The Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions and anemia in children aged 2-5 years

Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional assistance to low-income women and children in the United States. The WIC food package was revised to align more closely to dietary recommendations in October 2009. The revised package included more fruits, vegetables, whole grains, and low-fat milk. Objectives The objective of this study was to examine the association of the revised WIC package with anemia indicators and iron intake in children. Methods A quasi-experimental difference-in-difference design compared anemia and iron intake variables between WIC (n = 1497 and n = 1626 for anemia and iron intake variables, respectively) and WIC-eligible nonparticipating children (n = 1183 and n = 1322 for anemia and iron intake variables, respectively), aged 2-5 y, before and after the 2009 revisions. The NHANES 2003-2008 and 2011-2018 data represented the period pre- and post-2009 revisions, respectively. Results The 2009 package revisions were significantly associated with reduced probability of anemia (-4.3% points; 95% CI: -7.5, -1.1% points) and nonthalassemic microcytic anemia (-1.7% points; 95% CI: -3.3, -0.1% points) in children from WIC-participating households. The revised WIC package also was significantly related to higher nutrient adequacy ratio (0.04; 95% CI: 0.02, 0.07) and greater probability of meeting the RDA (12.1% points; 95% CI: 3.2, 21.0% points) for iron among WIC participants. Conclusions This study found that the WIC 2009 revisions were associated with lower probability of nonthalassemic microcytic anemia and better adequacy of dietary iron intake, thereby suggesting the beneficial impact of WIC revisions on iron deficiency anemia in children. The current study findings suggest that nutritional policies could play a crucial role in supporting the health of vulnerable children in the United States.