Research Letters

Ready-to-use therapeutic food for treatment of marasmus

Ready-to-Use Therapeutic Food (RUTF) or Ready-to-Use Supplementary Food (RUSF) has been widely used in home-based treatment for severely and moderately acute malnourished children. These programs showed positive results in short term nutritional recovery in children, which were reported in some research settings. Nowadays, the RUTF/RUSF formulation has been improved using a variety of RUTF/RUSF from locally available food ingredients. This paper aims to review the essential aspects of the development and provision of RUTF/RUSF made from local food resources and monitor program effectiveness that warrants the program’s sustainability. The modified recipes of RUTF/RUSF were developed following the international dietary guidelines for the rehabilitation of severely and moderately acute malnourished children. The local production of RUTF/RUSF provided some benefits that include empowering the local community, consideration of the common eating pattern, promoting the diversification of food consumption, strengthening food security, as well as supporting the sustainability of RUTF/RUSF production. Results of the PRISMA-based systematic literature review revealed various ingredient developments and processing techniques which could improve the product characteristics and sensory evaluation. RUTF/RUSF in local food production provided different food carriers (e.g., biscuits, wafers) and seemed to be more readily accepted by the children. Furthermore, the program sustainability of RUTF/RUSF depends on a continuous ingredients supply and support from the local government. The findings presented the importance of development of such food supplements based on the local food resources and with improved technology for prevention and rehabilitation of malnourished children.

The International Malnutrition Task Force (IMTF) of the International Union of Nutritional Sciences was set up as an advocacy and capacity-building initiative in 2005 at a time when malnutrition contributed to 60% of deaths among children under-five, and when a reduction in under-five mortality by two-thirds had been set as Millennium Development Goal 4.

By forging partnerships through regional networks of academics, and linking with international agencies and non-governmental organizations, IMTF was able to increase awareness of the urgent need to address the prevention and treatment of child malnutrition. With modest funding, but a common purpose, partners initiated capacity building efforts to reduce high inpatient mortality rates among children admitted with severe malnutrition. In all regions, these initiatives catalysed scaling-up of the WHO 10-step treatment guidelines, resulting in substantial improvements in child survival. Many lessons were learned during this process including the importance of operational research, supervision and teamwork, political commitment, and the potential of eLearning. By establishing alliances between academics, health professionals, policy makers, and national and international paediatric and nutrition societies through a Task Force, we suggest that similar benefits might accrue in other fields, including childhood cancer and school feeding.

Irrespective of geographical location, disadvantaged people are disproportionately affected by unnecessary disease and suffering caused by inequalities in health. Although equal access to opportunities for healthy living medicine regardless of legal, political, economic, or other circumstances should be a basic human right, it is increasingly improbable for scores of people, particularly in Africa, Asia, Latin America, and the Caribbean, to acquire this. In recent times, global initiatives have attempted to make ‘healthy lifestyles’ more equitable by pledging to be relevant to all economies, promoting prosperity, environmental protection, climate change interventions, and purposeful action to meet the needs of vulnerable populations, including women and children. Yet there remains much to be done to address and reduce the substantial international health equity gaps. Reducing disparities that disproportionately affect the lower end of social strata must entail collaborative and systemic action from important stakeholders across the whole system, an approach that translates theory and research into practice. Ideally, realist approaches that appreciate the importance of the context of problems and assume nothing works everywhere or for everyone, should be prioritised over linear/simple and non-scalable intervention strategies.

Therapeutic foods (RUTF) are used to treat severe acute malnutrition in children 5 years and under in low and middle income countries (LMI), while liquid nutritional supplements (ONS) are used in affluent societies. With globalisation and economic growth in LMI, there will be an inclination to move towards practices applied in affluent countries. This study compared the effect of supplementation with a RUTF and an ONS, on nutritional outcomes in mildly underweight children.

68 Pakistani (5–10 y), mildly underweight (weight Z-score: −2 to −1) children randomly received either RUTF or ONS (500 kcal/day), in addition to their habitual diet for four weeks. Weight, height, skinfolds and their changes during intervention, were compared between the two groups and at follow up, post-supplementation.

All nutritional outcomes and height improved with both supplements, but net weight gain (kg) and changes from baseline for weight, height, triceps and sub-scapular thickness Z-scores did not differ between the two supplements [mean (SD), RUTF vs ONS; weight gain (kg), 0.59 (0.30) vs 0.65 (0.42), p = 0.483; weight Z-score, 0.12 (0.09) vs 0.15 (0.13), p = 0.347; height Z-score, 0.04 (0.08) vs 0.04 (0.08), p = 0.908; triceps Z-score, 0.29 (0.24) vs 0.31 (0.23), p = 0.796; subscapular Z-score, 0.37 (0.29) vs 0.31 (0.25), p = 0.385]. Weight gain (0.6 kg) for both groups was lower than anticipated (2 kg). Post-supplementation, there was a tendency for weight and height Z-score to return to baseline.

RUTF and ONS are equivalently effective in improving nutritional outcomes in children 5 to 10 y at risk of malnutrition but the observed benefit is less than expected and not sustainable.

This trial was registered at www.controlled-trials.com reference: ISRCTN51555749.

This trial was registered at www.controlled-trials.com reference: ISRCTN51555749.

This article first orients readers to the concept of food aid, presenting a brief history and architecture of food aid as a global institution. It is followed by an overview of the donors and recipients of food aid, the products used in food aid, and the multiple ways food aid can be programmed to meet the needs of food insecure or undernourished people around the world. International mechanisms for regulating food aid programs are discussed, and the piece concludes with a brief discussion on the ways food aid is evolving alongside the changing global environment.