Importance of WIC in Improving Fruit and Vegetable Consumption

Laurence Grummer-Strawn

WIC Leadership Forum

Washington, DC

March 5, 2013

Nutrition behaviors

Nutrition

•Underconsumed nutrients –Folate

–Magnesium

–Potassium

–Dietary fiber

–Vitamins A, C, and K

Disease Prevention

Heart Disease Stroke

Hyper-tension

Cancer Diabetes

Coronary Heart Disease Risk Reduction

• >5 servings of FV/day ==> 17% reduced risk of CHD

– (meta-analysis of 13 cohorts)

J Human Hypertension, 2007.

• 4% reduction in CHD risk for each additional portion/day of FV intake

– (meta-analysis of 13 cohorts) J Nutr, 2006

Heart Disease Stroke

Hyper-tension

Cancer Diabetes

Stroke and Hypertension

• >5 servings of FV/day ==> 26% reduced risk of stroke

3-5 servings of FV/day ==> 11% reduced risk of stroke

– Lancet, 2006

• Highest quartile of fruit intake ==> 79% lower odds of being hypertensive (among overweight)

– J Human Hypertension, 2010

Heart Disease Stroke

Hyper-tension

Cancer Diabetes

Cancers

• Higher intake of FV reduced risk of overall cancer

– Cancer Epidemiol Biomarkers Prev. 2008

• 20-70% lower risk of cancers of digestive tract between the highest and lowest levels of vegetable intake

– Nutr and Cancer 2009

• Case studies: lower risk of breast cancer

– Am J Epidemiol, 2010. Int J Cancer, 2009.

Heart Disease Stroke

Hyper-tension

Cancer Diabetes

Diabetes

• 22% reduced risk of diabetes for highest versus lowest quintile of FV intake

–30% reduced risk associated with fruit alone

–20% for vegetables – Arch Intern Med 2008

• 18-26% lower risk associated with a 3-serving-per-day increase of fruit

9-12% reduction with a 1-serving- per-day increase in green leafy vegetables

– Diabetes Care, 2008

Heart Disease Stroke

Hyper-tension

Cancer Diabetes

Energy intake

Each meal contains

1575 kcal/d

Low ED day

High ED Day

Reduce overall energy intake

Promote satiety

Allow to consume “more”

Improve weight status

Policy documents

Recommended intake

Age (years) Vegetables (cups)

Fruits (cups)

Children 2-3 1 1

4-8 1½ 1 to 1½

Females 9-13 2 1½

14-18 2½ 1½

19-30 2½ 2

31-50 2½ 1½

51+ 2 1½

Males 9-13 2½ 1½

14-50 3 2

51+ 2½ 2

Percent of U.S. adults who consumed vegetables at least three times a day

0

5

10

15

20

25

30

35

Percen

t

Education Income

Behavioral Risk Factor Surveillance System, 2009

Percent of infants consuming vegetables at least twice a day, by age and participation in WIC

0

10

20

30

40

50

60

70

2 3 4 5 6 7 9 10.5 12

Percen

t

Age of infant (months)

Infant not on WIC

Infant on WIC

Infant Feeding Practices Study II

Percent of infants consuming fruits at least twice a day, by age and participation in WIC

0

10

20

30

40

50

60

70

2 3 4 5 6 7 9 10.5 12

Percen

t

Age of infant (months)

Infant not on WIC

Infant on WIC

Infant Feeding Practices Study II

Percent of 6 year olds consuming vegetables and fruits at least twice a day, by participation in WIC

0

5

10

15

20

25

30

35

40

45

50

Vegetables Fruits

Percen

t

Age of infant (months)

Infant Feeding Practices Study II

Non-WIC WIC WIC Non-WIC

Correlation between consumption at 12 months and consumption at 6 years of age

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<1X /

day

1 -

<2X / day

> 2X /

day

<1X /

day

1 -

<2X / day

> 2X /

day Percen

t co

nsu

min

g a

t 6

years

of

ag

e

Consumption at 12 months of age

<1X / day

1 - <2X / day

> 2X / day

Infant Feeding Practices Study II

Vegetables Fruits

Intervention Guide

• Food policy councils

• Access and availability in retail stores

• Farm-to-institution programs

• Farmers’ markets

• Community supported agriculture

• Access to f&v in workplace cafeterias

• Access to f&v at meetings and events

• Community and home gardens

• Fruit and vegetable activities in schools

• Emergency food programs

Access to Healthy Food

• USDA, HHS, Treasury

• Focus on Food Deserts

• Loans, grants, promotion

• Evaluation and research

Access to Healthy Food

Source: Gleason et al, 2011

Food Service Guidelines

• Health and Sustainability Guidelines for Federal Concessions and Vending Operations

Key component of state funding

Working with 17 federal departments in National Prevention Council

Implementation in DOD, HHS, and GSA

Developing Operational Guide

Let’s Move!

Farm-to-Preschool

• Collaboration with Natl Farm-to-School Network

• www.farmtopreschool.org

Monitoring

• NHANES

• BRFSS

• YRBS

• NYPANS

• HealthStyles

• State Indicator Report

Healthier Food Retail

Farmers Markets

School/child care rules

Farm-to-school

Food policy councils

Guidelines for Birth-24

• Dietary Guidelines begin at age 2 years

• USDA & HHS gathering science for birth-24 months

• Workshops to define key issues

Communications

• Products promotable –Clarification

–Expansion to meals

National Fruit & Vegetable Alliance

NANA

WIC Call to Action

• Strengthen counseling on fruits and vegetables

• Carefully examine CVV program

• Begin process of food package revision

• Strengthen requirements for WIC vendors

• Create/participate in coalitions

THANK YOU!