Review of WIC Food Packages: Improving Balance and Choice: Final Report (2017)
Chapter: Appendix I: Complementary Feeding: Summary of Information Reviewed
Appendix I
Complementary Feeding: Summary of Information Reviewed
To evaluate complementary feeding of infants in this report, the committee relied on food intake data from three large contemporary datasets: (1) Infant Feeding Practices Study II (IFPS II) (Grummer-Strawn et al., 2008), (2) 2008 Feeding Infants and Toddlers Study (FITS 2008) (Deming et al., 2014), and (3) National Health and Nutrition Examination Survey (NHANES) (Grimes et al., 2015). The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study, (WIC ITFPS II) is currently under way, but only limited results were available in time for this report. A summary of the study designs is presented in Table I-1 and key results are outlined in Tables I-2 and I-3.
TABLE I-1 Study Designs and Characteristics of Selected Reports, IFPS II, FITS 2008, and NHANES 2005–2012
| IFPS IIa | FITS 2008b | NHANES, 2005–2012c | |
|---|---|---|---|
| Design | Longitudinal data collected from the last trimester of pregnancy through infant’s first year of lifed | Cross-sectional evaluation of dietary intake of U.S. children, 0–4 years | Cross-sectional |
| Data Collection Dates | May 2005–June 2007; 6-year follow-up in 2012d | June 2008–January 2009 | 2005–2012 |
| Recruitment | Pregnant women who were part of a nationally distributed consumer opinion panel | Sample frame came from the New Parent Database and the Consumer Database and the Consumer Database from the Experian, Inc. | Complex, multistage, probability sampling |
| Eligibility | Women at least 18 years of age Delivered a singleton infant who was at least 35 weeks gestation and weighed at least 5 pounds at birth Both mother and child were free from conditions that could affect feeding | Household had child 0–47 months | Non-institutionalized U.S. population |
| Sample Size | 4,902 qualified in prenatal period 3,033 qualified in neonatal period 1,807 remained by end of study | 3,273 infants and children | 2,857 children enrollede 2,791 completed the first 24-hour dietary recall 2,740 had reliable dietary recall data 765 infants, 0–5.9 months 854 infants, 6–11.9 months 1,121 toddlers, 12–23.9 months |
| WIC Participants in Sample | 1,112 (36.7%) of enrolled households (mother and/or infant) participated in WIC in the neonatal period 912 (30.1%) of | 794 WIC infants and children 117 infants, 0–5.9 months 84 infants, 6–8.9 months 76 infants 9–11.9 months 238 toddlers, |
Not identified in this analysis |
| IFPS IIa | FITS 2008b | NHANES, 2005–2012c | |
|---|---|---|---|
| enrolled households (mother and/or infants) participated in WIC any time from month 1 to 12 | 12–23.9 months 279 preschoolers, 24–47.9 months |
||
| Data Collection | Mail-based survey Sent monthly approximately 2–7 months postpartum, then approximately every 7 weeks thereafter through 12 months postpartum | Phone-based | Face-to-face interview |
| Dietary Assessmentf | Food frequency table of liquids and solids the infant consumed in previous 7 days Quantities consumed not captured | 24-hour recall and brief questionnaire Second 24-hour recall performed in a subsample, 7–10 days after first (n = 701)h Descriptive findings of unadjusted prevalence are presented for WIC vs. non-WIC participants; analyses used sample weights and groups were compared using t-testsg |
24-hour proxy-recalli Evaluated contributions of foods to energy and nutrient intake |
NOTES: FITS = 2008 Feeding Infants and Toddlers Study; IFPS II = Infant Feeding Practices Study II; NHANES = National Health and Nutrition Examination Survey.
a Overall study design, Fein et al., 2008; CDC, 2014.
b Overall study design, Briefel et al., 2010.
d A year 6 follow-up study of children initially assessed in the IFPS II has been conducted, evaluating links between early feeding practices and various health outcomes (Fein et al., 2014).
e Number represents sample included in the analysis, not entire NHANES sample.
f Information about dietary supplement use was collected in each of the overall study designs, but the three reports on food group intakes did not evaluate supplement use.
g Report-specific analysis, Deming et al., 2014.
h Two days of dietary intake per sampled child was used to calculate usual nutrient intake distributions, Briefel et al., 2010.
i While two 24-hour recalls are part of the NHANES procedures, Grimes et al. (2015) only evaluated intake reported on the first day of recall.
SOURCES: CDC, 2014; Fein et al., 2008, 2014; Grimes et al., 2015.
TABLE I-2 Complementary Food Intake of Infants, Ages 0 to 2 Years, from IFPS II and FITS II
| Food Group | IFPS IIa | FITS 2008b | |||
|---|---|---|---|---|---|
| Age in Months | Percent Consuming in the Previous Week | Age in Months | Percent Consuming on a Given Day | ||
| WIC | Non-WIC | ||||
| Fruit (excluding juice) | 3 | 2.8 | 0–5.9 | 8.6c | 6.4c |
| 6 | 71.3 | 6–11.9 | 69.1 | 75.6 | |
| 9 | 97.0 | 12–23.9 | 62.3 | 83.6d | |
| 12 | 98.4 | ||||
| 100% Juice | 3 | 5.0 | 0–5.9 | 8.2c | 3.8c |
| 6 | 33.4 | 6–11.9 | 46.1 | 28.3e | |
| 9 | 62.8 | 12–23.9 | 61.9 | 52.4 | |
| 12 | 76.9 | ||||
| Vegetables, total | 3 | 1.4 | 0–5.9 | 11.2c | 8.4 |
| 6 | 73.1 | 6–11.9 | 57.7 | 75.6e | |
| 9 | 97.2 | 12–23.9 | 73.5 | 69.5 | |
| 12 | 98.7 | ||||
| Grains and grain products, total | 3 | 18.3 | 0–5.9 | 26.7 | 22.7 |
| 6 | 86.1 | 6–11.9 | 91.5c | 90.3 | |
| 9 | 96.3 | 12–23.9 | 99.5c | 98.4c | |
| 12 | 97.0 | ||||
| Infant cereal | 3 | 18.2 | 0–5.9 | 26.7 | 21.9 |
| 6 | 83.7 | 6–11.9 | 61.8 | 66.9 | |
| 9 | 83.4 | 12–23.9 | 6.9c | 11.4 | |
| 12 | 46.6 | ||||
| Meats and meat substitutesf | 3 | 0.7 | 0–5.9 | 2.8c | 0.0c |
| 6 | 22.0 | 6–11.9 | 64.1 | 53.6 | |
| 9 | 78.4 | 12–23.9 | 93.9c | 94.1 | |
| 12 | 96.6 | ||||
| Cow’s milk, total | 3 | 0.3 | 0–5.9 | 0.0 | 0.0 |
| 6 | 1.2 | 6–11.9 | 13.3 | 9.4 | |
| 9 | 5 3 | 12–23 9 | 86 5 | 81 0 | |
| 12 | . 81.2 | . | . | . | |
| Cow’s milk, whole | NR | 6–11.9 | 10.0c | 7.8 | |
| 12–23.9 | 59.2 | 64.2 | |||
| Cow’s milk, reduced- or low-fat | NR | 6–11.9 | 2.7c | 1.1c | |
| 12–23.9 | 31.8 | 19.7e | |||
| Cow’s milk, nonfat | NR | 6–11.9 | 0.5 | 0.1c | |
| 12–23.9 | 1.0c | 1.0 | |||
| Sweetened beverages | 3 | 1.1 | 0–5.9 | 0.0c | 0.3c |
| 6 | 3.1 | 6–11.9 | 12.3c | 4.5c | |
| 9 | 6.2 | 12–23.9 | 39.6 | 22.0 | |
| 12 | 14.6 | ||||
| Food Group | IFPS IIa | FITS 2008b | |||
|---|---|---|---|---|---|
| Age in Months | Percent Consuming in the Previous Week | Age in Months | Percent Consuming on a Given Day | ||
| WIC | Non-WIC | ||||
| Desserts and candy | 3 | 0.2 | 0–5.9 | 1.7c | 1.1c |
| 6 | 1.5 | 6–11.9 | 22.7 | 24.8 | |
| 9 | 12.3 | 12–23.9 | 63.6 | 55.5 | |
| 12 | 52.2 | ||||
NOTES: NR = not reported.
a Grummer-Strawn et al., 2008.
b Deming et al., 2014 (data reprinted with permission).
c Point estimate imprecise due to small sample size and it being an uncommon or very common response.
d Significantly different from WIC group at 0.01 level by t-test.
e Significantly different from WIC group at 0.05 level by t-test.
f FITS 2008 classified this category as “Meat and other protein sources” and included cheese and yogurt in this category while IFPS II has a separate “Other Dairy” category.
SOURCES: Grummer-Strawn et al., 2008; Deming et al., 2014.
TABLE I-3 Percent of Daily Energy Intake of Complementary Food Groups by Infants Ages 6 to 23.9 Months, NHANES 2005–2012a
| Food Group | Percent of Daily Energy Intake | |
|---|---|---|
| 6–11.9 months | 12–23.9 months | |
| Fruit (excluding juice) | 2.3 | 4.8 |
| 100% Juice | 1.5 | 5.9 |
| Vegetables | NAb | 3.2c |
| Grains and grain products | ||
| Mixed dishes—grain-based | 2.3 | 5.5 |
| Bread, rolls, tortillas | 1.1 | 3.8 |
| Crackers | NA | 2.4 |
| Ready-to-eat cereal | NA | 2.3 |
| Quick breads and bread products | NA | 1.6 |
| Cooked cereals | NA | 1.4 |
| Meats and meat substitutes | ||
| Poultry | NA | 3.6 |
| Cured meats and poultry | NA | 2.5 |
| Eggs | NA | 2.2 |
| Mixed dishes—meat, poultry, seafood | NA | 2.0 |
| Plant-based protein foods | NA | 1.6 |
| Dairy | ||
| Cow’s milk, all fat levels | 3.1 | 22.4 |
| Cheese | NA | 2.6 |
| Yogurt | NA | 1.7 |
| Flavored milk | NA | 1.3 |
| Desserts, sweetened beverages, and savory snacks | ||
| Sweet bakery products | 1.8 | 4.6 |
| Sweetened beverages | NA | 3.1 |
| Savory snacks | NA | 2.4 |
| Candy | NA | 1.3 |
| Other desserts | NA | 1.2 |
NOTES: NA = data not available.
a Intake of human milk and infant formulas not represented in this table.
b All NA notations indicate that data were not presented in Grimes et al. (2015), as intake contributed to less than 1 percent of total energy intake.
c Sum of “White Potatoes” group and “Vegetables, excluding potatoes” group.
SOURCE: Grimes et al., 2015.
REFERENCES
Briefel, R. R., L. M. Kalb, E. Condon, D. M. Deming, N. A. Clusen, M. K. Fox, L. Harnack, E. Gemmill, M. Stevens, and K. C. Reidy. 2010. The Feeding Infants and Toddlers Study 2008: Study design and methods. Journal of the American Dietetic Association 110(12 Suppl):S16–S26.
CDC (Centers for Disease Control and Prevention). 2014. Infant Feeding Practices Study II and its year six follow-up, chapter 2: Neonatal survey. http://www.cdc.gov/ifps/pdfs/data/ifps2_tables_ch2.pdf (accessed December 20, 2016).
Deming, D. M., R. R. Briefel, and K. C. Reidy. 2014. Infant feeding practices and food consumption patterns of children participating in WIC. Journal of Nutrition Education and Behavior 46(3 Suppl):S29–S37.
Fein, S. B., J. Labiner-Wolfe, K. R. Shealy, R. Li, J. Chen, and L. M. Grummer-Strawn. 2008. Infant Feeding Practices Study II: Study methods. Pediatrics 122(Suppl 2):S28–S35.
Fein, S. B., R. Li, J. Chen, K. S. Scanlon, and L. M. Grummer-Strawn. 2014. Methods for the year 6 follow-up study of children in the Infant Feeding Practices Study II. Pediatrics 134(Suppl 1):S4–S12.
Grimes, C. A., E. A. Szymlek-Gay, K. J. Campbell, and T. A. Nicklas. 2015. Food sources of total energy and nutrients among U.S. infants and toddlers: National Health and Nutrition Examination Survey 2005–2012. Nutrients 7(8):6797–6836.
Grummer-Strawn, L. M., K. S. Scanlon, and S. B. Fein. 2008. Infant feeding and feeding transitions during the first year of life. Pediatrics 122(Suppl 2):S36–S42.
