WIC participants should be given vouchers or coupons for fresh produce totaling $10 per month for each woman and $8 a month per child, the report recommends. The amount corresponds to one to two servings of fruits and vegetables a day.

If implemented, the proposed revisions would be the most substantial changes to the mix of foods offered through WIC since the supplemental nutrition program for low-income women, infants and children was launched in 1974. The recommendations also are the first effort to apply the new Dietary Guidelines for Americans to a national food program.

"Because scientific knowledge about nutrition has greatly increased since the WIC program's inception, and the nutritional challenges facing families have altered significantly, it is definitely time for a change in the foods offered through WIC," said Suzanne P. Murphy, chair of the committee that wrote the report and research professor, Cancer Research Center of Hawaii, University of Hawaii, Honolulu.

"We now know much more about the links between nutrition and chronic diseases; plus, the nation is in the midst of an obesity epidemic. Our proposed revisions would bring the foods provided through WIC up to date with current nutritional science and make it easier for participants to improve their diets and health," she added.

Include Fruits and Vegetables

In 2000, the WIC program served about half of all U.S. infants and about a quarter of children ages 1 through 4, along with many of their mothers.

The costs of providing supplemental food packages as well as nutrition education, breastfeeding support and other assistance to 7.6 million WIC participants a month totaled $4.7 billion in 2003.

In many localities, food "packages" are actually itemized vouchers or checks that participants use to obtain specific foods at participating grocery outlets. The packages have remained largely unchanged since the U.S. Department of Agriculture initiated the program 30 years ago.

One of the most fundamental revisions proposed by the report is the inclusion of a wide choice of fruits and vegetables in the food packages for women and children.

WIC participants should be given vouchers or coupons for fresh produce totaling $10 per month for each woman and $8 a month per child, the report recommends. The amount corresponds to one to two servings of fruits and vegetables a day. When access to fresh produce is limited, WIC state agencies can specify that participating women may choose processed items, such as canned fruits and vegetables, in comparable amounts.

The expansion of the WIC food packages to include fresh produce applies a major recommendation of the new federal dietary guidelines, which call for people to eat more fruits and vegetables daily. The only fruits and vegetables currently provided through WIC are juice for all participants 4 months and older, and carrots for new mothers who breastfeed rather than formula-feed.

Switch to Whole Grains

The committee also proposed that fruit and vegetable baby foods be added to the packages for infants 6 months and older. Baby food meats also should be added to the packages for infants 6 months and older who are primarily breastfed to ensure that their iron and zinc needs are met.

Currently, the only semisolid foods offered through WIC are infant cereals, starting at 4 months. Cereal and other semisolid foods should not be part of the packages for infants until they reach 6 months, the age at which many medical and nutritional experts agree that almost all infants are developmentally ready for such foods, the report says.

The breakfast cereals that have been a key part of WIC food packages for women and children should be whole-grain varieties only, the report says. Some popular breakfast cereals are whole grain, but others do not provide whole grains' health benefits, such as protection against heart disease.

The food packages also should provide whole-grain bread or brown rice, among other options. These additions will help WIC participants meet the new dietary guidelines to get at least three servings of whole grains daily.

Reduce Saturated Fats

To help ensure that these changes are cost-neutral, the committee recommended reducing the amount of juice, eggs, cheese and milk offered through the program.

These reductions are consistent with current dietary guidance, such as the American Academy of Pediatrics' recommendation that young children drink no more than 4 to 6 ounces of fruit juice per day, and the American Heart Association's recommendation that people limit their intake of cholesterol, saturated fat and total fat.

To help participants reduce their saturated fat intakes, the WIC program should offer only milk that contains no more than 2 percent fat in the food packages for women and children over age 2, the report says.

However, children up to 2 years old should receive whole milk because of their developmental need for dietary fat. In addition, the committee recommended that the amount of cheese provided for most participants be reduced from a maximum of 4 pounds per month to no more than 1 pound monthly.

Promote Breastfeeding

To promote the benefits of breastfeeding, the revised food packages for mother-infant pairs who rely on breastfeeding as the primary feeding method should contain greater amounts and a wider variety of foods to be more attractive, the report says.

For example, the package for mothers who primarily breastfeed should include more milk, eggs, cheese and whole grains than the packages for women who formula-feed. The packages for older infants who are given no formula should contain twice the amount of baby food fruits and vegetables than the packages for older infants who receive formula.

The committee called for the WIC program to provide a broader variety of food options and allow more choices to take into account the wide range of dietary and cultural preferences among WIC participants.

There should be few restrictions on participants' choices among fresh produce, the report says. Yogurt should be permitted as a substitute for some of the milk for both women and children, and tofu and soy beverages should be allowed as alternatives to milk for women.

Test Plan in Pilot Programs

Overall, the proposed additions, deletions, and substitutions would make it possible for the WIC program to provide a wider variety of foods without raising the total cost of the food packages, the committee concluded. The average monthly cost per participant currently is estimated to be about $35, which would be approximately the same for the revised packages if all the changes are made.

Recognizing that some of the proposed changes entail significant adjustments and could result in unanticipated effects, the committee recommended that they be tested first in pilot programs before being implemented nationwide. For example, if participants will not drink milk with less fat or eat whole-grain products, then the revised food packages for children and women may inadvertently result in less grain and milk consumption.

The study was sponsored by the U.S. Department of Agriculture. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.