Amino acid-enriched plant-based RUTF treatment was not inferior to peanut-milk RUTF treatment in restoring plasma amino acid levels among patients with oedematous or non-oedematous malnutrition

Abstract

Ready-to-use therapeutic food (RUTF) with adequate quality protein is used to treat children with oedematous and non-oedematous severe acute malnutrition (SAM). The plasma amino acid (AA) profile reflects the protein nutritional status; hence, its assessment during SAM treatment is useful in evaluating AA delivery from RUTFs. The objective was to evaluate the plasma AAs during the treatment of oedematous and non-oedematous SAM in community-based management of acute malnutrition (CMAM) using amino acid-enriched plant-based RUTFs with 10% milk (MSMS-RUTF) or without milk (FSMS-RUTF) compared to peanut milk RUTF (PM-RUTF). Plasma AA was measured in a non-blinded, 3-arm, parallel-group, simple randomized controlled trial conducted in Malawi. The RUTFs used for SAM were FSMS-RUTF, MSMS-RUTF or PM-RUTF. A non-inferiority hypothesis was tested to compare plasma AA levels from patients treated with FSMS-RUTF or MSMS-RUTF with those from patients treated with PM-RUTF at discharge. For both types of SAM, FSMS-RUTF and MSMS-RUTF treatments were non-inferior to the PM-RUTF treatment in restoration of the EAA and cystine except that for FSMS-RUTF, methionine and tryptophan partially satisfied the non-inferiority criteria in the oedematous group. Amino-acid-enriched milk-free plant-source-protein RUTF has the potential to restore all the EAA, but it is possible that enrichment with amino acids may require more methionine and tryptophan for oedematous children.

Brewers’ Spent Grain: An Unprecedented Opportunity to Develop Sustainable Plant-Based Nutrition Ingredients Addressing Global Malnutrition Challenges

“…Until recently the guidelines for the formulation of RUTF stated that at least 50% of the protein should be derived from dairy sources; however in 2022 the Codex Alimentarius Commission adopted new guidelines on RUTF with protein quality now of greater importance than protein type, stipulating that cereals, legumes, seeds, or any other locally available ingredients can be used together with/instead of dairy protein, as long as a protein digestibility corrected amino acid score (PDCAAS) of ≥0.9 is achieved . Efforts are ongoing to reformulate RUTF with alternative protein sources, with several published studies and clinical trials investigating the use of legumes and cereals such as soy, oat, rice, sesame, chickpea, sorghum, and maize. − …”

Ready-to-use therapeutic/supplementary foods from local food resources: Technology accessibility, program effectiveness, and sustainability, a review

“…In addition, two countries in Europe (France and Italy) were also involved in developing the RUTF products during its initial development [ 2 ], and with more advanced technology [ 30 , 39 ]. In Africa, the ingredients are mostly combined with sorghum, maize, and chickpea and were recently improved with the crystalline amino acid-enriched plant [ 45 , 46 ]. While in Asia, the combination of rice, cereals, legumes, and animal sources [ 38 , 37 ] were usually used, as well as omega 3 and omega six sources [ 17 ].…”

“…The efficacy of amino acid-enriched plant-based (soy, maize, and sorghum) RUTF treatment is not inferior to peanut-milk RUTF treatment in reestablishing plasma amino acid concentrations in SAM children with oedematous or non-oedematous malnutrition [ 45 ]. An efficacy study of the plant-based RUTFs (with or without milk) in Malawi showed both were as efficacious as PM-RUTF in the treatment of patients with SAM in terms of recovery rates and were more efficacious in alleviating anemia and restoring body iron stores in children aged 6–59 months suffering from oedematous and non-oedematous malnutrition [ 46 , 80 , 81 ].…”

Genetic and molecular understanding for the development of methionine-rich maize: a holistic approach

“…Given this information, the source of Met (in the form of plant or animal protein) also needs to be carefully considered while re-assessing the Met life cycle as suggested by Neubauer and Landecker (2021). Sato et al (2021) have demonstrated the potential of amino acidenriched plant-based therapeutic food for restoring amino acids levels in plasma of malnourished people. With the increasing concern for environmental and health-related issues, it is necessary to make a thorough scientific assessment of the current knowledge to guide administrative policies around human food components.…”

“…Given this information, the source of Met (in the form of plant or animal protein) also needs to be carefully considered while re-assessing the Met life cycle as suggested by Neubauer and Landecker (2021) . Sato et al. (2021) have demonstrated the potential of amino acid-enriched plant-based therapeutic food for restoring amino acids levels in plasma of malnourished people.…”