Ready-to-use Therapeutic Foods (RUT F) are used in the treatment of children with Severe Acute Malnutrition (SAM) without medical complications. This article focuses on the value of an RUT F guideline. Knowing what is required for children with SAM helps manufacturers produce safe, efficacious, and good quality products, which will ultimately benefit end users. It will also help with the evaluation of products and provide guidance for researchers or innovators.
Since 2000, the number of children globally suffering from undernutrition has been reduced by one-third. Childhood undernutrition contributes to about 45% of deaths among children younger than 5 years, mainly in low- and middle-income countries. Globally, in 2020, it was estimated that 149 million children younger than 5 years were stunted (too short for their age) and 45 million were wasted (too thin for their height). Under nutrition is a major global health problem, which contributes to mortality, morbidity, and long-term health consequences.
Acute malnutrition is due to an inadequate energy or protein intake because of food insecurity caused by social, economic, and environmental factors. SAM is when children aged between 6 and 59 months, have a mid‒upper-arm circumference of less than 115 mm.6 A weight-for-height z-score of more than 3 standard deviations, also indicates SAM.
Patients with SAM are classified into two groups – those with and those without medical complications. Hospitalization is required only for patients with SAM and medical complications, so that they can be stabilized. Those without medical complications can be managed in an outpatient or home-based care setting. In these settings, RUT F may be used.
RUT F are foods for special medical purposes. It is lipid-based therapeutic food with a high energy content and contains adequate amounts of protein, vitamins, and minerals. The major ingredients typically include ground peanuts, oil, sugar, milk powder, vitamins, and minerals. They are soft or crush able foods that can be easily consumed by children from age 6 months or older, without requiring any prior preparation. Children can consume RUT F with minimal supervision at home, often directly from the package, at any time of the day or night.
International guideline for RUT F
RUT F, as part of the dietary management of uncomplicated SAM, has saved millions of lives of children. Yet there has been no official, international standard for RUT F that countries could follow to ensure a safe and efficacious product. Until now, some purchasing agencies have written their specifications based on the 2007 joint statement on community-based management of SAM and technical guidance and the United Nations Children’s Fund provided technical support to governmental and nongovernmental organizations on the use of RUT F. During the 37th Session of the Codex Committee on Nutrition and Foods for Special Dietary Uses in 2015, the committee agreed to establish an electronic working group – chaired by South Africa and co haired by Senegal and Uganda – to develop a guideline for RUT F for children with SAM. The guideline was finalized at the end of 2021 during the 43rd Codex Committee on Nutrition and Foods for Special Dietary meeting and is expected soon to be endorsed by the CODEX Alimentary Commission. It provides a reassuring framework and will assist in the development and endorsement of new producers and products. It may be used as an appropriate reference for imported or locally produced products to facilitate local regulations and encourage allocation of national budgets to these products. The guideline includes the following sections.
Preamble
Purpose of the guideline – To provide guidance on technical and nutritional aspects of the production of RUT F for children aged between 6 and 59 months with SAM.
Scope – RUT F for children aged 6 to 59 months with severe acute malnutrition.
Descriptions – Provide definitions for RUT F and SAM, as there was no previous universal agreement on what should be termed an RUT F.
Suitable raw material and ingredients – For example, milk and other dairy products, legumes and seeds, fats and oils, cereals, roots and tubers and their derived products, vitamins, and minerals. It also includes a section on the type of carbohydrates that must be used, as well as the permitted additives.
Nutritional composition and quality factors – Includes macronutrients and essential micronutrients.
Contaminants
Processing technologies
Good manufacturing and good hygiene practices
Methods of analysis and sampling – Include macronutrients and essential micro-nutrients.
Packaging – Guidelines to ensure products are packaged to safeguard hygienic and other qualities, including its nutritional properties, for the duration of its defined shelf-life.
Labelling guidelines – Include what the product should be called, the ingredients listing, and mandatory statements. RUT F must include the following statement. Exclusive breastfeeding is recommended for the first 6 months of life, and continued breastfeeding is recommended for up to 2 years or beyond.
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