evidence-based blog of Filippo Dibari

Posts Tagged ‘RUSF’

The role of dairy in the comparative effectiveness and cost of fortified blended foods versus ready-to-use foods in treatment of children with moderate acute malnutrition

In Under-nutrition on June 6, 2016 at 8:41 pm

from FASEB journal

Authors:Devika J Suri, Denish Moorthy and Irwin H. Rosenberg1



Objective Recent meta-analyses found treating young children with MAM using ready-to-use foods (RUF) versus fortified blended foods (FBF) resulted in higher recovery rates and weight gain. This analysis aimed to compare studies of RUF and FBF with and without dairy to determine whether the addition of dairy to these food supplements modified the comparative effectiveness and cost of treatment.


Methods A review of literature on the comparative effectiveness of FBF and RUF in treatment of MAM was conducted. Outcomes of recovery from MAM, weight gain and length gain were compared among study cohorts, which included FBF with dairy (FBF+), FBF without dairy (FBF−), RUF with dairy (RUF+) and RUF without dairy (RUF−). Data on recovery from MAM was pooled among the 4 supplement categories. The cost per 500 kcal of each category of food supplement was averaged among studies that reported cost data.


Results Among the 7 studies included, 9 RUFs were tested, of which 5 contained dairy, and 9 FBFs were tested, of which 3 contained dairy. Children treated with RUF+ had higher recovery rates compared with FBF− in 5 out of 5 study cohorts, higher weight gain in 4 out of 4, and significantly higher length gain in 1 out of 4. Children treated with RUF+ vs FBF+ had higher recovery rates in 1 out of 2 study cohorts, with no differences in weight or length gain. No differences were found in the 2 studies comparing RUF− and FBF+. Finally, children treated with RUF− had higher recovery rates compared with FBF− in 1 of 2 studies, higher weight gain in 2 out of 2, and no differences in length gain. Recovery from MAM among the 7 studies was 65% (FBF−), 79% (FBF+), 82% (RUF−), and 80% (RUF+). Four of the 7 studies included cost data; on average per 500 kcal costs were $0.15 (FBF−), $0.18 (FBF+), $0.17 (RUF−), and $0.35 (RUF+).


Conclusion Our results suggest that addition of dairy to FBF make it comparative in effectiveness to both RUF with and without dairy, but does not appear to be a factor between the RUF categories. RUF with dairy was twice the cost per kcal compared with the other food supplement categories. Cost-effectiveness analysis will be useful to help determine the most appropriate food supplement for treatment of MAM.

A Lipid-Based Nutrient Supplement but Not Corn-Soy Blend Modestly Increases Weight Gain among 6- to 18-Month-Old Moderately Underweight Children in Rural Malawi

In Under-nutrition on April 19, 2014 at 9:07 am

by Thakwalakwa C, Ashorn P, Phuka J, Cheung YB, Briend A, Puumalainen T, Maleta K.

J. Nutr. November 1, 2010 vol. 140 no. 11 2008-2013



Although widely used, there is little information concerning the efficacy of corn-soy blend (CSB) supplementation in the treatment of moderate underweight in African children. Lipid-based nutrient supplements (LNS), which have proven to be beneficial treatment for severely wasted children, could offer benefits to less severely affected individuals.

We conducted a clinical randomized trial to determine whether LNS or CSB supplementation improves weight gain of moderately underweight children. A total of 182 underweight [weight-for-age Z-score (WAZ) < −2] 6- to 15-mo-old children were randomized to receive for 12 wk a ration of 43 g/d LNS or 71 g/d CSB, providing 1189 and 921 kJ, respectively, or no supplementation (control). The primary outcome was weight change; secondary outcomes included changes in anthropometric indices, hemoglobin levels, and morbidity.

The body weight increases (mean ± SD) did not differ and were 620 ± 470, 510 ± 350, and 470 ± 350 g in the LNS, CSB, and control groups, respectively (P = 0.11). Compared with controls, infants and children in the LNS group gained more weight [mean (95% CI) = 150 g (0–300 g); P = 0.05] and had a greater increase in WAZ [0.33 (−0.02–0.65); P = 0.04]. Weight and WAZ changes did not differ between the control and CSB groups. In exploratory stratified analysis, the weight increase was higher in the LNS group compared with the control group among those with lower initial WAZ [250 g (60–430 g; P = 0.01].

Supplementation with LNS but not CSB modestly increases weight gain among moderately underweight children and the effect appears most pronounced among those with a lower initial WAZ.



International Symposium on Understanding Moderate Malnutrition in Children for Effective Interventions

In Under-nutrition on March 30, 2014 at 8:56 am



Vienna 20 – 29 May 2014

I will be there. If you also participate and wish to link up in Vienna,

send an email to this email address.

(for detailed info see the conference web site or download the flyer)

Objectives of the conference
The symposium will have the following objectives:
• To share experience related to the implementation and evaluation of programmes to prevent and treat MAM in infants and children, particularly during the first 1000 days;
• To support overall policy and specific evidence-based programmes dealing with the management of MAM;
• To identify knowledge gaps and define needs for future research to improve the management of MAM;
• To issue recommendations on how to improve the monitoring and evaluation of programmes dealing with the management of MAM; and
• To identify the role of the IAEA in addressing knowledge gaps and evaluating programmes to prevent and treat MAM.




Use, perceptions, and acceptability of a ready-to-use supplementary food among adult HIV patients initiating antiretroviral treatment: a qualitative study in Ethiopia

In Under-nutrition on March 30, 2014 at 6:38 am
Mette Frahm Olsen, Markos Tesfaye, Pernille Kaestel, Henrik Friis, and Lotte Holm
Patient Preference and Adherence 2013:7 481–488 (download)


Ready-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia.


The study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF.


Participants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to “rebuild the body,” and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with “medicinal qualities,” which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences.


HIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients.

– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trial

In Under-nutrition on February 5, 2014 at 11:18 am

by Lieven Huybregts, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, Patrick Kolsteren.

PLOS Medicine | 1 September 2012 | Volume 9 | Issue 9

(download the paper)




Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program.

Methods and Findings

We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p<0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (−29.3%; 95% CI: 20.5, 37.2; p<0.001) and fever episodes (−22.5%; 95% CI: 14.0, 30.2; p<0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions.


Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.


– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).


In Under-nutrition on November 16, 2013 at 7:14 pm

by Andrew K. Amegovu, Patrick Ogwok, Sophie Ochola, Peter Yiga, Juliet H. Musalima, Emma Mutenyo

from Journal of Food Chemisty and Nutrition – Vol 1, No 2 (2013)



Infant and young child feeding practices in low-income countries are still inadequate leading to high rates of acute malnutrition. Formulas from local food materials are vital in formulations for management of child malnutrition in poor countries because they are affordable. Nutrient composition of sorghum-peanut blend (SPB) mixed with honey and ghee, and micronutrient-fortified corn-soy blend (CSB), a traditional food supplement, were analyzed. Proximate components and beta-carotene amounts were high in both products. Vitamin A level was higher in CSB than SPB. Proportions of essential fatty acids were low. Levels of iron, zinc, calcium, magnesium, phosphorus, potassium, manganese and sodium were adequate for recovery from moderate acute malnutrition (MAM). Energy content of CSB was 421kcal/100g while that of SPB was 430kcal/100g. Levels of condensed tannin, phytates, trypsin inhibitors and aflatoxins were below prescribed limits. In conclusion, levels of nutrients in SPB and CSB were adequate for treatment of MAM in children.

– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Corporations and the fight against hunger: why CSR won’t do

In Under-nutrition on August 12, 2013 at 6:01 am

by Steve Collins and Paul Murphy – on The Guardian Professional, Thursday 18 July 2013 10.51 BST

In addition to the many millions still suffering from acute malnutrition, over one-third of all children in developing countries globally experience chronic malnutrition – often referred to as “hidden hunger” (pdf). Aside from the inherent suffering, the devastating longer-term consequences (both for the child and ultimately for their country) are often not understood.

Progress has been made in the fight against malnutrition. The development of highly fortified nutritious pastes, ready-to-use therapeutic foods, together with community-based management has revolutionised our ability to treat severe malnutrition. These products are eaten directly from the pack, do not require mixing with water, are stable without refrigeration and are highly convenient and palatable. Combined with the innovative approach of empowering mothers by delivering nutritional care to people in their communities rather than in hospitals, these foods have resulted in dramatic improvements in treatment and prevention, with death rates cut fivefold. But the problem is too big to leave to the UN, NGOs and the public sector to resolve.

 Engaging private sector

There is an opportunity for the private sector to lead in tackling this problem but traditional models that approach the treatment and prevention of malnutrition from the perspective of corporate social responsibility or charity, are not only failing to address the problem, they are also missing major opportunities for revenue growth. Malnutrition can now be treated at real scale. However, in order to extend this approach to include prevention, we need more effective engagement with the corporate sector. The debate shouldn’t be about if, but rather about how, the private sector should engage.

We set up our company, Valid Nutrition, as a social enterprise with the specific mission of manufacturing these life saving foods exclusively in developing countries and making them more available, appealing and affordable to those who need them most. Fundamental to our vision and approach is the concept of regarding malnourished people as customers – and not just as passive beneficiaries of goodwill.

In our opinion, the reason engagement has moved so slowly is that it has been based too often on a flawed CSR viewpoint. Despite all the hyperbole, CSR tends to be peripheral in most organisations and is not woven into the fabric of the business. It’s not always transparent and there maybe strings attached. Sometimes it’s driven by a need to buy profile and even worse, CSR has been used as a type of moral counterbalance to practices that have had direct negative impacts on the poor. To make a lasting difference, we believe the prevention of malnutrition must be integrated into the core business of major food companies. Realistically, that requires shareholders to receive a tangible return. At some point, companies must be able to generate profit out of their engagement with the so-called “base of the pyramid” (the economically poorest 1 billion people on our planet). Controversial perhaps, but also rooted in realism.

So how can we align two such apparently conflicting aims – the prevention and treatment of malnutrition, and profit making?

Advantages of a business model

Ultimately, there should be no conflict. The World Bank has identifiedmalnutrition as the single greatest cause of poverty. There is strong evidence that children who receive adequate nutrition go on to have substantially increased earning power as adults [43% more according to a major study published in The Lancet, in 2008]. A lifetime of increased earning power from an initial investment of less than $100 (£66), is a massive return that has huge potential to boost consumer markets and economies. Given the vast numbers of people in this segment of the global population, investment in early child nutrition is highly economically attractive for both governments and industry alike.

Reaching those consumers however demands that we create viable business models that establish better mechanisms for engagement between public and private sectors. There are two distinct and complementary models that combine and maximise the comparative advantages of each sector; one designed to increase the efficiency, impact and reach of free or subsidised products, the second, designed to increase the availability, purchase and consumption of beneficial nutritional products by those who can afford them. Both require standards and metrics to guarantee efficacy and protect the food security and self-sufficiency of vulnerable groups. Ingredients must be procured in developing countries in a way that supports local agriculture and avoids the dumping of subsidised farm outputs on the developing world.

The first model requires public nutrition interventions targeting the very poor. The low or non-existent purchasing power of these groups means that such products must be free or heavily subsidised, funded by public bodies, manufactured by businesses willing to accept a low margin and targeted to public sector and civil society actors. Although many of the essential elements of this system are already in place, its efficacy and impact needs to be increased by better harnessing private sector capability. We need commercial engagement to expand production, reduce cost and enhance distribution of new appropriately formulated foods. We also need to link these initiatives to public sector nutritional assessment and diagnosis through the use of prescriptions or vouchers. The widespread use of mobile phones, even in the poorest communities, provides an exciting and powerful potential mechanism for related cash transfers to offset against purchase price.

The second model requires appropriately formulated consumer food products to be sold to the lower levels of the socio-economic pyramid at affordable prices. Each consumer persuaded to buy effective nutritional snacks, enhances the economic productivity of future generations and frees up vital public resources to focus on those who cannot afford even the simplest foods.

To achieve this requires innovation, courage and imagination. Although ultimately the market is attractive, private sector companies entering this space on their own, face high initial risk, especially having to accept diluted margins for a considerable period. Unfortunately, typical shareholder requirements (including from many so-called “impact investors”) preclude this sort of patience and vision.

Going beyond CSR

Many companies also fear criticism of their motives in attempting to operate commercially. Business requires encouragement to face challenges. We are convinced that we can demonstrate that suitable commercial models can align revenue generation with social impact.

We believe that to open up this market requires a new genre of businesses, free from the short-term demands of typical shareholders. Structured imaginatively to avoid dilution of corporate margins, such businesses could harness commercial sector capability through purchasing R&D and “route to market” expertise and develop suitable brands produced on a commercial basis that penetrate through the population pyramid.

Such social businesses, committed to addressing humanitarian need while also achieving a commercial return, are beginning to emerge. By combining an enterprising social vision with a disciplined business approach, many are now punching above their weight and can use their presence to leverage a much wider ethical engagement from other commercial actors.

The current model for nutritional development has failed the poor of so many developing nations. Much CSR contributes to this failure through its focus on disbursements that do nothing to harness business capability or add value to the money given. Socially orientated corporate engagement through commercial enterprises can however create a multiplier effect that both improves nutrition and ultimately fosters sustainable economic development. This in turn can stimulate agricultural activity, thereby helping to create a positive cycle that both treats and prevents undernutrition. Such an approach will increase both the social and economic returns of investment.

Enabling all children to reach their full potential depends largely on nutrition. By imaginatively broadening the scope of engagement with the private sector, we can make meaningful and sustainable progress and in so doing create a massive beneficial change for individuals, societies and economies.

– – –

Dr Steve Collins, is a medical doctor, child nutrition expert and chairman of Valid Nutrition. Paul Murphy is Valid Nutrition’s chief executive. Prior to joining the social enterprise, he worked with Unilever in a variety of senior roles for over 27 years.

– – –

NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery

In Under-nutrition on February 27, 2013 at 7:50 pm

J Nutr. 2013 Feb;143(2):215-20. doi: 10.3945/jn.112.168047. Epub 2012 Dec 19.

by Chang CYTrehan IWang RJThakwalakwa CMaleta KDeitchler MManary MJ.


Moderate acute malnutrition (MAM) affects 11% of children <5 y old worldwide and increases their risk for morbidity and mortality. It is assumed that successful treatment of MAM reduces these risks.

A total of 1967 children aged 6-59 mo successfully treated for MAM in rural Malawi following randomized treatment with corn-soy blend plus milk  and oil (CSB++), soy ready-to-use supplementary food (RUSF), or soy/whey RUSF were followed for 12 mo. The initial supplementary food was given until the child reached a weight-for-height Z-score (WHZ) >-2. The median duration of feeding was 2 wk, with a maximum of 12 wk.

The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++.The primary outcome, remaining well-nourished, was defined as mid-upper arm circumference ≥12.5 cm or WHZ ≥-2 for the entire duration of follow-up.

During the 12-mo follow-up period, only 1230 (63%) children remained well-nourished, 334 (17%) relapsed to MAM, 190 (10%) developed severe acute malnutrition, 74 (4%) died, and 139 (7%) were lost to follow-up.

Children who were treated with soy/whey RUSF were more likely to remain well-nourished (67%) than those treated with CSB++ (62%) or soy RUSF (59%) (P = 0.01).

A seasonal pattern of food insecurity and adverse clinical outcomes was observed. This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished; however, all children successfully treated for MAM remain vulnerable.


– – –

NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Development, acceptability, and nutritional characteristics of a low-cost, shelf-stable supplementary food product for vulnerable groups in Kenya

In Uncategorized, Under-nutrition on October 15, 2012 at 8:14 am

 Kunyanga, Catherine; Imungi, Jasper; Okoth, Michael; Vadivel, Vellingiri; Biesalski, Hans Konrad

Food & Nutrition Bulletin, Volume 33, Number 1, March 2012 , pp. 43-52(10)


Background. Food-based approaches have been advocated as the best strategies to curb hunger and malnutrition in developing countries. The use of low-cost, locally available, nutritious foods in the development of supplementary foods has been recommended.

 Objective. To develop low-cost food supplements using different traditionally processed local foods, consisting of cereals, legumes, nuts, fish, and vegetables, to meet the nutrient requirements for vulnerable groups in Kenya.

 Methods. Four food supplements were developed and evaluated by taste panel procedures. The product containing amaranth grain, pigeon pea, sweet potato, groundnuts, and brown sugar was found to be the most acceptable supplement. Evaluation of nutritional composition, shelf-life, and cost analysis of the acceptable supplement was carried out to assess if it could satisfactorily provide more than 50% of the Recommended Dietary Allowances (RDAs) of the basic nutrients for vulnerable groups.

 Results. The acceptable supplement contained 453.2 kcal energy, 12.7 g crude protein, 54.3 g soluble carbohydrates, 20.8 g crude fat, and 10.1 g crude fiber per 110 g. The micronutrient contents were 93.0 mg calcium, 172.4 mg magnesium, 2.7 mg zinc, 5.7 mg iron, 0.8 mg vitamin B1, 0.2 mg vitamin B2, 7.9 mg niacin, 100 μg folic acid, and 140 μg retinol equivalent per 110 g. The supplement also contained 21% total essential amino acid in addition to appreciable levels of palmitic, stearic, oleic, linoleic, and α-linolenic fatty acids. The shelf-life study showed that it could be stored in different packaging materials (polythene bags, gunny bags, and kraft paper) at 26°C without deleterious effects on its chemical composition for up to 4 months. Cost analysis of the supplement indicated that the product could be competitively sold at US$0.812/kg (KES 65.50/kg).

 Conclusions. Locally available indigenous foods can be used in the formulation of acceptable, low-cost, shelf-stable, nutritious supplementary foods for vulnerable groups.

– – –

NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

WHO: Supplementary foods for the management of moderate acute malnutrition

In Under-nutrition on October 12, 2012 at 12:34 pm

Original title: Supplementary foods  for the management of moderate acute malnutrition in infants and children 6–59 months of age (Technical note)

by WHO (2012)

(download here a brief version of the document)

This document proposes the nutrient composition of supplementary foods to manage moderate acute malnutrition (MAM) in children under 5 years of age.

Experimental data were used to inform the estimates, taking into consideration the effect of different levels of nutrients and their bio-availability.

The document also lists the principles of nutritional management of children with MAM and reports the assumptions considered to set up the proposed recommendations, suggesting  which uses the latter can be applied for and topics for further research in this area.

– – –

NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

%d bloggers like this: