Designing a Nutritionally Balanced Ready-to-Use Therapeutic Food from Local Ingredients
The World Health Organisation considers Ready-to-Use Therapeutic Food (RUTF) to have “revolutionized” the treatment of severe malnutrition in children. RUTF saves the lives of hundreds of thousands of children every year. RUTF are shelf-stable pastes that can be used at home, and contain a nutritionally-balanced mix of ingredients that provide children with the energy, protein, fat, vitamins and minerals for them to put on weight and treat deficiency. The products do not need to be mixed with water, which avoids bacterial contamination of the product, and was a major drawback of therapeutic foods for severely malnourished children that were used in the past.
The traditional RUTF product is a mixture of peanuts, milk powder and a vitamin and mineral premix. Other ingredients that meet specifications in providing complete protein, carbohydrates and a source of fat are also suitable for use in the paste. Alternative formulations may be desirable due to cultural norms, lower cost, and the ability to source ingredients locally to support the economy and help malnourished populations to become self-sufficient.
Ryan and co-workers report on the development of a RUTF for use in Ethiopian children, where around 9% of children are severely malnourished (acute hunger) and 44% show stunted growth (chronic hunger) according to 2008-2012 statistics from UNICEF. The authors used an optimization technique called linear programming to analyze the use of various locally-available ingredients from the FAO’s Food and Agriculture database FAOSTAT in the RUTF. The aim was to reduce the cost price of the RUTF, as this constrains the ability of aid organizations to reach all children affected. Even so, some imported ingredients were considered in the model.
The authors found 32 potential formulations that met basic needs in terms of nutrient content, price, and ingredient availability. These were made up in the laboratory for sensory acceptability testing with an untrained taste panel. From the original 32, four formulations were selected that were “most promising” in terms of both sensory evaluation and the ability to scale up production from a food-handling perspective. The four formulations were: fish/pumpkinseed, peanut/pea/pumpkin seed, oat/peanut, and millet.
These four formulations all met the nutritional criteria for an RUTF, and were palatable. The cost of the (mostly) locally-sourced RUTF was almost half the cost of the traditional formulation according to the calculations used in the tool. The new formulations were shelf-stable and large-scale production was considered feasible. The new formulations, however, contain a larger number of ingredients (7-10) than the traditional RUTF (5). In addition, each formulation contains a different mix of micronutrients, therefore a separate vitamin and mineral premix may have to be developed for each formulation.
The authors aim to make this tool publically available and free-of-charge to allow international agencies and governments to develop their own RUTF that meets nutritional guidelines, is safe to consume and cost-effective.
Kelsey N Ryan, Katherine P Adams, Stephen A Vosti, M Isabel Ordiz, Elizabeth D Cimo, and Mark J Manary. A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: an application to Ethiopia. Am J Clin Nutr 2014 ajcn.090670; First published online October 22, 2014. doi:10.3945/ajcn.114.090670
Unicef. Statistics. Ethiopia. Updated 24 December 2013. http://www.unicef.org/infobycountry/ethiopia_statistics.html