Revision 10 Risk Criteria Detail Judith Anderson, DrPH, RD Judith - - PDF document

Risk Code Web Cast 9-9-10 Judith Anderson 1

Revision 10 Risk Criteria Detail

Judith Anderson DrPH RD Judith Anderson DrPH RD

9-9-10 Risk Code Web Cast 1

Judith Anderson, DrPH, RD Judith Anderson, DrPH, RD Michigan WIC Nutrition Coordinator Michigan WIC Nutrition Coordinator andersonjv@michigan.gov andersonjv@michigan.gov

Introduction

 Newest staff member in the Consultation &  Newest staff member in the Consultation &

Nutrition Services Unit

 Diane Traver, RD, CDE, PhD.  Areas of responsibility (Orienting over next 3 months)

 Nutrition Education  Nutrition Risk

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 Nutrition Risk  Nutrition High Risk  Internet Nutrition Education – wichealth.org

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Revision 10 Risk Criteria Changes

September 2010 MI-WIC Release

Notable Revisions: Notable Revisions:

 MI-WIC Policy 2.13A – Nutrition Risk Criteria  MI-WIC Screens  Health & Diet Question Forms  Laminated Forms

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 Medical Conditions & Illnesses  Client Assessment Reference Tool

Revision 10 Risk Criteria Changes

September 2010 MI-WIC Release

Notable Revisions:

 2 New Risk Criteria added to MI-WIC  1 Risk Criteria removed from MI-WIC  A Number of Criteria have additions or

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A Number of Criteria have additions or changes

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Risk Criteria Additions

September 2010 MI-WIC Release

New Risk Criteria

 #304, History of Preeclampsia  #363, Pre-Diabetes

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Risk Criteria Deletion

September 2010 MI-WIC Release

 Deleting Criteria #350 Pyloric Stenosis  Deleting Criteria #350, Pyloric Stenosis

Treated with surgery immediately after birth No nutrition considerations if treated Mortality dropped from 50% to near 0%

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Criteria: Revised Criteria:

 #101, Underweight (Women)  #111, Overweight (Women)  #131, Low Maternal Weight Gain  #133, High Maternal Weight Gain

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 New charts in MI-WIC

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #101, Prepregnancy Underweight

(Pregnant Women)

BMI changed from 19.8 to 18.5 Rationale – Same BMI used for all

women regardless of age

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women, regardless of age

More research is needed for

adolescent categories

New grid in MI-WIC

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #111, Prepregnancy Overweight

(Pregnant Women)

BMI changed from 26.1 to 25.0 Rationale – Same BMI used for all

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Rationale

Same BMI used for all women, regardless of age

New grid in MI-WIC

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #111, Prepregnancy Overweight

(Pregnant Women)

Guidance - Encourage nutrient

dense, high nutritional quality

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, g q y foods; limit or avoid calorie-rich, low nutritional quality foods rather than weight loss

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #131, Low Maternal Weight Gain

(Pregnant Women)

Rationale – Same BMI used for all

women, regardless of age

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, g g

New grid in MI-WIC

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #131, Low Maternal Weight Gain (Pregnant

Women)

 Category A (underweight) pregnant woman

gaining less than 4 pounds per month (same)

 Category B (normal weight) pregnant woman

gaining less than 1.6 pounds per month

 Category C (overweight) pregnant woman

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 Category C (overweight) pregnant woman

gaining less than 2 pounds per month (same)

 Category D (obese) pregnant woman gaining

less than 1 pound per month. (same)

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria:

 #133, High Maternal Weight Gain

(Pregnant Women, BE, BP. NPP)

Rationale – Same BMI used for all

women, regardless of age

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PG - Gain of 6.6 lbs or more per

month

New grid in MI-WIC

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria:

 #133, High Maternal Weight Gain

(Pregnant Women, BE, BP. NPP)

 Category A (underweight) BE, BP, NPP

woman with BMI < 18.5

 - Category B (normal weight) BE, BP, NPP

woman with BMI 18.5 to 24.9

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woman with BMI 18.5 to 24.9

 - Category C (overweight) BE, BP, NPP

woman with BMI 24.9 to 29.9

 - Category D (obese) BE, BP, NPP woman

with BMI > 30 and cut-off more than 20 #

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Risk Criteria Addition

 #302+, Gestational Diabetes

#302 , Gestational Diabetes

 Diagnosed presence of either insulin dependent or diet-

controlled gestational diabetes

 Diagnosed presence of glucose intolerance at onset or

first recognition of pregnancy, whether diet or insulin controlled.

 Self-reported diagnosis by medical professional should

lead to more in-depth questions to validate or involve

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lead to more in depth questions to validate or involve referral to a medical professional. Evaluation of the amount, type, and distribution of carbohydrate eaten, as well as physical activity is recommended.

Risk Criteria Changes

September 2010 MI-WIC Release

New Risk Criteria: New Risk Criteria:

 #304, History of Preeclampsia (PG, BE)

 Pregnancy-induced hypertension  Preeclampsia generally occurs >20th week and

includes protein in the urine.

 Rationale – Cause unclear No medical treatment

Risk Code Web Cast 16 9-9-10  Cause unclear , No medical treatment  Good diet, regular physical activity & lifestyle reduce

risk

 Condition resolves on placenta delivery

 Food Choices - Calcium & Vitamin D help

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Criteria and Categories: Revised Criteria and Categories:

 #335, Multi-fetal Gestation  New Charts for Multi-fetal Pregnancy  #342, Gastrointestinal Disorders  New risk – Bariatric & Post-bariatric

Surgery

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Surgery

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #335, Multi-fetal Gestation

 New Charts for Multi-fetal Pregnancy  Steady weight gain of 1.5 pounds per week, during

2nd and 3rd trimesters is recommended for multi-fetal

 Provisional guidelines for overall weight gain for twin

pregnancy are

Risk Code Web Cast 18 9-9-10  Category B (normal weight) 37-54 pounds total,  Category C (overweight) 31-50 pounds total  Category D (obese) 25-42 pounds total  Triplets 50 pounds total, regardless of initial weight.  4 or more- no provisional guidelines are available

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria: Revised Risk Criteria:

 #342, Gastrointestinal Disorders (PG,

BE, BP, NNP, IBE, IBP, IFF, C1 – C4)

 New risk added – Bariatric & Post-bariatric

(weight-loss) Surgery

 Lifetime vitamin-mineral supplementation due to

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pp lower food intake & absorption  Manually assigned risk criteria  Added to MI-WIC and laminated Medical

Conditions & Illnesses form

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Criteria:

 #345+, Hypertension, Chronic and

Prehypertension

 In addition to diagnosed hypertension

 Added to laminated form

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 Added to laminated form  Risk must be added manually  Clients with blood pressure reading between

130/80 and 139/89 mn Hg

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Risk Criteria Changes

September 2010 MI-WIC Release

New Risk Criteria:

 #363, Pre-Diabetes (PG, BE, BP)

Rationale – Diet & Physical Activity primary

interventions to prevent progression

Validate self-diagnosis with medical

diagnosis - Diagnosed Impaired Fasting Gl (IFG) I i d Gl

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Glucose (IFG) or Impaired Glucose Tolerance (IGT)

High risk for Type 2 Diabetes, CVD Risk must be added manually

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Criteria: Revised Criteria:

 Milk substitute, contaminated foods and

vitamin/mineral changes in MI-WIC and Policy 2.13A

 #411, Inappropriate Nutrition Practices for

Infants

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Infants

 #425, Inappropriate Nutrition Practices for

Children

 #427, Inappropriate Nutrition Practices for

Women

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria:

 MI-WIC and Policy 2.13A

 #411, Inappropriate Nutrition Practices for Infants  Raw sprouts/tofu separated on Health & Diet

Questions and on Nutrition History Screen #16 in MI- WIC - 411.5

 IBP, IFF Milk storage - Nutrition History Screen #8 in

MI-WIC; 2 hours to 1 hour & Refrig > 48 hours if powder - 411 9

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powder - 411.9

 Vitamin/mineral changes - Nutrition History Screen

#12 in MI-WIC to vitamin D supplement (BE, BP) if not supp or 1 L fortified formula - 411.11

 Client Assessment Reference Tool & H & D Questions

Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria:

 MI-WIC and Policy 2.13A

 #425, Inappropriate Nutrition Practices for Children  C1-4 Milk substitute rice, soy, etc - Nutrition History

Screen #10 in MI-WIC; - 425.1

 C1-4 - Raw sprouts/tofu separated on Health & Diet

Questions and on Nutrition History Screen #11 in MI- WIC - 425.5

 Vit

i / i l h N t iti Hi t S

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 Vitamin/mineral changes - Nutrition History Screen

#13 in MI-WIC to vitamin D supplement (C1-4) if not supp w/ 400 IU Vit D or 1 L (1 qt.) fortified milk - 425.8

 Client Assessment Reference Tool  H & D Questions

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Risk Criteria Changes

September 2010 MI-WIC Release

Revised Risk Criteria:

 MI-WIC and Policy 2.13A

 #427, Inappropriate Nutrition Practices for

Women

 PG, BE, BP, NPP  Vitamin/mineral changes - Nutrition History

S # C S

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Screen #13 in MI-WIC – Iodine Supplement daily - 427.4

 Client Assessment Reference Tool  H & D Questions

 Thank you!

Thank you!

 Thank you!

Thank you!

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Questions? Questions?

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