Risk Code Web Cast 9-9-10 Revision 10 Risk Criteria Detail Judith Anderson, DrPH, RD Judith Anderson DrPH RD Judith Anderson DrPH RD Judith Anderson, DrPH, RD Michigan WIC Nutrition Coordinator Michigan WIC Nutrition Coordinator andersonjv@michigan.gov andersonjv@michigan.gov 9-9-10 Risk Code Web Cast 1 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 Nutrition Risk Nutrition High Risk Internet Nutrition Education – wichealth.org Risk Code Web Cast 2 9-9-10 Judith Anderson 1
Risk Code Web Cast 9-9-10 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 Medical Conditions & Illnesses Client Assessment Reference Tool Risk Code Web Cast 3 9-9-10 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 A Number of Criteria have additions or changes Risk Code Web Cast 4 9-9-10 Judith Anderson 2
Risk Code Web Cast 9-9-10 Risk Criteria Additions September 2010 MI-WIC Release New Risk Criteria #304, History of Preeclampsia #363, Pre-Diabetes Risk Code Web Cast 5 9-9-10 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% Risk Code Web Cast 6 9-9-10 Judith Anderson 3
Risk Code Web Cast 9-9-10 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 New charts in MI-WIC Risk Code Web Cast 7 9-9-10 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 women regardless of age More research is needed for adolescent categories New grid in MI-WIC Risk Code Web Cast 8 9-9-10 Judith Anderson 4
Risk Code Web Cast 9-9-10 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 Rationale – Same BMI used for all Same BMI used for all women, regardless of age New grid in MI-WIC Risk Code Web Cast 9 9-9-10 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 , g q y foods; limit or avoid calorie-rich, low nutritional quality foods rather than weight loss Risk Code Web Cast 10 9-9-10 Judith Anderson 5
Risk Code Web Cast 9-9-10 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 , g g New grid in MI-WIC Risk Code Web Cast 11 9-9-10 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 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) Risk Code Web Cast 12 9-9-10 Judith Anderson 6
Risk Code Web Cast 9-9-10 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 PG - Gain of 6.6 lbs or more per month New grid in MI-WIC Risk Code Web Cast 13 9-9-10 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 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 # Risk Code Web Cast 14 9-9-10 Judith Anderson 7
Risk Code Web Cast 9-9-10 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 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 Code Web Cast 15 9-9-10 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 Cause unclear No medical treatment Good diet, regular physical activity & lifestyle reduce risk Condition resolves on placenta delivery Food Choices - Calcium & Vitamin D help Risk Code Web Cast 16 9-9-10 Judith Anderson 8
Risk Code Web Cast 9-9-10 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 Surgery Risk Code Web Cast 17 9-9-10 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 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 Risk Code Web Cast 18 9-9-10 Judith Anderson 9
Risk Code Web Cast 9-9-10 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 pp lower food intake & absorption Manually assigned risk criteria Added to MI-WIC and laminated Medical Conditions & Illnesses form Risk Code Web Cast 19 9-9-10 Risk Criteria Changes September 2010 MI-WIC Release Revised Criteria: #345+, Hypertension, Chronic and Prehypertension In addition to diagnosed hypertension Added to laminated form Added to laminated form Risk must be added manually Clients with blood pressure reading between 130/80 and 139/89 mn Hg Risk Code Web Cast 20 9-9-10 Judith Anderson 10
Risk Code Web Cast 9-9-10 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 Glucose (IFG) or Impaired Glucose (IFG) I i d Gl Tolerance (IGT) High risk for Type 2 Diabetes, CVD Risk must be added manually Risk Code Web Cast 21 9-9-10 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 Infants #425, Inappropriate Nutrition Practices for Children #427, Inappropriate Nutrition Practices for Women Risk Code Web Cast 22 9-9-10 Judith Anderson 11
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