The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population. To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. This, the second report of this series, provides a summary of the work of phase I of the study, and serves as the analytical underpinning for phase II in which the committee will report its final conclusions and recommendations. Table of Contents Front Matter Summary 1 Introduction and Background 2 The WIC Participant Experience 3 Approach to the Task 4 Nutrient Intakes of WIC-Eligible Populations 5 Food Intake of WIC-Eligible Populations 6 Nutrition-Related Health Risks in the WIC Population 7 Promotion, Motivation, and Support of Breastfeeding with the WIC Food Packages 8 Meeting Diverse Dietary Needs and Preferences: Considerations for the WIC Food Packages 9 Background and Approach to Considering Food Package Options 10 Food Expenditure Analysis 11 Findings and Conclusions Appendix A: Acronyms and Abbreviations Appendix B: Glossary Appendix C: Comparison of Institute of Medicine 2006 Recommendations and Regulatory Implementation Appendix D: Composition of the WIC Food Packages Appendix E: The U.S. Department of Agriculture's Food and Nutrition Service Funded Studies Describing the Effect of the 2009 WIC Food Package Changes Appendix F: Changes in the WIC Food Packages and Program Participation: Methods Appendix G: Literature Findings on Barriers and Incentives to WIC Participation and Redemption Appendix H: Workshop Agendas Appendix I: Evidence Review Strategy Appendix J: Dietary Reference Intake Values and Nutrients and Foods Analyzed Appendix K: Diet Quality Indexes Appendix L: Household Food Expenditure Analysis Appendix M: Regulatory Impact Analysis Approach Appendix N: Committee Perceptions of the WIC Experience Appendix O: Summary Results from the Diet Quality of American Young Children by WIC Participation Status Appendix P: Nutrient Intake of WIC and WIC-Eligible Populations Appendix Q: Food Intake of WIC and WIC-Eligible Populations Appendix R: Summary of National Dataset Characteristics Applied in the Evaluation of Health Risks Appendix S: Breastfeeding Literature Findings Appendix T: Chronology of Statutes Pertaining to the Definition of WIC Supplemental Foods Appendix U: Committee Biosketches

Review of WIC Food Packages: An Evaluation of White Potatoes in the Cash Value Voucher assesses the impact of 2009 regulation to allow the purchase of vegetables and fruits, excluding white potatoes, with a cash value voucher on food and nutrient intakes of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) population and to consider whether white potatoes should be permitted for purchase with the voucher. This report considers the effects on diet quality, the health and cultural needs of the WIC population, and allows for effective and efficient administration nationwide in a cost-effective manner. Review of WIC Food Packages: An Evaluation of White Potatoes in the Cash Value Voucher recommends that the U.S. Department of Agriculture should allow white potatoes as a WIC-eligible vegetable, in forms currently permitted for other vegetables, in the cash value voucher pending changes to starchy vegetable intake recommendations in the 2015 Dietary Guidelines for Americans. Table of Contents Front Matter Summary Letter Report Appendix A: Acronyms and Abbreviations Appendix B: Statement of Task Appendix C: Workshop Agendas Appendix D: Literature Search Strategy Appendix E: Dietary Reference Intakes Appendix F: Description of Sensitivity Analysis Scenarios Appendix G: Food Group and Subgroup Intakes Appendix H: Nutrient Intakes Appendix I: Nutrient Profiles Appendix J: Food Group Distributions Appendix K: Healthy Eating Index 2010 Assessment Appendix L: Background Example Data for Sensitivity Analysis Appendix M: Committee Biosketches

This midcourse report provides an initial assessment of how the process used to develop the Dietary Guidelines for Americans, 2020-2025 (DGA) compares to the recommendations in the 2017 National Academies report on redesigning the process for establishing the DGA. It also assesses the criteria and processes for including the scientific studies used to develop the guidelines. The scope of this study was to address the process and not the content of the guidelines. Table of Contents Front Matter Summary 1 Introduction 2 Methodological Approach to the Task 3 Analysis of the Scientific Methodologies, Review Protocols, and Evaluation Processes of the Dietary Guidelines 4 Analysis of the Scientific Studies Used to Develop the Dietary Guidelines for Americans 5 Concluding Remarks Appendix A: Committee Member Biographies Appendix B: Open Session Agendas and Comments Appendix C: Systematic Review Matrix Summary Appendix D: Dietary Guidelines Advisory Committee/Dietary Guidelines for Americans Recommendation Comparison Table Appendix E: Summary of Selected Systematic Review Practices Appendix F: Selected Systematic Review Methodologies 2015 Versus 2020 Appendix G: Systematic Review Questions Addressing Diet-Related Metabolic Diseases Appendix H: Updated Systematic Reviews

In response to a request from Congress, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine conducted a study comparing the process to develop the Dietary Guidelines for Americans, 2020-2025 (DGA 2020-2025) to recommendations included in the previously published National Academies report, Redesigning the Process for Establishing the Dietary Guidelines for Americans. This report describes the findings of the committee and conclusions related to this assessment. Notably, this report does not evaluate the merits of the DGA 2020-2025 but evaluates the process by which they were created relative to the recommendations made in the previously published National Academies report. Table of Contents Front Matter Summary 1 Introduction 2 The Process to Create the Dietary Guidelines for Americans is Both Complicated and Complex: Background and Context for Task 3 3 Methodological Approach to the Task 4 Assessing the Potential Implications of Fully Implementing the 2017 Recommendations to Redesign the Process to Establish the Dietary Guidelines for Americans: Committee Findings and Conclusions 5 Concluding Remarks Appendix A: Committee Member Biographies Appendix B: Elements of the 20202025 Dietary Guidelines for Americans Process Appendix C: Data Sources Used by the 2020 Dietary Guidelines Advisory Committee Appendix D: Open Session Materials

As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women. Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes. Table of Contents Front Matter Summary 1 Setting the Stage for Revising Pregnancy Weight Guidelines: Conceptual Framework 2 Descriptive Epidemiology and Trends 3 Composition and Components of Gestational Weight Gain: Physiology and Metabolism 4 Determinants of Gestational Weight Gain 5 Consequences of Gestational Weight Gain for the Mother 6 Consequences of Gestational Weight Gain for the Child 7 Determining Optimal Weight Gain 8 Approaches to Achieving Recommended Gestational Weight Gain 9 Open Session and Workshop Agendas 10 Committee Member Biographical Sketches Appendix A: Acronyms and Abbreviations, Glossary, and Supplemental Information Appendix B: Supplementary Information on Nutritional Intake Appendix C: Supplementary Information on Composition and Components of Gestational Weight Gain Appendix D: Summary of Determinants of Gestational Weight Gain Appendix E: Results from the Evidence-Based Report on Outcomes of Maternal Weight Gain Appendix F: Data Tables Appendix G: Consultant Reports Index