's Task Force on
Minority Health, on nutritional risk Issues for U.S. minority groups.
3. Dr. Marv Frances Plcclano Is a Professor of Nutrition at The
Pennsylvania State University. She has been actively engaged in maternal and
Infant nutrition research for 20 years. Her research activities In trace
elements, an.ino adds, and follc acid during development funded by NIH, USDA
and Infant Food Manufacturers have culminated In approximately 75
publications. She recently co-edited a book entitled Follc Acid:
Biochemical. Phvsloloolcal and Nutritional Aspects with Drs. E.R.L. Stokstad
and J.F. Gregory and a book with Dr. B. Lonnerdal on Mechanisms Regulating
Human Lactation and Infant Nutrient Utilization.
Dr. Picciano has been recognized for her research accomplishments by
being awarded the Borden Award in Human Nutrition by the American Home
Economics Association, the Lederle Award In Human Nutrition by the American
Institute of Nutrition, The Paul A. Funk Award for Research Achievements by
2M
the College of Agriculture at the University of Illinois and The Pattishall
Award for Research Accomplishments by the College of Health and Human
D< elopment at The Pennsylvania State University. Dr. Plcclano 1s engaged 1n
numerous professional service activities. She 1s a member of the Program
Planning Committee and the Nominating Committee of the American Institute of
Nutrition and the Editorial Board of the Journal of Nutrition. She serves on
the Executive Committee of the International Society for Research on Human
Milk and Lactation and recently co-organized and secured NIH funding for the
5th International Conference of the Society. She 1s a member of the
Subcommittee on Nutrition During Lactation and the Committee on International
Nutrition Programs of the National Academy of Sciences. In this project, Dr.
Plcclano was the Individual In charge for overall coordination of the review.
4. Dr. Helen Smldklas-WHoht has been a faculty member 1n the
Nutrition Department since 1970. She was brought Into the department to
develop an emphasis In Community Nutrition, one of the first such programs In
the U.S. She and a colleague, Dr. Laura Sims, edited a textbook, Community
Nutrition:People. Policies, and Programs which was widely used In community
nutrition courses.
Dr. Wright's main teaching as well as research emphasis 1s In the areas
of nutritional assessment. She has served on national nutritional committees
pertinent to nutritional assessment. She was a member of the Coordination
Committee on Evaluation of Food Consumption Surveys, Food & Nutrition Board,
National Academy of Sciences. She was a member of this committee's
Subcommittee on Criteria for Dietary Evaluations which published Its report
"Guidelines For Use of Dietary Intake Data." She served on a Life Science's
Research Office (LSRO) ad hoc Expert Panel addressing Guidelines for the
Appropriate Use of Dietary Data which published Its report "Nutrient Adequacy:
Assessment Using Food Consumption Surveys."
Dr. Wright has worked as director and co-director of projects funded by
USDA's Human Nutrition Information Service to examine nationwide food
consumption survey data. Her work with the 1985 Continuing Survey of Food
Intake of Individuals and the 1977-1988 National Food Consumption Surveys Is
Important to this project. She has examined data on food and nutrient Intake
by age and demographlcal variables.
5. Dr. Jeannle McKenzle Is a registered dietitian whose experience
over the past 15 years has focused on nutrition Intervention for
cardiovascular disease risk reduction. Initially, her research activities
Involved evaluating the relationship between sodium and potassium Intakes and
blood pressure among Infants. As co-director of the Nutrition Lipid Program
at the Graduate School of Public Health, University of Pittsburgh for 6 years,
Dr. McKenzle developed and Implemented an Intervention prooram to assist
families, designated at high risk of premature atherosclerosis, In their
efforts to decrease serum ?1p1d levels through modification of their dietary
fat and cholesterol Intakes. Between 1979 and 1986 she was also Involved with
nutrition Intervention for the NHLBI's Multiple Risk Factor Intervention Trial
and the Hypertension Prevention Trial. She began teaching student nurses at
The Pennsylvania State University In 1981. Her commitment to teaching and
public health nutrition Issues has led to recognition from numerous community
agencies.
75
APPENDIX C
COMMENT ANALYSIS
at
#58-3198-1-006
Review of WIC Food Packages
Federal Register, Vol. 55, No. 206
10/24/90
COMMENT ANALYSIS
A total of one hundred and eighty-seven (187) consent letters were received on
the "Review of MIC Food Packages." The number of letters received by
organization Is as fallows:
Total consents received 187
State Agencies 38
Geographic
IT0Ts
35
s
Local Agencies 80
Public Interest Groups 17
Industry 13
Other 39
SA Staff a
Other State/Local Agency
(non-MIC) *
General Public 13
Participants 1
Individual Health Professionals IS
The Major consents and consent areas addressed are as follows:
ISSUE #1: VIC TARGET NUTRIENTS
Sublssue la: Retain Current 5 Target Nutrients
la.l A total of ninety-one (91) consenters addressed this sublssue. The
nunber of letters received by organization are as follows:
29 Geographic State Agencies
3 Indian State Agencies
35 Local Agencies
4 State Agency Staff
2 Other State and Local Agencies (non'-WIC)
5 Industries
10 Public Interest Groups
1 General Public (Academic)
_1 Individual Health Professionals (non-HIC)
Total 91
2"i
#58-3198-1-006
la.2 The comments were distributed is follows:
57 In support
27 In support with exceptions
2 opposed
4 were informational
_1 misunderstood the subissue
Total 91
la.3 Of the fifty-seven (57) commenters supporting the continuance of
the 5 target nutrients, their reasons, explanations or comments
Included the following:
• subgroups of the population need these nutrients to be
targeted
• 1986 National WIC evaluation showed participants to have
Improved Intakes of these and other nutrients
• recent published evidence In mixed ethnic groups showed a
low Intake of one or all of the existing target nutrients
• WIC has been successful
• surveys of diets of participants support current 5 target
nutrients
• the current 5 target nutrients are Important In times of
rapid growth
• the current 5 target nutrients are the "backbone" of basic
nutrition education provided to clients
la.4 Of the twenty-seven (27) commenters supporting this subissue with
exception, ten (10) recommended the elimination of protein as a
target nutrient. The National Association of WIC Directors (NAWD)
recommended to discontinue targeting protein but also not to
significantly reduce the amount of protein In the WIC food
packages. Fourteen (14) commenters supported this NAWD
recommendation. One (1) commenter recommended that the 5 target
nutrients should continue for children but be altered for women.
One (1) commenter recommended altering the 5 target nutrients.
la.5 Two (2) commenters were opposed to the current 5 target nutrients
and made the following recommendations:
• target only calcium, Iron and vitamin C because Americans
consume more protein than necessary and there Is virtually
no vitamin A deficiency
• continue to target vitamins A and C plus Iron
la.6 Four (4) Informational comments were provided,
la.7 One (1) commenter misunderstood the subissue.
2
1%
#58-3198-1-006
Sublssue lb: Recommended Additions to the Current 5 Target Nutrients
lb.l A total of sixty-six (66) conmenters addressed this sublssue. The
number of letters received by organization are as follows:
25 Geographic State Agencies
1 Indian State Agency
21 Local Agencies
4 State Agency Staff
1 Other State and Local Agencies (non-WIC)
2 Industries
9 Public Interest Groups
1 General Public (Academic)
_2 Individual Health Professionals (non-WIC)
Total 66
lb.2 The comments were distributed as follows:
63 in support
0 in support with exceptions
0 opposed
3 were Informational
_0 misunderstood the sublssue
Total 66
A total of sixty-three (63) conmenters recommended one or more
additional WIC target nutrients.
lb.3 The additional nutrients recommended for targeting In decreasing
order of prevalence are as follows:
Folic Add (52)
Zinc (47)
Fiber (34)
Vitamin B-6 (31)
Magnesium (3)
Calories (3)
Copper (1)
Thiamin (1)
Heme Fe (1)
The two principal reasons given for recommending that the above
listed nutrients be targeted were: 1) results from recent dietary
surveys show that these nutrients are low in the diets of potential
participants of the WIC Program; and 2) literature citations
Indicate that women and children are at risk for deficiencies of
the above listed nutrients.
lb.4 No (0) support with exception comments were provided.
3
V\
#58-3198-1-006
lb.5 No (0) opposed coments were provided.
lb.6 Three (3) coaaenters provided Information related to this sublssue
but did not wake a recoaaendatlon for additional target nutrients.
lb.7 No (0) coawenters Misunderstood the sublssue.
4
3o
158-3198-1-006
ISSUE #2t NUTRIENT DEHSITY/BIOAVAILABILITY OF NIC FOOD PACKAGES
Sublssue 2a; Retain Currant Food Package y Nutr1ent-Dense/B1oava11able
Sources of Recommended Target Nutrients
2a.1 A total of fifty-eight (58) comenters addressed this sublssue.
The number of letters received by organization are as follows:
22 Geographic State Agencies
1 Indian State Agency
20 Local Agencies
4 State Agency Staff
2 Other State Agencies and Local Agencies (non-WIC)
2 Industry
4 Public Interest Groups
1 Participant
_2 Individual Health Professionals
Total 58
2a.2 The comments Mere distributed as follows:
43 In support
7 In support with exceptions
1 opposed
7 were Informational
J) misunderstood the Issue
Total 58
2a.3 The forty-three (43) commenters who supported the sublssue favored
current NIC food packages and recommended no change. They did,
however, express concern over the controversy on the
bloavallability of Iron In dry cereal, emphasized that low-Iron
Infant formula should not be allowed, and stated the desirability
of further lowering the current sugar limit In cereals.
2a.4 Seven (7) commenters who supported the sublssue with exception
proposed a minor change and asked that the juice be eliminated from
the Infants' package on the basis that formula and breast milk
offered comparable nutritional advantages without the problem of
nursing bottle syndrome.
2a.5 One (1) commenter (GSA) requested a major change to Include
nutrient- dense foods to correct for lack of vitamin A In the
current package.
2a.6 Seven (7) commenters Identified as providing Information only
emphasized the Importance of assessing the bloavallability of Iron
In accepted foods.
2a.7 No (0) commenters misunderstood the sublssue.
5
3)
#58-3198-1-006
Sublssue 2b: Recommended Changes In or Additions to WIC Foods as Nutrlent-
I^M/B1oivt11iMt Spurra of Tirqet Nutrient?
2b. 1 A total of one hundred eleven (HI) commenters recommended
additional foods be added to the UIC - :d packages. The number of
letters received by organization are as follows:
28 Geographic State Agencies
3 Indian State Agencies
38 Local Agencies
1 State Agency Staff
3 Other State and Local Agencies (non-WIC)
7 Industry
14 Public Interest Groups
11 General Public (8 academic)
1 Participant
_5 Individual Health Professionals
Total 111
2b.2 The comments were distributed as follows:
2 In support
102 In support with exceptions
0 opposed
7 Informational
_fi misunderstood the sublssue
Total 111
2b.3 Two (2) commenters supported current food packages and recommended
that no changes be made.
2b.4 One hundred two (102) commenters supported the sublssue with
exception. The most frequently mentioned changes (each was
mentioned at least 5 times by commenters) were:
• the addition of whole grain breads*, whole wheat crackers or
bread, flour and cornmeal as#a source of dietary fiber
• the addition of canned beans as an allowable legume
• the addition of vegetables - especially carotene-rich (e.g.,
carrots ) and/or cruciferous ones (e.g., broccoli, spinach,
greens)
• the option of lactald tablets" for lactose Intolerant
participants
• addition of yogurt and/or tofu or calcium-fortified orange
juice as allowable calcium sources
• substitution of tuna fish for eggs or peanut butter
• removal of juice from the Infant package
• reduction or elimination of eggs because of high cholesterol
content
3*
#58-3198-1-006
• Other less frequently recommended changes Included
providing breast pumps
addition of,cottage cheese as a calcium source
ground beer as a heme Iron source
rice and pasta
Iron fortified formula and cereal for the breast-fed
infant
allowance of cheese food as a low-fat alternative to
cheese
calorie enhanced foods
dehydrated Infant foods
removal of cereal from the Infant package (FPU)
exclusion of goat or cow's milk from the Infant
package (FPU) and exclusion of whole milk after 2
years of age
"For those Identified by asterisks, one or more commenters
specifically opposed the change proposed.
2b.5 No (0) comments were opposed to the sub1ssue.
2b.6 Seven (7) informational comments were provided.
2b.7 No (0) commenters misunderstood the sublssue.
7
33
#58-3198-1-006
ISSUE #3: NIC FOOD PACKAGE GROUPINGS
Subissue 3a: Retain Current Six Participant Groupings for Food Packages
3a. 1 A total of seventy-seven (77) commenters addressed this subissue.
The number of letters received by organization are as follows:
26 Geographical State Agencies
3 Indian State Agencies
34 Local Agencies
1 State Agency Staff
1 Other State and Local Agency (non-HIC)
1 Industry
8 Public Interest Groups
1 General Public (non-acadea1c)
1 Participant
JL Individual Health Professional (non-NIC)
Total 77
3a.2 The comments were distributed as follows:
34 in support
39 In support with exceptions
1 opposed
3 were Informational
_p_ Misunderstood the subissue
Total 77
3a.3 Of thirty-four (34) in support of retaining the current participant
food grcjplngs, their reasons, explanations, or comments included
the following:
• the six categories are fine and fit into the RDA breakdowns
• the six categories work well
• the nunbers of categories are adequate
• the current categories generally cover the Majority of needs
3a.4 Of those thirty-nine (39) In support of retaining the current
participant groupings with the exceptions, the following
recommendations were made:
• revise to Include Infants with special dietary needs (3)
• divide package IV Into children 1-2 or 3 yrs and children 3
or 4-6 yrs (5)
• add a package for just breastfeeding women (10)
• combine the two Infant packages Into one (0-12 months)
• divide Infants Into 3 categories (3)
• add a separate participant grouping for teens (2)
• add a food package for partially breastfed Infants (3)
8
3H
#58-3198-1-006
• add • food package for the boneless (1)
• add a food package for overweight children/women with only
low fat HiIk (2)
3a.5 The one (1) commenter opposing the current participant groupings
recommended the following four participant groupings for MIC food
packages: 1) infants 0-3 Months of age, 2) Infants 4-12 Months of
age, 3) children 1-5 years of age and non-breastfeeding postpartum
woaen, and 4) pregnant and breastfeeding women.
3a.6 Three (3) Informational comments were provided.
3a.7 No (0) commenters Misunderstood the sublssue.
Sublssue 3b: Retain Maximum Monthly Allowances of WIC Foods
3b. 1 A total of one hundred twenty-four (124) coMMenters addressed this
sublssue. The number of letters received by organization are as
follows:
32 Geographic State Agencies
1 Indian State Agency
44 Local Agencies
6 State Agency Staff
3 Other State and Local Agencies (non-VIC)
5 Industries
14 Public Interest Groups
10 General Public (9 acadeMlcs; 1 non-academic)
_5 Individual Health Professionals (non-WIC)
Total 124
3b.2 The comments were distributed as follows:
1 1n support
113 In support with exceptions
2 opposed
8 were informational
_0 Misunderstood the sublssue
Total 124
3b.3 One (1) commenter who supported the current maximum Monthly
allowances gave no reasons for this position.
3b.4 Of the one hundred thirteen (113) commenters supporting retaining
the current maximum Monthly allowances with exceptions, the
recommendations were numerous, varied and often 1n opposition to
other commenters' recommendations. For example, Increase or decrease
the amount of eggs In a single package. No consistent reasoning was
evident for the sane recommendations by different commenters but
providing "flexibility" in the maximum Monthly allowances of WIC
9
#58-r. 98-1-006
foods was • principal theae. The commonly cited recommendations
and/or revisions Include the following:
• revise Food Package III
• Increase the quantities of foods provided to breastfeeding
women In Food Package V
• Include the option to provide peanut butter, legumes, eggs,
cheese, fomul a, cereal and juice In food package for women
and children with special needs (Food Package III)
• decrease eggs, milk and juice in packages for children and
postparturn nonbreastfeeding women
• Include breast pumps, pads, etc. as a food expense
• add bread and fruits and vegetables to Food Packages III-VI
• allow lactase-treated milk
• add tofu and yogurt for cultural subgroups
• allow more formula for older Infants
• Increase cereal allowance In Food Package II for Infants
• Increase the amount of Iron-fortified formula to provide 1
liter of reconstituted formula/day
3b.5 The two (2) commenters opposed to the current maximum monthly
allowances for WIC food packages recommended numerous changes and
sometimes complete restructuring of each food package.
3b.6 Eight (8) commenters provided Informational comments only and did
not support or oppose the Issue.
3b.7 No (0) commenters misunderstood the Issue.
10
158-3198-1-006
ISSUE #4: CATEGORICALLY TAILORED NIC FOOD PACKAGES
Sublssue 4a: UM of guidelines bv USDA for approving state agency
categorically tailored food packages
4a. 1 A total of seventy-one (71) commenters addressed this sublssue.
The number of letters received by organization are as follows:
27 Geographical State Agencies
2 Indian State Agencies
27 Local Agencies
4 State Agency Staff
2 Other State and Local Agencies (non-WIC)
_2 Public Interest Groups
Total 71
4a.2 The contents were distributed as follows:
58 In support
1 In support with exceptions
0 opposed
5 were Informational
_Z misunderstood the sublssue
Total 71
4a.3 Of the fifty-eight (58) commenters who were In support of using
such guidelines, some of the comments were general and some were
more specific In recommending types of guidelines. Examples of
several comments are:
• use sound nutrition policy for guidelines not cost
• Incorporate current national nutrition and health policy
guidelines and recommendations
• base guidelines on patterns of growth not cost
More specific recommendations elicited a large number of possible
guidelines which fall Into several categories:
Guidelines Developed by Government Agencies, e.g.,
USDA/Dletary Guidelines for Americans
Guidelines Developed by Professional Associations, e.g.,
American Dietetic Association (ADA), American Academy of
Pediatrics (AAP), American Heart Association (AHA), and
American Cancer Society (ACS) Recommendations; National
Association of Obstetrics and Gynecology.
Dietary Recommendations/Guidelines - Recommended Dietary
Allowances (RDA); Surgeon General's Report on Nutrition and
Health, AAP Prudent Lifestyle for Children
11
31
#58-3198-1-006
National Surveys - National Health and Nutrition Examination
Survey (NHANES), food surveys
Other - medical guidelines In approving state agency proposal;
repllcable/valid studies reviewed by experts; documented
nutritional deficiencies of needs In the target population
4a.4 One (1) commenter who supported the sublssue with exception wrote
"give State agencies the option to establish their own policies for
categorical tailoring of food packages" (PI)
4a.5 No (0) comments were categorized as "opposed" to the sublssue.
4a.6 The five (5) commenters that provided Information varied In theme
as follows:
• the food package for each participant category should
contribute approximately the same percentage of the RDA for
that particular group (LA)
• approve only those foods that target specific nutrient
deficiencies (LA)
• Individual state categorical tailoring proposals must be
carefully reviewed (SAS)
4a.7 The seven (7) commenters that Indicated misunderstanding of the
sublssue took two positions. Two (2) commenters (LA) recommended
that categorical tailoring not be allowed; one (lj commenter
recommended against categorical tailoring particularly for the
prenatal package (LA). The second position by three (3) commenters
was one of opposition to standardizing national nutritional risk
criteria (LA).
Sublssue 4b; Identification of Population Croups That Warrant Categorically
Tailored Food Pledges
4b. 1 A total of thirty-seven (37) commenters addressed this sublssue.
The number of letters received by organization are as follows:
12
3*
#58-3198-1-006
18 Geographical State Agencies
11 Local Agencies
3 Public Interest Groups
1 General Public (Academic)
_4 Individual Health Professionals (non-WIC)
Total 37
4b.2 The comments were distributed as follows:
6 In support
27 In support with exceptions
0 opposed
4 were Informational
J) misunderstood the Issue
Total 37
4b.3 The six (6) commenters supporting categorical tailoring for
population groups stated that categorical tailoring be based on
nutritional requirements of specific groups. Representative
comments are:
• base tailoring upon a combination of category (I.e. age,
pregnancy) and nutritional risk (GSA)
• uniformly Interpret and Implement tailoring guidelines among
regions (GSA)
• energy needs must be based on age, height and weight
4b.4 The twenty-seven (27) commenters In favor of supporting categorical
tailoring for population groups with exception fell Into several
categories:
o Comments relevant to Infants and children:
• Two (2) commenters proposed categorical tailoring for
younger (1-3 years old) and older (3-5 years old) children
(2 LA)
• One (1) commenter proposed reduction of the package for
children on another feeding program which serves meals five
(5) days a week, e.g., Head Start (LA)
o Comments relevant to women:
• Five (5) commenters proposed categorical tailoring for PKU
women (4 IHP, 1 GP)
• Two (2) commenters proposed categorical tailoring for
breastfeeding women. A specific comment (GSA) was "develop
regulations so states cannot limit the breastfeeding
mother/Infant dyad food package"
• Two (2) commenters proposed a lactose Intolerance food
package (2 PI). These comments may be more appropriately
addressed In Issue 7.
13
31
#58-3198-1-006
o Coaaents relevant to participants In all groups:
Numerous coaaenters recoaaended reducing fat In food packages
for certain age groups of participants. Soae of the coaaents
are as follows:
"2% lowfat allk for children *2 years of age and
nonbreastfeeding postpartua women" (NAMD)
"stress lowfat ailk and lowfat yogurt. L1a1t eggs to
4/week; high fiber cereals" (LA)
"hypercholesterolealcs need acre lowfat foods" (GSA)
4b.5 No (0) coaaenters opposed the sublssue.
4b.6 The four (4) Inforaational coaaenters had responses as follows:
"This organization Is conducting a study of the barriers to
utilization of MIC services aaong adolescent participants.
They will be happy to share their findings." (LA)
"If children's package Is not subdivided allow agencies to
do so via Individual tailoring." (LA)
"Prefer a percentage (X) of the Recoaaended Dietary
Allowance (RDA) for target nutrients as the general
guideline for 66 2/3% seeas reasonable. Apply this to
tailoring for children 1 and 2 years old who eat less than 3
and 4 year olds."
4b.7 No (0) coaaenters aisunderstood the sublssue.
14
Ho
158-3198-1-006
ISSUE #61 CURRENT FOOD PACKA8ES PROVIDE SUFFICIENT FLEXIBILITY FOR INDIVIDUAL
TAIL0RIN8
5.1 A total of sovtnty-stvtn (77) commenters iddressed this sublssuc.
Tho number of lotttrs roctlvod by organization aro as follows:
33 Geographical State Agencies
1 Indian Stata Agency
26 Local Agencies
4 Stata Agancy Staff
1 Other Stata and Local Agendas (non-HIC)
2 Industry
9 Public Interest Groups
JL Participant
Total 77
5.2 The consents ware distributed as follows:
60 In support
8 In support with exceptions
4 opposed
5 ware Infomatlonal
_C Misunderstood the Issue
Total 77
5.3 The sixty (60) coanenters who supported the Issue Indicated that
the current package allows sufficient flexibility for Individual
tailoring. One (1) commenter (GSA) wrote "a nutritionist should do
the tailoring and counsel on appropriate other dietary or lifestyle
changes". Another (1) commenter (LA) wrote that "tailoring 1s
often not needed if the participant Is wall counseled 1n
appropriate choices within the MIC food groups". Sevan (7) of the
coanenters used words such a "valuable", "important" and "vital" to
describe the personal tailoring guidelines.
5.4 Of the eight (8) commenters who supported the Issue with
exceptions, the leading position was to continue to allow local
Competent Professional Authority (CPA) the authority to tailor the
food packages based on Individual needs but to Increase the
flexibility.
Several of these letters Identified specific recommendations for
Increasing flexibility:
• revise Food Package III (GSA)
• allow canned beans only for the homeless (LA)
• children with Iron deficiency anemia should be allowed extra
juice as needed (LA)
• quantity of food for hyperllpldemlcs would not be reduced
when the package Is tailored, e.g. permit egg substitutes
and/or legumes for eggs (GSA)
HI
#58-3198-1-006
• provide food packages for overweight child >2 years (for
example, excluding cheese and offer only low fat milks) (LA)
5.5 Of the four (4) commenters who opposed the Issue, the theme was
that more flexibility In tailoring the food packages 1s needed.
Specific comments were as follows:
• Increase flexibility at the Federal level, allowing local
CPAs to Individually tailor according to needs (2 LA)
• alternative food choices for participants on decreased fat,
decreased cholesterol are needed, e.g. dried beans for eggs.
Waive the required 45% of the RDA for Iron so that cereal
choices can Increase and still be within criterion for sugar
content limit.
• too limited for different cultural populations, teens,
special energy needs of Infants as well as Individuals on
low cholesterol or low sodium regimes (6SA)
5.6 The five (5) commenters providing Information primarily expressed
the need to educate clients as follows:
• tailoring to meet Individual needs as related to fat, sugar
and sodium would be Ideal if It didn't take too much staff
time and paperwork
• we educate clients as to which foods to select from each
group If on a special diet
• tailor to monitor cholesterol, sodium and fat - to educate
participants about the U.S. Dietary Guidelines
One (1) of the five (5) comment letters classified as
"Informational" stated that "if the NAWD recommendations are used
there Is almost no room for Individual tailoring and this 1s
undesirable."
5.7 No (0) commenters misunderstood the Issue.
16
41
IBS SlOt ) 006
ISSUE III RETAIN CURRENT RERULATORY UNITI/REqUIRENENTI ON CONPONINTI OP MIC
POOOS
6.1 A total of ninety nvin (07) commentary ipeclflcally eddressod this
question:
34 fienerel State Agencies
2 Indian State Agencies
17 Local Agencies
1 Stito Agtncy Stiff
2 Othor Stito ind Local Agencies (non-NIC)
• Industry
10 Public Interest Groups
_i Participant
Total 07
f.l Tho comments Moro dtitrlbutod u follows:
•• In support
20 In support with exceptions
1 opposod
0 woro Informational
Jl alsundorstood tho Issuo
Total 07
1.3 Tho Majority, sixty-six (00
currant Fodoral llalts/raqu
In coroals but proforrad rol
of tho comnenters supportod tho
rements and luggtitad no changa.
Specifically, thoy supportod retaining currant NIC Units on sugar
ying on Individual tailoring rathar
than Padaral regulations for othor Units.
1.4 Tho nost frequently nentlonod recommendation from the twenty (20)
comnenters who supportod retaining currant Federal
11n1ts/raqu1renents with exceptions suggested minor changes to:
• control fat for participants over 2 years of age and those
with weight problems, salt and/or sodlun, sugar In cereals
and artificial colors, flavors and sweeteners
6.0 Three (3) Industry connenters opposed rotelnlng the current Federal
Units/requirements by suggesting:
• removing or Increasing the Unit on sugar In NIC-eligible
cereals on the basis of lack of scientific evidence to
support the current Unit.
6.6 Eight (0) connenters provided Informational comment! only and did
not support or oppose the Issue.
6.7 No (0) commenter misunderstood the Issue.
17
V3
#58-3198-1-006
ISSUE #7: RETAIN CURRENT FEDERAL CRITERIA FOR CULTURAL FOOD SUBSTITUTIONS
7.1 A total of seventy-five (75) commenters addressed this Issue. The
number of letters received by organization are as follows:
33 Geographic State Agencies
2 Indian State Agencies
24 Local Agencies
2 State Agency Staff
2 Other State Local Agencies (non WIC)
2 Industry
9 Public Interest Groups
_1 General Public
Total 75
7.2 The comments were distributed as follows:
11 in support
15 in support with exceptions
36 opposed
12 were informational
_1 misunderstood the Issue
Total 75
7.3 Of the eleven (11) who supported retaining the current regulations,
comments, If any refer to the need to stay cost conscious. One
Indian State Agency In Florida stated that "for our tribe, current
substitutions are adequate..."
7.4 Of those fifteen (15) supporting the current regulations with
exceptions, barring Incidental comments, most supported the
recommendations of the NAWD. The others argued for more
flexibility 1n the criteria regarding culturally driven
substitutions.
7.5 Of those thirty-six (36) opposed to the current regulations, the
leading theme can be summarized as a need for greater flexibility
In setting criteria for substitution, disregarding the cost and
nutritional value of any particular food Item and applying the
nutritional and cost limits to the total food package. Most
comments referred to the lactose Intolerance of many minority
populations and the waste associated with WIC food that Is not
consumed due to this problem.
Specific comments Include:
• set an 80 per cent limit compared to the WIC food that
substitute foods must meet
• provide homeless pregnant women with food coupons (vouchers)
to be used In delicatessens and fast food restaurants (to
18
K4
#58-3198-1-006
purchase fro* salad bant Juices), ilnca food preparation 1i
noarly Impossible for this group
• txpand tht typos of food that can bo offorod by applying
tho criteria of acceptability and nutritional equivalence
only to tho total food package
• food substitutions should also Include criteria of local
availability that nay override the cost criteria
• food substitution criteria should bo developed on tho State
level and based on local noeds
• allow tho following additional foods as cultural
substitutions:
sweetened yogurt; calcium fortified orange Julcoi
fresh neat} tofu and cheese, all as replacements for
mil lu
enriched rice and cornmeal, as substitutes for cereal
0 design special food packages for homeless
• one (1) commentor suggested a specific altomatlvo food
package for Asian populations and another (1) for Hispanic
populations
7.6 Those twelve (12) whose comments were Informational concentrated on
the need to have the same criteria nationwide superseding any State
restrictions.
• Surveys are needed to establish tho scope of the need for
substitutions to overcome cultural food barriers.
• Training of nutrition professionals regarding cultural
Impact of food Items, food choices, food preparation etc. 1s
yry much needed.
• Overall, the milk aspect of tho MIC food package should be
changed. Since the U.S. comprises many people from all over
the world, NIC Programs should be set up In a client
oriented way (LAS)
• There 1s concern about MIC not reaching vegans
7.7 Tho one (1) commonter that reflected a misunderstanding of the
Issue of cultural food substitutions related the broader Issue of
allowing fruits and vegetables as substitutions during periods when
farmer's markets are available, which might have soaie Incidental
benefit in Increasing food choices for certain cultural groups.
19
«/5
APPENDIX D
GUXDILXNIS WOH NXNIMUN CONTENT OP
PROPOHD TICMNXCAL PAPIM
(APRIL 10, 1991)
Hio
APPENDIX D
OUIDILIHES FOR MJHMK OaTONT OF PRQP062D TECHNICAL PAPERS
Taohnioal Inv #i—Ravisw Xasua #1, svtoiaaua flat
Mat avidanoa mxiatm to support or oontraindioata tha oontinuanoa of tha fiva
currant targst nutrianta (hitfi-quality potato, iron, oalaim, and vitamina A
and C) in tha MIC food paokagasf
ma thami of thin taohnioal p«par will too a aunaary of an •valuation of
currant aoiantifio avidanoa to support or oantralndioata tha oontinuanoa of
tha fiva ourrant taryat nutrianta In tha NIC food padcagaa.
xnoluda a diaeuatlon of tha aoat currant fIndingi of any national nutrition
and othar data ralavant to nutrianta aoat lacking in tha dlata (or of
to tha haalth) of tha MIC taroat population.
Taohnioal Papar #a-*aviaw Zaaua #i# fublasua #lbi
What, if any, changas in or additions (».g., thiamin, rlboflavin, or lino) to
tha mo taryat nutrianta ahould ba oonaidarad and why?
lha than* of this taohnioal papar will ba a suajuary of tha aoiantifio avidanoa
to support or oontraindioata raooanandationa for targating additional
nutrianta (i.a.# folio aold, ilno, fiber, vitamin *-€, aagnaalun, ooppar,
thiamin, hana iron and rlboflavin) and Oaloriaa in tha wic food padkagaa.
moiuda rlboflavin in tha Hat of additional nutrianta to ba oonaidarad ainoa
tha »^frn1 BMlataC Notioa apaoifioally mantionad it. (MWBi m tha auraary
of MManalyaia, indloata whether any ooaaantara raooanandad rlboflavin aa
a MIC taroat nutriant.)
Tecflmioal Papar fJ-ftarie* zaaua ft, tUbiMttt #2ai
What avidanoa axiata to aupport or oontraindioata tha ourrant NIC rood
package* aa nutrlant-danaa and bioavailabla sources of tha rannssanrtal MIC
targat nutrianta?
In light of tha avidanoa praaantad in tha first two taohnioal papara, tha
thaaa of this taohnioal papar will ba an evaluation of tha nutriant profilaa
and bioavailability of tha ourrant MIC foods and food packages ralatad to tha
proviaion of valid ronrwmnln) taroat nutrianta.
V
jiiVliaaa ths extent to which Iron is bioaveilabla in the current Wic foods and
food packages. Also include dlsoussion on:
the laportonos of trcn-fortiflad infant formula in Ibod Packages Z
and ZZ;
whether ths iron in KXD-sligihls oarsals for adults and infants is
bloevailabls in the presence or abssnos of a vitamin e-rich juice;
and
a oafSBiaBB of ths iron bioavallability of dry infant caraal
vat pack infant oaraal.
-Review Zssna fi9 ftsumous #20:
What, if any, foods should ha introduced as nutrient-dense and taioavailabls
of the nriraiienlert mc target nutrients and why?
in light of the evidence jwsaajsnl in the first three teohnieal papers, the
these of thia technical paper will he en evaluation of the nutrient profiles
end bioavailebility of the edrtltlonal foods which night he appropriate
edditions or alternatives to the currant HXC foods and My*
feohnioal leper f% ■siiaw Zasue #3t
Do the currant aaadjasB Monthly alloyenoee c* MIC foods
the nutritional neads of the six different participant groups for whom they
3he these of this technical paper will be an ewtOuation of how wall the
current NIC food packages supply the valid raooassnded target nutrients
relative to the nutrient requirements and intakes of the six different WIC
Particularly focus on whether food Package V for hraastfeeding
nutritionally adequate.
Also address whether the following ssadaun monthly allowances of the current
NIC foods era nutritionally appropriates
formula, for infants in Food Packages Z and n; and
juice for infants in Pood Package ZZ.
2
4<*
As tin permits, this technical paper My induae discussion on tha
nutritional adequacy of tha WIC food packagee for tha following other
subgroup! of participente:
partially breastfsd infants
children subdivided ky oge (identifying apprepriata ago ranges)
pregnant adolescents, breastfeeding adolasoants and pestpartua
nonbreaatfeeding adolescence (as ssparata groups or oaubinad with
other participant groups)
Technical Paper #«—Review Zasua H, tubiesua #6ai
Are there valid raasons for liadting tha dietary intakes of total fat,
saturated fat and cholesterol by the NIC target population end why?
The these of this technical paper will be a msmary of the ecientifio svidanoa
on whether Uniting total fat, saturated fat and cholesterol in tha diets of
tha WIC target population ie nutritionally warranted end why.
Include discussion about tha contributions of total fat, saturated fat and
cholesterol that tha currant NIC foode (espacdally eggs and oheeee) and food
sake to the total diate of the NIC texget population.
Also discuss tha role that substituting chases foods, reduced-fat chaoses, or
reduoaa-chcOestarol rhoaaao for tha current WJC-ollglhlo chaoses (ire.,
American Pasteurised Process, Brick, Cheddar, Colby, Monterey Jade, Moiiarella
(part akin or whole), MAenster, Provolons end Swiss) say have in reduolng the
total fat, saturated fat and cholesterol content of the WIC food packagee.
(NQSli Sheee eperrifin types of ohaeeaa were originally seleoted on the basis
of their protein and oaldue content, substitute anrtlflart ohaaaas should be
nutritionally rarpirahle with regard to thass two target nutrients.) Include
an evaluation of the nutrient profiles and bicevailability of any renrnranrtal
modified oheeee substitutes.
Technical Paper #7—Review zasua H, ■ubieeue #abi
Are thara valid reasons for Uniting tha dietary Intake of aodiua by the Hie
target population and why?
Ohe thsoa of this technical paper will be e suonaxy of the ecientifie evidence
on whether Uniting aodium in the diets of the WIC target population Is
nutritionally warranted end why.
Include discussion about tha contribution of aodiua that the current IOC foods
(especially cheese end adult cereals) and food packages sake to the total
diate of the KXC texget population. Also discuss the role that substituting
raducad-eodiue ohaaaas and low-eodiue oareala say have In reduolng the total
oodiue oontsnt of the WIC food packages.
W
Ssobnloal Paper #•—Review -lesua #«, Bubissus #6es
An there wild XIBIOM far Halting the dietary intake of artificial flavors
and colors by tha wic target population and why?
Ths than* of this technical paper will ba a sunmry of the aoiantifio avldanoa
an whether laaitlaf; artificial colors and flavors In the dlata of tha WIC
target population la nutritionally warranted and why.
Discuss whether hyparaotivlty (or hyperkinesis) In childran la influenced by
ingesting artificial colon, artificial flavors or other food additivaa.
Teohnioal Paper ft—levies zaaua #«, e\fclssue #sds
Are thara valid reasons for Halting tha dietary intakes of artificial
aaastsaaal (e.g,, aapartaaa and saccharine) and natural sugars by tha NIC
taroat population and why?
tt» than* of this technical paper will be a sunaary of tha aciantlfio evidence
on whether Halting artificial awootonare and natural augara in the diets of
tha NIC taroat population Is nutritionally warranted and why.
Address the aasociation between sugar in breakfast cereals (e.g., pLeoweoteiad
varieties) and dental problsaa in children.
Teohnioal Paper #10—Ssvisv Issue #71
Io what extent Is lactose intolerance a significant problsa asong different
ethnio groups, e.g., Aslant, Klspanics, Aaarioan Indiana and Alaskan Natives?
The these of this teohnioal paper will be a sunaary of the aciantific evidence
en the incidence of lactose intolerance among tha stated different ethnic
include discussion about the safety, effectiveness, and appropriate use of
oalciua-fortifisd juices for the NIC target population In tha context of
addressing the special needs of the cited ethnio groups.
Technical Paper #11 Separate Issue:
What adjustments can be aade in the current NIC food packages to better
aoooBaodate the special needs of the hmeleea and these without
or cocking facilities?
She theaa of this technical paper will be a discussion of the suggested*
alterations in the currant NIC food packages;
ready-to-eat fans of the current NIC foods; end
substitutes for the current NIC foods.
4
50
include an •valuation of the nutrient profile* and bioavaliability of any
foods raaoasandsd aa appropriate alternatives to tfaa current IOC foods.
Alao discuss tfaa types of packaging aoat appropriate for tha NIC foods to be
provided to the hnwlaaa and those without refrigeration or cooking
facilities.
51
APPENDIX E
NIC FOOD PACKAGE
TECHNICAL PAPERS
(JUNE 4V 1991)
52
APPENDIX E
WIC POCD PACX1GE TECHNICAL PAPERS
(6/4/91)
#1 What evidence exists to support or contraindicate the continuance of the
five current target nutrients (high quality protein, iron, calcium and
vitamins A and C) in the NIC food packages?
#2 What, if any, changes in or additions (e.g., thiamin, riboflavin or
zinc) to the NIC target nutrients should be considered and why?
#3 What evidence exists to support or contraindicate the current NIC food
packages as nutrient dense and bioavailable sources of the recawsnded
NIC target nutrients?
#4 What, if any, foods should be introduced as nutrient-dense and
bioavailable sources of the recommended NIC target nutrients and why?
#5 Do the current —rf— monthly allowances of WIC foods appropriately
address the nutritional needs of the six different participant groups
for whom they were designed?
#6 Are there valid reasons for limiting the dietary intakes of total fat,
saturated fat (SFA) and cholesterol by the NIC target population and
why?
#7 Are there valid reasons for limiting the dietary intakes of sodium by
the NIC target population and why?
#8 Are there valid reasons for limiting the dietary intakes of artificial
colors and flavors by the NIC target population and why?
#9 Are there valid reasons for limiting the dietary intakes of artificial
swoctams and natural sugars by the NIC target population and why?
#10 To what extent is lactose intolerance a significant problem among
different ethnic groups, e.g., Asians, Hispanics, American Indians and
Alaskan Natives?
Ohe attached technical papers were prepared by Pennsylvania State University
under Cooperative Agreement #58-3198-1-006 with FNS to assist the Agency in
conducting a review of the appropriateness of the NIC food packages. These
papers address specific technical nutrition issues of concern to USDA which
are directly related to the issues identified in the Federal Register Notice
for the review.
y3
APPENDIX F
MIC FOOD PACKAGE
TECHNICAL PAPERS
JUNE 18, 1991
$H
APPENDIX F
WIC FOOD PACKAGE TECHNICAL PAPERS
(6/18/91)
#1 What evidence exists to support or contraindicate the continuance of the
five current target nutrients (high quality protein, Iron, calcium and
vitamins A and C) 1n the WIC food packages?
#2 What, If any, changes In or additions (e.g., thiamin, riboflavin or
zinc) to the WIC target nutrients should be considered and why?
#3 What evidence exists to support or contraindicate the current WIC food
packages as nutrient dense and bioavailable sources of the recommended
WIC target nutrients?
#4 What, if any, foods should be Introduced as nutrient-dense and
bioavailable sources of the recommended WIC target nutrients and why?
#5 Do the current maximum monthly allowances of WIC foods appropriately
address the nutritional needs of the six different participant groups
for whom they were designed?
#6 Are there valid reasons for limiting the dietary Intakes of total fat,
saturated fat (SFA) and cholesterol by the WIC target population and
why?
#7 Are there valid reasons for Uniting the dietary Intakes of sodium by
the WIC target population and why?
#8 Are there valid reasons for limiting the dietary Intakes of artificial
colors and flavors by the WIC target population and why?
#9 Are there valid reasons for limiting the dietary Intakes of artificial
sweeteners and natural sugars by the WIC target population and why?
110 Are there valid reasons to recommend that dietary fiber be targeted In
the WIC food packages?
#11 To what extent 1s lactose Intolerance a significant problem among
different ethnic groups, e.g., Asians, Hispanics, American Indians and
Alaskan Natives?
?5
APPENDIX G
COMPARISON OF 1980 AND 1989
RECOMMENDED DZETARY ALLOWANCES
#
#58-3198-1-006
Comparison of the 1980 and 1989 Recommended Dietary Allowances (RDA)
for Infants
Infants (0.0-0.5 years) Infants (0.5-1.0 years)
Nutrient 1980 1989 1980 1989
RDA RDA Change RDA RDA Change
Protein 13.2 13 19.8 20
Vitamin A (/ig
Vitamin D (jig
420 375 -45.0 400 375 -25.0
10 7.5 -2.5 10 10 none
Vitamin E (mg 3 3 none 4 4 none
Vitamin K (/*g * 5 * ♦10 *
Vitamin C (mg 35 30 -5.0 35 35 none
TMamin (mg) 0.3 0.3 none 0.5 0.4 -0.1
Riboflavin (mcI) 0.4 0.4 none 0.6 0.5 -0.1
Niacin (mg) 6 5 -1.0 8 6 -2.0
Vitamin B6 (mg
Folate (pg)
) 0.3 0.3 none 0.6 0.6 none
30 25 -5.0 45 35 -10.0
Vitamin B12
Calcium (mg)
0.5 0.3 -0.2 1.5 0.5 -1.0
360 400 440.0 540 600 460.0
Phosphorus (mc1) 240 300 460.0 360 500 4140.0
Magnesium (mg] 50 40 -10.0 70 60 -10.0
Iron (mg) 10 6 -4.0 15 10 -5.0
Z1nc (mg) 3 5 •f2.0 5 5 none
Iodine (/ig) 40 40 none 50 50 none
Selenium lug) * 10 • * 15 *
*RDAs for vitamin K and selenium were established for the first til
1989 revision of the RDAs.
In the
1A 6 kg infant was used as the reference to establish the protein 1980 RDA for
infants (0.0-0.5 years).
2A 9 kg Infant was used as the reference to establish the protein 1980 RDA for
Infants (0.5-1.0 ye*rs).
57
#58-3198-1-006
Comparison of the 1980 and 1989 Recommended Dietary Allowances (RDA) for children
1-3 years 4-6 years 7« 10 years
Nutrient 1980 1989 1980 1989 1980 1989
RDA RDA Change RDA RDA Change RDA RDA Change
Protein (g) 23 16 -7 30 24 -6 34 28 -6
Vitamin A (fig) 400 400 none 500 500 none 700 700 none
Vitamin D (jig) 10 10 none 10 10 none 10 10 none
Vitamin E (mg) 5 6 +1 6 7 +1 7 7 none
Vitamin K (jig) * 15 * * 20 * * .1 *
Vitamin C (mg) 45 40 -5 45 45 none 45 none
Thlamln (mg) 0.7 0.7 none 0.9 0.9 none 1.2 1.0 -0.2
Rlboflavln (mg) 0.8 0.8 none 1.0 1.1 +0.1 1.4 1.2 -0.2
Nlacln (mg) 9 9 none 11 12 +1.0 16 13 -3
Vitamin B6 (mg)
Folate (/ig)
0.9 1.0 +0.1 1.3 1.1 •0.2 1.6 1.4 -0.2
100 50 -50 200 75 -125 300 100 -200
Vitamin B12 (/ig) 2.0 0.7 -1.3 2.5 1.0 -1.5 3.0 1.4 -1.6
Calcium (mg) 800 800 none 800 800 none 800 800 none
Phosphorus (mg)
Magnesium (mg)
800 800 none 800 800 none 800 800 none
150 80 -70 200 120 -80 250 170 -80
Iron (mg) 15 10 -5 10 10 none 10 10 none
Zinc (mg) 10 10 none 10 10 none 10 10 none
Iodine (/ig) 70 70 none 90 90 none 120 120 none
Selenium (/ig) * 20 * * 20 * * 30 *
*RDAs for vitamin K and selenium were established for the first time In the 1989 revision of the RDAs.
GV
■mi
#58-3198-1-006
Comparison of the 1980 and 1989 Recommended Dietary Allowances (RDA) for
pregnant and lactatlng women
Pregnant Women Lactatlng Women
Nutrient 19801 1989 19801 1989
RDA RDA Change RDA RDA
1st 6 mo Change
Protein (g, 74 60 -14 64 65 +1
Vitamin A m 1000 800 -200 1200 1300 +100
Vitamin D m 10 10 none 10 10 none
Vitamin E mg 10 10 none 11 12 +1
Vitamin K Mg * 65 * * 65 *
Vitamin C mg 80 70 -10 100 95 -5
Thlamln (mg) 1.4 1.5 +0.1 1.5 1.6 +0.1
Rlboflavln (mc1) 1.5 1.6 40.1 1.7 1.8 +0.1
Nlacln (mg) 15 17 +2.0 18 20 +2.0
Vitamin B6 (mg ) 2.6 2.2 -0.4 2.5 2.1 -0.4
Folate (/ig) 800 400 -400 500 280 -120
Vitamin B12 (Mg) 4.0 2.2 -1.8 4.0 2.6 -1.4
Calcium (mg) 1200 1200 none 1200 1200 none
Phosphorus (mc|) 1200 1200 none 1200 1200 none
Magnesium,(mg] 450 320 -130 450 355 -95
Iron (mg)2 30 15
Zinc (mg) 20 15 -5 25 19 -6
Iodine (/ig) 175 175 none 200 200 none
Selenium (/tg) * 65 * 75 75
*RDAs for vitamin K and selenium were established for the first time In the
1989 version of the RDAs.
11980 RDAs for pregnant and lactatlng women were based on the 23-50 year old
female age group.
21980 RDAs recommended the dally use of 30-60 mg supplemental Iron.
b1
IBB 3198 1 006
Review of NIC Food Package*
Tochnlcal Papor II
!. REVIEW ISSUE II
What ovldonco exists to aupport or contralndlcate tha contlnuanct of iho
five currant target nutrlanti (high <iual11
vitamin* A and C) 1n tho MIC food packagoi
II. SCIENTIFIC EVIDENCE
A. Introduction
targot nutrlant* quality protoln, Iron, calcium and
Phyalologlcal requirements for nutrlant* are high In reproducing
woman. Infanta and young children because the nutrient! muit function in
growth and development as well as In maintenance. Insuring optimal
nutrient Intakes during these vulnerable periods of life is paramount to
prevent Immediate and long-term adverse health outcomes.
National statistics on oregnancy outcome are cause for great
concern and signal the need for Improvement. In 1117, the Infant
mortality rate In the U.S. was 10.1/1,000 live births, the lowest ever
recorded (NCHS, 1110). Yet, the U.S. ranks Itnd 1n the world. There 1s
a significant discrepancy between mortality of white Infants (1.1/1,000)
and of black Infants (17.1/1,000). Moreover, from 1171 to 1117, the
ratio of black-to-white Infant mortality rates actually Increased
because of a higher average percent decline for white Infants (1.6*)
than for black Infants (l.lft). Of all Infanta who die 1s the first year
of life. 60S are low birth weight (< 2,BOO g) and 40ft of these are vary
low birth weight (< 1,100 g). Low birth weight Infants are not only it
greater risk of dying but also of developing long-term disability.
Early prenatal care (during first trimester) has been shown to reduce
the risk of having a low-birth walght Infant. While there Is ample
evidence that nutritional status of the mother before and during
pregnancy has a direct Influence on maternal health and Infant growth
and development, the extent to which maternal nutritional variables
contribute to these alarming statistics 1s not known because largo
scale, prospective Intervention trials have not been undertaken.
National statistics on the prevalence of childhood growth
retardation (helght-for-age below the Sth percentlle of children In the
National Center for Health Statistics' reference population) among low
Income children 1a likewise cause for concern (OKHS. 1990). Retardation
in linear growth in preschool children 1s an overall Indicator of health
and development especially dietary adequacy. The prevalence of growth
retardation 1s up to lift among some age and subgroups of low-income
children (Table 1.1). The prevalence of short stature 1s especially
high for Asian and Pacific islanders aged It to It months, Hispanic
children up to age 14 months and black Infants In the first year of
Ufa. Reduction In growth retardation among low-Income children aged S
and younger to less than 10ft has been Identified as a national public
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health objtctlvt for tht year 2000 and Improvtd nutrition 1s cltod as
the priority Intervention stratagy.
The national statistics briefly summarized above serve to
undarscora the naad for nutritional Intervention such as that provided
by tha Special Supplemental Food Program for Women, Infants and Children
(WIC). According to U.S. Department of Agriculture data, tha WIC
Program served 4.3 million Infants, children, and pregnant,
breastfeeding and postpartum woman In Fiscal Year 1989. This number was
about 55 percent of the population that Is potentially eligible to
participate In tha WIC Program. The WIC Program provides food packages
o tha most nutritionally vulnerable segments of our population and art
designed to furnish those nutrients most likely to be limiting and with
which adverse health and/or nutritional consequences are linked. The
nutrients currently targeted In this program are protein, calcium,
vitamins A and C and Iron. In this paper, available evidence to support
or refute continuance of these target nutrients will be reviewed.
8. Plttirv Stitm of U.S. Prmnint and Lictttlnq Mo— ind Inftnti
1. Pregnancy
The National Academy of Sciences' Subcommittees on Dietary
Intake and Nutrient Supplements During Pregnancy recently
published a review of tha 11 studies that quantified energy and
nutrient Intakes of pregnant women In tht United States (NAS/IOM,
1990). All reports published since 1978 were selected H they
Included data for energy and at least 4 nutrients. The severe
limitations of available data were highlighted by the
Subcommittee, most notably the lack of representative national
data for pregnant wc*an 1n the U.S. and the fact that of tha 11
available surveys, 8 were focused on low-Income women with tht
parctntagt of WIC participants not specified and whan specified,
they represented the majority of tha sample (56% to 86%). Tha
lack of representative national data results from tha fact that
neither tha National Health and Examination Surveys (NHANES), the
Nationwide Food Consumption Surveys (NFCS), nor the Continuing
Survey of Food Intake by Individuals (CSFI1) Include sufficient
numbers of pregnant women for meaningful analyses, I.e., 116 of
2,910 women In the first wava of CSFII In 1985 (USDA, 1985).
Thus, available Information on the five target nutrient Intakes of
pregnant women In tha U.S. Is substantially Influenced by WIC
participation. On average, results of available dietary surveys
summarized 1n the National Academy of Sciences' report with the
limitations specified above Indicate that pregnant women probably
meet the RDA for protein and vitamins A and C, but are less likely
to meet their RDAs for calcium and iron.
The strong Influence of WIC participation In thasa survey
results are borne out by two recant studies (Rush at al, 1988 and
Suitor at al, 1990). In tha National WIC Evaluation, Rush at al
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(1988) raportad higher dally Intakaa of energy (111 kcal), prottln
(6 a), Iron (3.1 mg), calcium (133 mg) and vitamin C (32 an) but
ilmllar Intakt of vitamin A for MIC participant! compared to non
participant! In tha third trlmeiter of pregnancy. Suitor ot al
(1990) raportad that NIC pcrtlclpanti hid ilgnlflcintly hlghtr
intakti of protaln, calcium and Iron par 1000 kcil thin non
participant! In their Millar lample of Manachuiatti raildanti.
In both of thaia itudlai. tha ralatlva Incraaiai In MIC
pirtlclpinti for moit nutrlanti wara higher than that for energy
reflecting tha greater nutrient damHy of MIC food! compared to
thoio of women'! uiual dleti.
2. LiCialifln
Tha Subcommittee on Nutrition During Lactation of tha
National Academy of Science! recently reviewed available dietary
data on lactatlng woman In tha U.I. publlihed ilnca 1976 (NAS/10M,
1991). Tha limitation! of available Information la llluatntad by
tha fact that only a total of 448 lactatlng woman wara atudlad.
Only ona atudy provided nationally rapraiantitlva data on
lactatlng woman (n-8B) while 18 itudlei provided dita from
nonrepreientatlve lamplai on only I total of 161 preiumably well
nourlihed woman with nearly all of thorn being well-educated
Caucailmi. Ivaluatlon of tha dleti of tha II lactatlng woman
from a nationally repreientatlve aample (USOA'i 1177-71 Nationwide
Food Coniumptlon Survey) wai performed by Krabi Smith and Clark
(1969).who calculated a dietary acoro ai wall ai nutrient adequacy
ratloi1 for lelected nutrlanti and than uiad thaia to calculate
two main adequacy ratloi1, one for overall nutrient adequacy and
tha other to rapraaant what tha authora called problem nutrlanti
(calcium, Iron, mignaalum, and vltamlni A and C). In thli
anslyili, only 1W of tha lactatlng woman itudlad hid lioth high
nutrient adequacy ratloi and high main adequacy ratloi Mean
valuaa raportad for protaln. Iron, calcium ind vltamlni A and C 1n
tha 16 itudlai compiled by tha Subcommittee on Nutrition During
Lactation wara atlaait 80* of tha RDAi (NAS/NRC/IOM, 1919) and,
In many caiei, aubitint 1illy exceeded them.
Tha Subcommittee on Nutrition During Lactation Identified
four itudlai that focuiad on lactatlng woman from varloui
lubgroupi of our population. Thaia ara itudlaa of American
'Nutrient adequacy ratio (NAR) - I lubject'i average dally Intake of a
nutrient divided by tha aga- ind tax ipeclflc RDA for that nutrient.
Nutrlanti Included wara Iron, magnailum, phoiphorui, thlamln, rlboflavln, and
vltamlni B-6, B 12, A and C.
'Main adequacy ratio ■ turn of NARi for lelected nutrlanti divided by tha
number of nutrlanti being aliened.
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Indians (Butte and Calloway, 1981), Vegetarians (Flnley et al,
1985), teenagers (Lisman et al, 1985) and low Income women
(Edozlen et al, 1976). Dietary calcium Intake of lactating
American Indians (n-23) was low and vitamin A Intake was highly
variable. The mean vitamin A Intake of the vegetarians (n-29) was
the highest reported while mean protein Intake was the lowest but
still exceeded the 1989 ROA. Lactating teenagers (n-25) were
reported to have mean dietary Intakes that met or exceeded the
1989 ROAs. The first national evaluation of the Special
Supplemental Food Program for Women, Infants and Children (WIC)
Included 179 post oartum low-Income women of which approximately
75% were lactating since breastfeeding was a necessary requisite
for enrollment In the evaluation at 12 weeks post oartum.
However, the authors of this report did not present maternal
Intake data according to breastfeeding status. In general, the
dietary intakes of this whole sample of women were much lower than
the current ROAs.
The general lack of nationally representative dietary Intake
data for lactating women, particularly for subpopulatlons of U.S.
women Is a serious obstacle for evaluating nutritional status of
this group. Moreover, few lactating women have been Included in
nutrition monitoring activities conducted by the U.S. Departments
of Agriculture and of Health and Human Services (LSRO, 1989). For
example, only 59 of the 2,910 women In the Continuing Survey of
Food Intake by Individuals were lactating. Clearly there Is an
urgent need for nationally representative data on nutritional
ststus of this vulnerable population group.
3. Infants and Children
A summary of four national surveys on food and nutrient
Intakes of Infants 6-12 months of age was recently published
(Ernst et al, 1990). Three of these surveys, the second National
Health and Nutrition examination survey (1976-1980), the Ross
Nutrition Survey (1984) and the U.S. Department of Agriculture
Nationwide Food Consumption Survey (1977-78), provided comparative
data on nutrient Intakes of Infants fed formula and Infants fed
cow milk 1n the second-half of the first year of life. The Gerber
Nutrition Survey (1986) provided nutrient Intake data on Infants
fed formula, cow milk or human milk, or a combination of these.
The results of all four surveys are similar. Infants fed an Iron-fortified
formula generally had median Intakes of all nutrients at
appropriate levels compared to the 1989 RDAs. In contrast,
Infants fed cow milk had a higher percentage of energy provided by
protein and a lower percentage provided by fat. Additionally,
Infants fed cow milk had low Intakes of bloavallable Iron and
llnolelc add. Generally, Infants fed cow milk were given more
table foods and fewer baby foods than Infants fed formula. Data
from the National MIC Evaluation show that WIC participants
consumed significantly higher amounts of Iron, vitamin A and
vitamin C and lower amounts of calcium and protein compared to low
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income control Infants, which reflected the finding that WIC
Infants were consuming more kl local orles from fomul a and fewer
k1 local ones from milk (Rush et ll, 1988).
Recent national survey data on dietary Intakes of children
aged 1-5 (CSFII, 1985 and CSFII, 1986) Indicate no differences
between energy and nutrient Intakes of this population group
according to income. However, these surveys Include WIC
participants. Results show that U.S. children's Man energy
Intake was 100% of the RDA and their Man Intakes of 13 out of 15
nutrients exceeded the RDA. Children's Man Intake of Iron was
84% of the RDA (The Nutrition Monitoring Division, HNIS, 1986,
1987, 1989). Results of the National WIC Evaluation Survey
indicated that children aged 1-5 enrolled 1n the WIC Program have
greater dally Iron (11.1 mg) and vltMln C (103.9 mg) Intakes than
those not enrolled (9.9 mg and 92.1 mg, respectively).
C. Linkages between low or hloh Intakes of current target nutrients
with adverse or beneficial nutritional and/or health consequences.
Of the current target nutrients, the Report on Nutritional
Monitoring In the united States (LSRO, 1989) cited only Iron and calcium
as food coaponents that are recoaMnded for high priority monitoring
status because they represent public health problems In the population.
Both vitamins A and C were nutrients considered to be potential public
health Issues for which further study Is needed. Protein 1s not
considered to be a current public health Issue.
There are serious limitations of available data for assessing
dietary adequacy of pregnant and lactatlng women 1n the U.S.
Representative national data for either of these groups do not exist and
data from local surveys overrepresent low-Income pregnant and affluent
lactatlng women. Moreover, the level of MIC participation Is most often
not specified and when It Is, WIC recipients represent the majority of
low-income populations saapl