evidence-based blog of Filippo Dibari

Posts Tagged ‘ready-to-use food’

Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Need for Routine Antibiotics as Part of the Outpatient Management of Severe Acute Malnutrition

In Under-nutrition on August 11, 2012 at 11:23 am

by Mark J. Manary, Kenneth Maleta, Indi Trehan
Food and Nutrition Technical Assistance II Project (FANTA-2) Bridge, FHI
360, March 2012

(download the entire document)

The Food and Nutrition Technical Assistance (FANTA) Project undertook a clinical trial comparing nutritional recovery and mortality outcomes in children with severe acute malnutrition (SAM) receiving 1 week of amoxicillin, cefdinir, or placebo, in addition to usual peanut-based ready-to-use therapeutic food (RUTF) therapy. This report documents the outcomes of the trial, which clearly showed the benefit of using antibiotics in the outpatient treatment of SAM without medical complications in a setting with high levels of kwashiorkor and HIV infection.

How to design, pre-test and trial low cost, local RUTF products to rehabilitate severely malnourished children and adults

In Under-nutrition on August 9, 2012 at 3:55 pm

The latest number of Field Exchange, a journal published by ENN, contains a summary of a recent research paper describing how to use “Linear programming to design low cost, local RUTF” with the aid of Microsoft Excel software.

Whereas the original paper abstract can be found on The Journal of Nutrition web site, in the Field Exchange journal (issue 43, part 1), the article summary is available (for free) at page 36, including an “adapted” flow chart with the step sequence proposed for the design (see beneath), the pre-testing and the trialling of these products, currently in high demand in feeding programmes around the world.

The authors of the original paper are Filippo Dibari (author also of this blog), El Hadji I. Diop, Steven Collins, and Andrew Seal from Valid International and the University College of London.

More information about the Linear Programming, applied to the field of nutrition, is also available from another post in this same blog.

How ready-to-use therapeutic food shapes a new technological regime to treat child malnutrition

In Under-nutrition on August 1, 2012 at 6:23 pm

by José Guimón and Pablo Guimón

from Technological Forecasting and Social Change; Volume 79, Issue 7, September 2012, Pages 1319–1327


Since the turn of the 21st century ready-to-use therapeutic food (RUTF) has emerged as the preferred solution to treat acute malnutrition without complications. RUTF is a more appropriate technology than formerly prevalent powdered milk solutions because it enables outpatient care, simpler treatment protocols and production in the field. In this paper we analyze the forces driving the diffusion of RUTF as an innovation to treat child malnutrition and discuss the main features characterizing the new technological regime that results from its wide adoption. We combine the theoretical discussion and the review of secondary sources with insights from field research in Ethiopia, encompassing personal interviews with relevant parties and direct observation of how RUTF works in practice. This technology assessment exercise enables us to suggest some opportunities for policy intervention.

Another less recent version of the same paper is available here.

Innovation to Fight Hunger: The Case of Plumpy’nut

In Under-nutrition on July 31, 2012 at 5:26 pm

by José Guimón* and Pablo Guimón** (2010)

UAM-Accenture Working Papers – ISSN: 2172-8143

(download the entire text)


A simple invention can at times prove extremely useful. This is the case with Plumpy‟nut, a variety of ready-to-use therapeutic food (RUTF) conceived in 1999 that  is shaping a new regime for emergency interventions to alleviate child malnutrition. This paper applies concepts from the innovation systems literature into the analysis of  Plumpy‟nut with the aim of identifying the forces driving its successful diffusion as an innovation. Special attention is paid to three features that define the diffusion process: 1) shifting from inpatient to outpatient treatment, 2) building networks through licences,  franchises and partnerships, and 3) exploring further varieties of application. We combine the theoretical discussion with insights from field research in Ethiopia, including personal interviews with relevant parties and direct observation of how Plumpy‟nut works in practice. The ultimate objectives of this technology assessment exercise are to better understand the innovation journey of Plumpy‟nut and to identify possible opportunities for policy intervention.

Keywords: food crises; malnutrition; therapeutic food; technology diffusion; technological regimes; Ethiopia

Acknowledgements: An earlier draft of this paper was presented at the Globelics International Conference 2009 organized by CRES and UNU-MERIT (Senegal, October 6-8, 2009).

* Departamento de Estructura Económica y Economía del Desarrollo. Universidad Autónoma de Madrid. Ctra. de Colmenar km. 15, 28049 Madrid. E-mail: jose.guimon@uam.es

** El País Semanal. El País. Miguel Yuste 40, 28037 Madrid. E-mail: pguimon@elpais.es

Finally! Everything, really everything, about treatment of undernutrition (CMAM). In just-one-click-away, comprehensive, interactive, open-access, website.

In Under-nutrition on July 10, 2012 at 10:42 am

A new electronic forum improves the management of acute malnutrition. Worldwide.

In this area of humanitarian intervention, CMAM is the acronym mostly used: Community-based Management of Acute Malnutrition.

The CMAM forum not only hosts e-discussions about this topic, but also collects all the key documents endorsed by the WHO, other UN agencies, national and international NGOs. Otherwise scattered around, in their web sites.

World experts in this field (Andre’ Briend, and Mark Myatt among them) support this forum. Therefore, the target consists of practitioners rather than the general public.

The main focus list of the e-forum includes:

  • malnutrition and HIV/AIDS
  • malnutrition and infants, children, adolescents and adults, whose specificities are treated separately
  • malnutrition and health systems in the individual countries
  • evidence for action aiming policy-making, advocacy, support in the area of malnutrition treatment
  • product development for malnutrition rehabilitation
  • current research and existing evidences about most of the topics mentioned above
The web site has important tools:
  • you are interested in CMAM in a specific country? Visit the country section of the CMAM web forum
  • you wish to receive notices about meetings, conferences, trainings? You want to ask questions, learn how to calculate case loads, or simply follow up other people’s questions? Create your website account (for free)
  • you are interested in the latest evidence-based documents or the current state of research? Visit the related section of the forum
  • you can also contribute sharing, with the other forum members, the lessons learnt from your community-based feeding programme

This important forum was conceived thanks to the effort of many organizations. However, the realization was led by Valid International and Action Against Hunger.

If you find the CMAM forum interesting, do not hesitate to re-blog this post, or forward the link of the forum to relevant people.

If you have some constructive criticism or ideas to improve this new important tool, I encourage you to contact its coordinators: Nicky Dent and Rebecca Brown (contacts): I promise that they will be extremely happy to hear from you…

WFP: foods and food supplements for preventing and treating malnutrition in children

In Under-nutrition on June 4, 2012 at 2:23 pm

Original title: “Current and potential role of   specially formulated foods and food supplements for   preventing malnutrition among 6-23 months old and   treating moderate malnutrition among 6-59 months old children”

by Saskia de Pee and Martin W Bloem (2008) – WFP



Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain accessibility of nutritious diets, including high protein quality, adequate micronutrient content and bioavailability, macro-minerals and essential fatty acids, low anti-nutrient content, and high nutrient density. Largely plant-source-based diets with few animal source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal source foods, e.g. milk, or other specific nutrients. Options include using specially formulated foods: fortified blended foods (FBFs), commercial infant cereals, ready-to-use foods i.e. pastes/compressed bars/biscuits, or complementary food supplements (CFS): micronutrient powders (MNP); powdered CFS containing (micro)nutrients, protein, amino acids and/or enzymes; or lipid-based nutrient supplements (LNS), 120-500 kcal/d, typically containing milk powder, high-quality vegetable oil, peanut-paste, sugar, (micro)nutrients. Most supplementary feeding programs for moderately malnourished children supply FBFs, such as corn soy blend, with oil and sugar, which has shortcomings: too many anti-nutrients, no milk (important for growth), suboptimal micronutrient content, high bulk and viscosity. Thus, for feeding young or malnourished children, FBFs need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTF) for treating severe acute malnutrition, modifying that recipe is also considered. Commodities for reducing child malnutrition should be chosen based on nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare impact of new or modified commodities to current (FBFs) and to RUTF developed for treating severe acute malnutrition.

Use of Lipid-Based Nutrient Supplements by HIV-Infected Malawian Women during Lactation Has No Effect on Infant Growth from 0 to 24 Weeks

In Under-nutrition on May 31, 2012 at 6:23 am

by Valerie L. Flax5, Margaret E. Bentley, Charles S. Chasela, Dumbani Kayira, Michael G. Hudgens, Rodney J. Knight, Alice Soko, Denise J. Jamieson, Charles M. van der Horst, and Linda S. Adair

J. Nutr. July 1, 2012


The Breastfeeding, Antiretrovirals, and Nutrition study evaluated the effect of daily consumption of lipid-based nutrient supplements (LNS) by 2121 lactating, HIV-infected mothers on the growth of their exclusively breast-fed, HIV-uninfected infants from 0 to 24 wk. The study had a 2 × 3 factorial design. Malawian mothers with CD4+ ≥250 cells/mm3, hemoglobin ≥70 g/L, and BMI ≥17 kg/m2 were randomized within 36 h of delivery to receive either no LNS or 140 g/d of LNS to meet lactation energy and protein needs, and mother-infant pairs were assigned to maternal antiretroviral drugs (ARV), infant ARV, or no ARV. Sex-stratified, longitudinal, random effects models were used to estimate the effect of the 6 study arms on infant weight, length, and BMI. Logistic regression models were used to calculate the odds of growth faltering [decline in weight-for-age Z-score (WAZ) or length-for-age Z-score (LAZ) >0.67] using the control arm as the reference. Although some differences between study arms emerged with increasing infant age in boys, there were no consistent effects of the maternal supplement across the 3 growth outcomes in longitudinal models. At the ages where differences were observed, the effects on weight and BMI were quite small (≤200 g and ≤0.4 kg/m2) and unlikely to be of clinical importance. Overall, 21 and 34% of infants faltered in WAZ and LAZ, respectively. Maternal supplementation did not reduce the odds of infant weight or length faltering from 0 to 24 wk in any arm. These results indicate that blanket supplementation of HIV-infected lactating women may have little impact on infant growth.


For more information on LNS products you can browse in this blog. 

Acceptability of Lipid-Based Nutrient Supplements and Micronutrient Powders among Pregnant and Lactating Women and Infants and Young Children in Bangladesh and Their Perceptions about Malnutrition and Nutrient Supplements (2012)

In Under-nutrition on May 25, 2012 at 9:17 am

FANTA-2 and partners University of California-Davis; the International Centre for Diarrhoeal Disease Research, Bangladesh; and the World Mission Prayer League (LAMB Hospital) conducted an assessment of the acceptability of lipid-based nutrient supplements (LNS) and micronutrient powders (MNP) among pregnant and lactating women and infants and young children in Bangladesh. Two different flavored LNS products, and one MNP (for infants and young children only) were tested for each group through a 2-day test feeding trial and a 2-week take-home trial. Focus groups were held with participants and community health program staff and volunteers to discuss their preferences for the LNS and MNP and to get feedback about their perceptions of malnutrition and nutrient supplements. Results showed that all tested supplements were acceptable in terms of both the amount of the test meal consumed and the rankings of overall acceptability. The home-use trials and focus group discussion data confirmed acceptability and indicated that sharing of supplements with others was uncommon.”

 Download the document.

Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Need for Routine Antibiotics as Part of the Outpatient Management of Severe Acute Malnutrition (2012)

In Under-nutrition on May 25, 2012 at 9:07 am

from FANTA:

“Severe acute malnutrition (SAM) in children contributes to the deaths of 1 million children every year. Until recently, children with SAM were treated as inpatients in crowded hospital wards with milk-based therapy and routine antibiotics for all children. With the advent and widespread acceptance of peanut-based ready-to-use-therapeutic food (RUTF), standard therapy for SAM without medical complications is to treat these children at home.

Even in the home setting, international guidelines recommend that children receive a course of oral antibiotics at the start of their RUTF therapy. Because this places an additional burden on already taxed health systems and caregivers, because clinical experience has shown good recovery rates without antibiotics, and because the bacteria most likely to cause severe infections in these children are unlikely to be susceptible to most options for routine antibiotics, their routine use has been called into question. Thus, FANTA undertook a clinical trial comparing nutritional recovery and mortality outcomes in children with SAM receiving 1 week of amoxicillin, cefdinir, or placebo, in addition to usual RUTF therapy. This report documents the outcomes of the trial, which clearly showed the benefit of using antibiotics in the outpatient treatment of SAM without medical complications”.

Download the document

Efficacy and Safety of Therapeutic Nutrition Products for Home Based Therapeutic Nutrition for Severe Acute Malnutrition: A Systematic Review

In Under-nutrition on May 20, 2012 at 9:41 am

by Tarun Gera

Indian Pediatrics (2010); vol. 47. Pages: 709-718.

(Free text available)


Context: Severe acute malnutrition (SAM) in children is a significant public health problem in India with associated increased morbidity and mortality. The current WHO recommendations on management of SAM are based on facility based treatment. Given the large number of children with SAM in India and the involved costs to the care-provider as well as the care-seeker, incorporation of alternative strategies like home based management of uncomplicated SAM is important. The present review assesses (a) the efficacy and safety of home based management of SAM using ‘therapeutic nutrition products’ or ready to use therapeutic foods (RUTF); and (b) efficacy of these products in comparison with F-100 and home-based diet.

Evidence Acquisition: Electronic database (Pubmed and Cochrane Controlled Trials Register) were scanned using keywords ‘severe malnutrition’, ‘therapy’, ‘diet’, ‘ready to use foods’ and ‘RUTF’. Bibliographics of identified articles, reviews and books were scanned. The information was extracted from the identified papers and graded according to the CEBM guidelines.

Results: Eighteen published papers (2 systematic reviews, 7 controlled trials, 7 observational trials and 2 consensus statements) were identified. Systematic reviews and RCTs showed RUTF to be at least as efficacious as F-100 in increasing weight (WMD=3.0 g/kg/day; 95% CI -1.70, 7.70) and more effective in comparison to home based dietary therapies. Locally made RUTFs were as effective as imported RUTFs (WMD=0.07 g/kg/d; 95% CI=-0.15, 0.29). Data from observational studies showed the energy intake with RUTF to be comparable to F-100. The pooled recovery rate, mortality and default in treatment with RUTF was 88.3%, 0.7% and 3.6%, respectively with a mean weight gain of 3.2 g/kg/day. The two consensus statements supported the use of RUTF for home based management of uncomplicated SAM.

Conclusions: The use of therapeutic nutrition products like RUTF for home based management of uncomplicated SAM appears to be safe and efficacious. However, most of the evidence on this promising strategy has emerged from observational studies conducted in emergency settings in Africa. There is need to generate more robust evidence, design similar products locally and establish their efficacy and cost-effectiveness in a ‘non-emergency’ setting, particularly in the Indian context.

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