L21 Ready-to-use Therapeutic Foods (RUTF's)

What further research on RUTF's is needed?

- RUTF's have been shown to effectively lead to weight gain, BUT.. - there is a poor understanding of how it influences vitamin and mineral status of children - measurement of outcomes other than weight gain is needed to better understand how RUTF's influence overall health --> eg. immune response, developmental milestones, cognitive abilities, productivity - more research needed on potential plant-based alternatives since reliance on dairy (ie. for plumpy'nut) is expensive and less sustainable

What are the strengths of RUTF's?

- can be readily consumed anywhere - children can be treated at home - nutrient-dense and effectively treats acute malnutrition - easy to eat and palatable - doesn't require water, cooking, or refrigeration (eg. like for milk formula, which can present health risks when there is inadequate WASH) - lasts two years without refrigeration - requires only 150 staff to deliver to 10000 children

What are the limitations of RUTF's?

- expensive - effectively leads to weight gain, but it is not well understood how it influences micronutrient status - may not be effective for severe cases of malnutrition (eg. nutritional edema) where the child doesn't have appetite and therefore needs to be fed by tube

What is the effectiveness of Plumpy'nut?

- in a study based on treatment of SAM and MAM in Malawi, Plumpy'nut had a recovery rate of 89% for children with SAM and 85% for children with MAM - did not have any adverse health effects

How were RUTF's developed?

- inspired by nutella - prior to RUTF's, therapeutic milk formula was extensively used to treat SAM (could be fed orally or nasal-gastrically) - developed as a home-based treatment for acute malnutrition, alternative to F-100 - first widely used in 2005 during the famine in Niger

How do RUTF's impact treatment of severe acute malnutrition?

- makes it more physically accessible - reduces the need for families to go to clinics, which may be far away from their homes, to receive SAM treatment - less staff required to deliver it

What are the limitations of therapeutic milk (eg. F-75, F-100 therapeutic milk)?

- requires extensive number of staff to deliver (eg. 2000 staff were needed to treat 10000 children during the 2002 famine in Angola) - requires families to leave their homes to attend clinics for treatment - children with SAM receiving treatment were in crowded spaces at the clinic, which increases the risk of infection --> since children with SAM are more vulnerable to sickness (due to compromised immune system), this presented an additional health risk

What is Plumpy'nut?

RUTF in the form of peanut paste - typical dose: 200kcal/kg/day for 6-8 weeks = 2-3 sachets/day nutritional value: - 500kcal - 25% peanut butter, oil, sugar, milk powder - contains micronutrients

What are ready-to-use therapeutic foods (RUTF's)?

nutrient-dense packaged foods that are designed to treat acute malnutrition - therapeutic = designed to treat acute malnutrition - can be readily consumed - don't require refrigeration - eg. plumpy'nut (brand name) for peanut paste RUTF

What is the WHO recommendations re. RUTF nutritional composition?

protein - 10-12% of kcal (vs 5-20% for children 1-3) lipids - 45-60% of kcal (vs 30-40% for children 1-3) --> more fat than recommended