Cereals and pulse-based ready-to-use therapeutic food as an alternative to the standard milk- and peanut paste–based formulation for treating severe acute malnutrition: a noninferiority, individually randomized controlled efficacy clinical trial

Bahwere, Paluku; Balaluka, Bisimwa; Wells, Jonathan C. K.; Mbiribindi, Chobohwa N; Sadler, Kate; Akomo, Peter; Dramaix-Wilmet, Michèle; Collins, Steve

doi:10.3945/ajcn.115.119537

Cited by 79 publications

(115 citation statements)

References 74 publications

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“…In previous studies, plant protein mixtures adjusted to meet the appropriate amino acid score for children were less effective than milk protein in terms of body weight and height gain in severe acute malnourished children [24, 25]. In addition, the requirements for amino acid variety and quantity may change under specific physiological and pathological conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Recently developed high-nutrition foods include ready-to-use therapeutic foods, ready-to-use supplemental foods, and standard nutritional supplements and the majority of these contain high milk content, making them expensive to apply in resource-poor settings, and higher proportions of the ingredients are imported from developed countries. Thus, there is an increased demand for affordable options that use more locally grown plant-based ingredients such as soy, maize, and sorghum; this facilitates sustainable use and maintains a stable supply in regions with high requirements [24, 39]. Based on this report, our novel concept of amino acid supplementation in combination with a plant-based protein diet may contribute to improving malnutrition in infants and children who require nutritional supplementation.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Concept of Amino Acid Supplementation to Improve the Growth of Young Malnourished Male Rats

Furuta¹,

Murakami²

2018

Ann Nutr Metab

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Backgrounds/Aims: This study was aimed at understanding the relationship between plasma amino acids and protein malnutrition and at determining whether amino acid supplementation associated with malnutrition and growth improves linear growth in growing rats. Methods: Body length and plasma amino acids were measured in young male rats that were fed the following diet for 3 weeks, mimicking a low and imbalanced protein diets based on maize, a major staple consumed in developing countries: a 70% calorically restricted cornmeal-based diet (C), C + micronutrients (CM), CM + casein (CMC), CM + soy protein (CMS) or CMS + 0.3% lysine. Results: A correlation analysis of linear growth and plasma amino acids indicated that lysine, tryptophan, branched-chain amino acids, methionine, and phenylalanine significantly correlated with body length. Supplementation with these 5 amino acids (AA1) significantly improved the body length in rats compared to CMC treatment whereas, nitrogen-balanced amino acid supplemented controls (AA2) did not (CM +1.2 ± 0.2, CMC +2.7 ± 0.3, CMS +2.1 ± 0.3, AA1 +2.8 ± 0.2, and AA2 +2.5 ± 0.3 cm). Conclusion: With securing proper amino acid balance, supplementing growth-related amino acids is more effective in improving linear growth in malnourished growing male rats. Analysis of the correlation between plasma amino acids and growth represents a powerful tool to determine candidate amino acids for supplementation to prevent malnutrition. This technology is adaptable to children in developing countries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Novel Concept of Amino Acid Supplementation to Improve the Growth of Young Malnourished Male Rats

Furuta¹,

Murakami²

2018

Ann Nutr Metab

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“…Research confirms that the effectiveness of RUF in treating acute malnutrition is subject to specific nutritional constraints (Bahwere et al, 2014;Bahwere et al, 2016;Oakley et al, 2010;World Food Programme [WFP], UNICEF, & United States Agency for International Development, 2016;Collins, Myatt, & Golden, 1998). Suitable caloric, oil, protein, carbohydrate, fibre, and omega-3/6 contents for recovery from SAM and MAM have been established (Nutriset, 2014;World Health Organization, 2016).…”

Section: Current Researchmentioning

confidence: 93%

Innovative optimization of ready to use food for treatment of acute malnutrition

Brixi¹

2018

Maternal & Child Nutrition

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Treatment of acute malnutrition typically requires the provision of ready-to-use food (RUF). Common RUF is effective but expensive, being manufactured from costly ingredients, and shipped worldwide from few global suppliers. I developed a linear programming tool to create RUF optimized for low cost using locally grown crops while maintaining necessary nutritional goals and other constraints. My tool utilizes a database of the nutritional value, price, and water efficiency of suitable ingredients and allows adjustment of constraints, including nutrients, flavour, and crop water efficiency. It is designed to (a) address nutrient requirements conforming to current standards and practice; (b) optimize RUF formulae for low cost using a wide range of ingredients for nutritional value and acceptability improvement; (c) ensure protein quality through protein digestibility corrected amino acid score; and (d) adjust RUF formulae according to locally grown crop selection, local prices, and crop water footprint. The tool creates formulae free of expensive dairy ingredients, ensuring desired protein digestibility corrected amino acid score by automatically balancing proteins with complementary quantities of essential amino acids. Using publicly available data with an application to Nigeria, my tool created RUF formulae suitable for local production using local crops to meet all nutrient requirements at a fraction of the ingredient cost and water footprint of current formulae, demonstrating the tool's effectiveness. Optimization of RUF for low cost using locally grown crops will facilitate local production and reduce ingredient as well as transport costs, so more patients can receive lifesaving treatment.

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“…These alternatives were 60% cheaper than the traditional RUTF and were generally acceptable by mothers and children. Valid nutrition also developed a milk and peanut free version of the RUTF made from soya, maize, and sorghum to reduce costs of local production, and Bahwere et al tested the product for efficacy against the peanut version in the Democratic Republic of Congo in 2011 [132]. Recovery was similar for children 24–59 months using the two products, but children ages 6–24 months did not do as well on the soy, maize, sorghum-RUTF compared to the peanut-RUTF [132]; the cheaper alternative may be viable for older children but more research is needed to understand the effect in younger children.…”

Section: Limitations Of Rutf and Potential Impact On Life Course Hmentioning

confidence: 99%

The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries

Bazzano

Potts

Bazzano

et al. 2017

IJERPH

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The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability.

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Cereals and pulse-based ready-to-use therapeutic food as an alternative to the standard milk- and peanut paste–based formulation for treating severe acute malnutrition: a noninferiority, individually randomized controlled efficacy clinical trial

Abstract: SMS-RUTF can be used to treat SAM in children aged ≥24 mo to reduce the costs of CMAM programs. More research is required to optimize SMS-RUTF for younger children. This trial was registered in the Pan African Clinical Trial Registry as PACTR201303000475166.

Cited by 79 publications

References 74 publications

A Novel Concept of Amino Acid Supplementation to Improve the Growth of Young Malnourished Male Rats

A Novel Concept of Amino Acid Supplementation to Improve the Growth of Young Malnourished Male Rats

Innovative optimization of ready to use food for treatment of acute malnutrition

The Life Course Implications of Ready to Use Therapeutic Food for Children in Low-Income Countries

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