Journal articles: 'Ready-to-use supplementary food (RUSF)'

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Sigh, Sanne, Nanna Roos, Daream Sok, Bindi Borg, Chhoun Chamnan, Arnaud Laillou, Marjoleine A. Dijkhuizen, and Frank T. Wieringa. "Development and Acceptability of Locally Made Fish-Based, Ready-to-Use Products for the Prevention and Treatment of Malnutrition in Cambodia." Food and Nutrition Bulletin 39, no. 3 (August 9, 2018): 420–34. http://dx.doi.org/10.1177/0379572118788266.

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Background: Cambodia has a high prevalence of moderate acute malnutrition and severe acute malnutrition (SAM). The SAM treatment requires ready-to-use therapeutic foods (RUTFs), whereas ready-to-use supplementary foods (RUSFs) are used for prevention of acute malnutrition. Three locally produced fish-based products were developed: an RUTF paste (NumTrey-Paste) for treatment and 2 wafer versions, one for prevention (NumTrey-RUSF) and one for treatment (NumTrey-RUTF). Objective: To assess the acceptability of NumTrey-Paste and NumTrey-RUSF in comparison to a standard biscuit product (BP-100) used for the treatment of SAM. Methods: Acceptability of NumTrey-RUSF and NumTrey-Paste was tested in a nonblinded crossover taste trial among children (n = 52), aged ≥ 6 months to 18 years, and their caregivers. Eight organoleptic qualities were assessed on a 5-point hedonic scale, as well as a ranking test. A score of 1 to 3 was categorized as acceptable. The acceptability of NumTrey-RUTF was assessed using the caregivers’ perception during an SAM treatment intervention. Results: Taste trial: The proportion of children categorizing products as overall acceptable was lowest for NumTrey-Paste compared to for BP-100 and NumTrey-RUSF (21% vs 43% [BP-100] and 36% [NumTrey-RUSF]). No difference was found in the proportion of children who ranked BP-100 or NumTrey-RUSF as “liked most” ( P > .05). Acceptability of NumTrey-RUSF ranked highest in appearance and taste (caregiver), whereas acceptability of NumTrey-Paste was ranked lowest in appearance and smell among the products. Intervention trial: The acceptability of NumTrey-RUTF increased from 72% to 86%. Conclusions: The overall acceptability was ranked lowest for a pure paste product. However, filling the paste into a wafer made the product more acceptable.

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Fetriyuna, Fetriyuna, Ratna Chrismiari Purwestri, May Susandy, Realm Köhler, Ignasius Radix A. P. Jati, Nia Novita Wirawan, and Hans-Konrad Biesalski. "Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children." Foods 10, no. 12 (December 5, 2021): 3013. http://dx.doi.org/10.3390/foods10123013.

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Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.

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Stobaugh, Heather. "Maximizing Recovery and Growth When Treating Moderate Acute Malnutrition with Whey-Containing Supplements." Food and Nutrition Bulletin 39, no. 2_suppl (September 2018): S30—S34. http://dx.doi.org/10.1177/0379572118774492.

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Background: Much debate exists about the utility of dairy ingredients in the supplementary foods used to treat childhood moderate acute malnutrition (MAM). Objective: To review the evidence regarding the effectiveness of dairy-containing supplements, particularly specially formulated foods containing whey permeate and whey protein concentrate, in treating children with MAM. Methods: A summary of a conference presentation regarding an overview of current evidence behind the use of whey in supplementary foods, including results of a randomized double-blinded clinical effectiveness trial involving 2259 Malawian children treated for MAM using either a soy ready-to-use supplementary food (RUSF) or a novel whey RUSF treatment. Results: While the majority of the evidence base only suggests potential benefits of including whey in supplementary foods to treat MAM, a recent study specifically demonstrates that a whey RUSF produced superior recovery and growth outcomes in treating children with MAM when compared with a soy RUSF. Conclusions: The use of whey ingredients has been shown to improve outcomes in the treatment of MAM; however, further research is needed to identify the ideal amount and type of dairy protein required to produce the best outcomes for the lowest cost.

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Das, Jai K., Rehana A. Salam, Marwah Saeed, Faheem Ali Kazmi, and Zulfiqar A. Bhutta. "Effectiveness of Interventions for Managing Acute Malnutrition in Children under Five Years of Age in Low-Income and Middle-Income Countries: A Systematic Review and Meta-Analysis." Nutrients 12, no. 1 (January 1, 2020): 116. http://dx.doi.org/10.3390/nu12010116.

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Childhood malnutrition is a major public health concern, as it is associated with significant short- and long-term morbidity and mortality. The objective of this review was to comprehensively review the evidence for the management of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) according to the current World Health Organization (WHO) protocol using facility- and community-based approaches, as well as the effectiveness of ready-to-use therapeutic food (RUTF), ready-to-use supplementary food (RUSF), prophylactic antibiotic use, and vitamin A supplementation. We searched relevant electronic databases until 11 February 2019, and performed a meta-analysis. This review summarizes findings from a total of 42 studies (48 papers), including 35,017 children. Limited data show some benefit of integrated community-based screening, identification, and management of SAM and MAM on improving recovery rate. Facility-based screening and management of uncomplicated SAM has no effect on recovery and mortality, while the effect of therapeutic milk F100 for SAM is comparable to RUTF for weight gain and mortality. Local food and whey RUSF are comparable to standard RUSF for recovery rate and weight gain in MAM, while standard RUSF has additional benefits to CSB. Prophylactic antibiotic administration in uncomplicated SAM improves recovery rate and probably improves weight gain and reduces mortality. Limited data suggest that high-dose vitamin A supplementation is comparable with low-dose vitamin A supplementation for weight gain and mortality among children with SAM.

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Ntsama, Patricia M., Julie Judith T. Tsafack, Gabriel Nama Medoua, and Carl M. F. Mbofung. "Preparation of Ready to Use Supplementary Food for Treating Moderate Acute Malnutrition in Children Aged 6 to 59 Months." IRA-International Journal of Applied Sciences (ISSN 2455-4499) 14, no. 3 (May 27, 2020): 22. http://dx.doi.org/10.21013/jas.v14.n3.p1.

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Children with moderate malnutrition have a high risk of mortality and MAM is associated with a high number of nutrition-related deaths. If some of these children suffering from MAM do not receive adequate support, they may progress towards severe acute malnutrition (SAM), which is a life-threatening condition. Therefore, the management of MAM should be a public health priorityA well-balanced diet was prepared based on the recommendation of WHO for the treatment of moderate acute malnourished children aged 6 -59 months. According to the formulae, nine products of RUSF were prepared using cereals, legumes, seeds, oil, sugar, and vitamin and mineral premix. Three products of RUSF MSPe, PBPe, and ISPe were found to be better among the nine products by the mothers after sensory evaluation.Based on sensory evaluation in children, RUSF MSPe was found to be the best among the three products. The product was analyzed for proximate composition, mineral, vitamin, digestibility of protein. The protein, fat, carbohydrate, dietary fiber, total ash, vitamin C, Vitamin A, iron, calcium and zinc of 100 g of the product were found to be 15.9g, 33.7g, 44.3g, 6.6g, 2.2g, 54.6 mg, 855 µg, 14.1 mg, 66.6 g and 12.4 µg respectively. The diet can supply 544.5 Kcal/100 g. The energy contributed by the protein, fat, and carbohydrate was found to be 11.68%, 55.7%, and 32.62% of total Kcals respectively. The protein digestibility adjusted to the chemical index PDCASS was 0.95.Hence, the prepared RUSF is in accordance with the specification given by WHO which could be effective in the treatment of moderate acute malnourished children after the clinical trial.

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Medoua, Gabriel Nama, Patricia M. Ntsama, Anne Christine A. Ndzana, Véronique J. Essa’a, Julie Judith T. Tsafack, and Henriette T. Dimodi. "Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn–soya blend (CSB+): a randomized controlled trial." Public Health Nutrition 19, no. 2 (May 5, 2015): 363–70. http://dx.doi.org/10.1017/s1368980015001238.

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AbstractObjectiveTo compare an improved corn–soya blend (CSB+) with a ready-to-use supplementary food (RUSF) to test the hypothesis that satisfactory recovery rate will be achieved with CSB+ or RUSF when these foods provide 50 % of the child’s energy requirement, the 50 % remaining coming from usual diet.DesignA comparative efficacy trial study was conducted with moderately wasted children, using a controlled randomized design, with parallel assignment for RUSF or CSB+. Every child received a daily ration of 167 kJ (40 kcal)/kg body weight during 56 d with a follow-up performed every 14 d. Every caregiver received nutrition counselling at enrolment and at each follow-up visit.SettingHealth districts of Mvog-Beti and Evodoula in the Centre region of Cameroon.SubjectsEight hundred and thirty-three children aged 6–59 months were screened and eighty-one malnourished children (weight-for-height Z-score between −3 and −2) aged 25–59 months were selected.ResultsOf children treated with CSB+ and RUSF, 73 % (95 % CI 59 %, 87 %) and 85 % (95 % CI 73 %, 97 %), respectively, recovered from moderate acute malnutrition, with no significant difference between groups. The mean duration of treatment required to achieve recovery was 44 d in the RUSF group and 51 d in the CSB+ group (log-rank test, P=0·0048).ConclusionsThere was no significant difference in recovery rate between the groups. Both CSB+ and RUSF were relatively successful for the treatment of moderate acute malnutrition in children. Despite the relatively low ration size provided, the recovery rates observed for both groups were comparable to or higher than those reported in previous studies, a probable effect of nutrition education.

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Steenkamp, Liana, Ronette Lategan, and Jacques Raubenheimer. "The impact of Ready-to-Use Supplementary Food (RUSF) in targeted supplementation of children with moderate acute malnutrition (MAM) in South Africa." South African Family Practice 57, no. 5 (September 1, 2015): 4. http://dx.doi.org/10.4102/safp.v57i5.4192.

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Objective: To describe catch-up growth in children with moderate acute malnutrition (MAM) on targeted supplementation using Ready-to-Use Supplementary Food (RUSF). Methods: An impact study was done to determine anthropometric changes in children aged 12–60 months who received RUSF (175 kcal/kg/day) for six weeks, managed as outpatients and followed up for 12 weeks until a final assessment. Results: Default rates were high, with 30% of children returning to the primary healthcare facility for follow-up only once or twice. Despite significant improvement in height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC), 70.5% of the sample remained in the same malnutrition classification and only 26% recovered. The growth velocity of children with a lower initial WHZ was significantly higher (r = –0.15, p 0.05) than those with less wasting, but only 20% grew at a rate to achieve catch-up growth. The mean growth velocity decreased as the intervention period continued. Conclusion: All median anthropometric indicators improved with RUSF supplementation. However, catch-up growth or recovery occurred in only 20–25% of children included in the study. These findings create questions about the value of supplementation in the absence of blanket food distribution or other interventions to address food security.

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Schlossman, Nina, Carrie Brown, Payal Batra, Augusto Braima de Sa, Ionela Balan, Adrian Balan, Madeleine G. Gamache, et al. "A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response." Food and Nutrition Bulletin 38, no. 3 (April 4, 2017): 275–90. http://dx.doi.org/10.1177/0379572117700754.

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Background: There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries. Objective: We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau. Methods: A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children. Results: There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02). Conclusion: Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.

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Cox, Sharon E., Julie Makani, Gurishaeli Walter, Selemani Mtunguja, Beatrice A. Kamala, Elizabeth Ellins, Charles RJ Newton, Fenella J. Kirkham, Andrew M. Prentice, and Julian P. Halcox. "Ready-to-Use Supplementary Food Supplements Improve Endothelial Function, Hemoglobin and Growth in Tanzanian Children with Sickle Cell Anaemia: The Vascular Function Intervention Study (V-FIT), a Random Order Crossover Trial." Blood 124, no. 21 (December 6, 2014): 4087. http://dx.doi.org/10.1182/blood.v124.21.4087.4087.

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Abstract Introduction: Endothelial function is impaired in sickle cell anemia (SCA) and may be prognostic of severity of pathophysiology underlying many complications. Poor nutritional status is documented in SCA in all income settings, yet no strategies exist to improve nutrition. Poor nutritional status and hemoglobin predict death and hospitalization in Tanzanian SCA patients (Cox, et al. Haematologica 96, 2011, Makani et al. PloSONE 6, 2011). The objectives are to determine the combined effect of two ready-to-use-supplementary food (RUSF) interventions on the primary endpoints of endothelial function, assessed by flow mediated dilatation (FMD), growth and body composition and hemoglobin (secondary endpoint). Methods: Tanzanian children (N=119) (HbSS) aged 8-11.9 years were enrolled in V-FIT (ISRCTN74331412/NCT01718054) in Aug to Nov 2012. Children received in random order a daily RUSF providing 500 kcal, 1 RDA of vitamins and minerals & 1mg folate (Nutriset, France), plus weekly anti-malarial prophylactic chloroquine syrup (150/225mg base) (Wallace manufacturing chemicals, UK), or a vascular-RUSF (RUSFv) fortified with arginine and citrulline (average 0.2g/kg/d & 0.1g/kg/d) plus daily chloroquine syrup (3mg base/kg/d). Patients and investigators were blind to the different interventions. Each intervention was received for 4 months with 4 month washout periods on either side (Figure 1A). Clinic visits were conducted at baseline and at the end of each intervention/washout period when endothelium-dependent and -independent vasodilatation were assessed (Donald et al. JACC 51, 2008), plus height, weight and body composition by impedance (Tanita BC418). Random effects models were used, adjusting for repeated measures within individuals. In multivariable analyses models were a priori adjusted for gender. Possible temporal effects were modelled via Fourier transformation of visit dates and included in models for growth and hemoglobin. Effects of the interventions on FMDmax were adjusted for arterial diameter before vasodilation induction, which was negatively correlated with FMDmax and for magnitude of reactive hyperaemia during induction of vasodilation, which was not correlated with FMDmax. Results: 115/119 (60% male; mean age at enrolment 10.0, 95% CI 9.8 – 10.2 years) enrolled patients completed the trial and all clinic visits. Endpoints at baseline and the adjusted and unadjusted effects of the interventions are shown in Table 1. FMDmax, baseline brachial diameter, absolute change in blood flow velocity during reactive hyperemia, hemoglobin, height velocity, weight and lean mass gain all increased on the RUSF (Fig 1B-F). Discussion: We demonstrate that providing extra protein, energy and micronutrients improves hemoglobin, vascular endothelial function and growth. It is possible that the effects observed are limited to the RUSFv, and/or from unadjusted for temporal effects. Unblinded analysis of the effect of RUSFv vs. RUSF on these endpoints, plasma amino acids and arginase are planned. Currently the only intervention for children with SCA is hydroxyurea, which although it improves hemoglobin and reduces hemolysis, does not appear to affect growth while its effect on vascular physiology is unknown (Wang et al. J Pediatr 140, 2002). In addition to specific nutrients, general improvement in nutrition may result in improvement in important intermediate endpoints in SCA. Future research should investigate effects of nutritional supplementation on clinical endpoints. Abstract 4087. Table 1. Endpoints at enrolment and combined effect of RUSF interventions. Baseline N=119 RUSF coefficient [95% CI] P-value Adjusted RUSF coefficient [95% CI] Adjusted P-value Endothelial function, mean [SD] FMDmax % 7.66 [3.37] 0.66 [0.15 – 1.17] 0.011 0.98 [0.42 – 1.54] 0.001 Baseline brachial diameter, mm 2.61 [0.35] 0.05 [0.03 – 0.09] <0.001 - - Reactive hyperemia absolute, m/s 0.69 [0.22] 0.034 [0.004 – 0.065] 0.026 - - Anemia, mean [95% CI] Hemoglobin, g/dl 7.5 [7.3 – 7.7] 0.29 [0.20 – 0.37] <0.001 0.34 [0.22 – 0.46] <0.001 Anthropometry, mean [95% CI] Height cm 126.5 [125.2 – 127.8] - - - - Linear growth velocity, cm/yr - 0.46 [0.08 – 0.83] 0.018 0.51 [0.01 – 1.02] 0.053 Weight, kg 22.8 [22.1 – 23.5] - - - - Weight gain, kg/yr - 1.37 [0.83 – 1.91] <0.001 1.98 [1.25 – 2.73] <0.001 Whole body fat free mass, kg 18.6 [18.1 – 19.1] - - - - Fat free mass gain, kg/yr - 0.89 [0.48 – 1.30] <0.001 0.93 [0.36 – 1.50] 0.001 Disclosures No relevant conflicts of interest to declare.

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Sastrawan, S., M. Menap, L. Sulaiman, and H. Hendrayani. "Development of home-based ready-to-use supplementary food (RUSF-HB) to overcome nutrition-related problems among children under five during the covid-19 pandemic." IOP Conference Series: Earth and Environmental Science 883, no. 1 (October 1, 2021): 012074. http://dx.doi.org/10.1088/1755-1315/883/1/012074.

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Abstract The most direct causes of malnutrition are food consumption and infection. Yet the prolonged Covid-19 pandemic has limited low-income families’ ability to fulfil the need for nutrition consumption, particularly for children under five. Responding to this situation, we sought to develop home-based ready-to-use supplementary foods (RUSF-HB) from local ingredients that are energy-protein-dense, affordable, simple and easy to produce at home. We created three milk-free formulas (MFFs) and six standard formulas (STFs). Three cheap and abundant local foods: soybeans, cowpeas, and mung beans were combined with rice flour, refined sugar, and coconut oil. A cross-over study design was used to assess food organoleptic, which showed that the products were comparable in several sensory aspects except for the odour and the taste. Soybeans-based formulas contain slightly more energy and protein compared to mung beans or cowpeas-based ones. However, the mung beans-based formulas were more favourable to caregivers and children, particularly their taste and smell. The products contain slightly less energy than the recommended ones but high enough to supply macronutrient for those in need on a regular basis. The caregivers considered the total price for the products was affordable, and the formula was easy to follow.

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Lelijveld, Natasha, Eunice Musyoki, Susan Were Adongo, Amy Mayberry, Jonathan C. Wells, Charles Opondo, Marko Kerac, and Jeanette Bailey. "Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol: A nested cohort from the ComPAS RCT." PLOS ONE 16, no. 2 (February 3, 2021): e0245477. http://dx.doi.org/10.1371/journal.pone.0245477.

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Introduction Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM/MAM protocol for children aged 6–59 months and found non-inferior recovery compared to standard care. To further inform policy, this study assessed post-discharge outcomes of children treated with this novel protocol in Kenya. Methods Six ‘combined’ protocol clinics treated SAM and MAM children using an optimised mid-upper arm circumference (MUAC)-based dose of ready-to-use therapeutic food (RUTF). Six ‘standard care’ clinics treated SAM with weight-based RUTF rations; MAM with ready-to-use supplementary food (RUSF). Four months post-discharge, we assessed anthropometry, recent history of illness, and body composition by bioelectrical impedance analysis. Data was analysed using multivariable linear regression, adjusted for age, sex and allowing for clustering by clinic. Results We sampled 850 children (median age 18 months, IQR 15–23); 44% of the original trial sample in Kenya. Children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores, and frequency of common illnesses 4 months post-discharge compared the standard protocol. Mean subscapular skinfold z-scores were close to the global norm (standard care: 0.24; combined 0.27). There was no significant difference in odds of relapse between protocols (SAM, 3% vs 3%, OR = 1.0 p = 0.75; MAM, 10% vs 12%, OR = 0.90 p = 0.34). Conclusions Despite the lower dosage of RUTF for most SAM children in the combined protocol, their anthropometry and relapse rates at 4 months post-discharge were similar to standard care. MAM children treated with RUTF had similar body composition to those treated with RUSF and neither group exhibited excess adiposity. These results add further evidence that a combined protocol is as effective as standard care with no evidence of adverse effects post-discharge. A simplified, combined approach could treat more children, stretch existing resources further, and contribute to achieving Sustainable Development Goal Two.

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Griswold, Stacy P., Breanne K. Langlois, Ye Shen, Ilana R. Cliffer, Devika J. Suri, Shelley Walton, Ken Chui, et al. "Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: results from a cluster-randomized intervention trial in Sierra Leone." American Journal of Clinical Nutrition 114, no. 3 (May 21, 2021): 973–85. http://dx.doi.org/10.1093/ajcn/nqab140.

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ABSTRACT Background Moderate acute malnutrition (MAM) affects 33 million children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effectively improved MAM recovery rates. Information costs and cost-effectiveness differences are still needed. Objectives We assessed recovery and sustained recovery rates of MAM children receiving a supplementary food: ready-to-use supplementary food (RUSF), corn soy whey blend with fortified vegetable oil (CSWB w/oil), or Super Cereal Plus with amylase (SC + A) compared to Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil). We also estimated differences in costs and cost effectiveness of each supplement. Methods In Sierra Leone, we randomly assigned 29 health centers to provide a supplement containing 550 kcal/d for ∼12 wk to 2691 children with MAM aged 6–59 mo. We calculated cost per enrollee, cost per child who recovered, and cost per child who sustained recovery each from 2 perspectives: program perspective and caregiver perspective, combined. Results Of 2653 MAM children (98.6%) with complete data, 1676 children (63%) recovered. There were no significant differences in the odds of recovery compared to CSB+ w/oil [0.83 (95% CI: 0.64–1.08) for CSWB w/oil, 1.01 (95% CI: 0.78–1.3) for SC + A, 1.05 (95% CI: 0.82–1.34) for RUSF]. The odds of sustaining recovery were significantly lower for RUSF (0.7; 95% CI 0.49–0.99) but not CSWB w/oil or SC + A [1.08 (95% CI: 0.73–1.6) and 0.96 (95% CI: 0.67–1.4), respectively] when compared to CSB+ w/oil. Costs per enrollee [US dollars (USD)/child] ranged from $105/child in RUSF to $112/child in SC + A and costs per recovered child (USD/child) ranged from $163/child in RUSF to $179/child in CSWB w/oil, with overlapping uncertainty ranges. Costs were highest per sustained recovery (USD/child), ranging from $214/child with the CSB+ w/oil to $226/child with the SC + A, with overlapping uncertainty ranges. Conclusions The 4 supplements performed similarly across recovery (but not sustained recovery) and costed measures. Analyses of posttreatment outcomes are necessary to estimate the full cost of MAM treatment. This trial was registered at clinicaltrials.gov as NCT03146897.

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Lee, Kyoung-Ae, Ye-Jung Kim, Kwangoh Koh, and Hee-Seon Kim. "Nutrient Analyses of Sustainable Ready-to-Use-Supplemental Food (RUSF) developed with East African Ethnic Plant Resources." Journal of the East Asian Society of Dietary Life 26, no. 5 (October 31, 2016): 466–72. http://dx.doi.org/10.17495/easdl.2016.10.26.5.466.

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Steenkamp, Liana, Ronette Lategan, and Jacques Raubenheimer. "The impact of Ready-to-Use Supplementary Food (RUSF) in targeted supplementation of children with moderate acute malnutrition (MAM) in South Africa." South African Family Practice 57, no. 5 (August 19, 2015): 322–25. http://dx.doi.org/10.1080/20786190.2015.1078153.

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Langlois, Breanne, Stacy Griswold, Ilana Cliffer, Devika Suri, Ye Shen, Patrick Webb, and Beatrice Rogers. "Behavioral Factors Related to Use of Specialized Nutritious Foods in a MAM Treatment Program in Sierra Leone." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 857. http://dx.doi.org/10.1093/cdn/nzaa053_062.

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Abstract Objectives This analysis describes differences in household-level use of four specialized nutritious foods (SNFs) for treatment of moderate acute malnutrition (MAM) in children 6–59 months of age in Sierra Leone and explores whether these behaviors influenced recovery. Methods From 4/2017 to 11/2018, sub-samples of caregivers whose children were enrolled in a supplemental feeding program (SFP) for a MAM treatment study were randomly selected for in-depth interviews and in-home observations. This was a cluster-randomized trial of 2653 children with MAM in Sierra Leone evaluating cost-effectiveness of 4 SNFs: Super Cereal Plus w/amylase (SC + A), Corn-soy Blend Plus w/oil (CSB + w/oil), Corn-soy-whey Blend w/oil (CSWB w/oil), and Ready-to-Use Supplementary Food (RUSF). Caregivers received bi-weekly isocaloric distributions of 1 of the 4 SNFs until recovery or up to 12 weeks. The purpose of the in-depth interviews was to understand caregivers’ experiences with the SFP and the SNF which they received. In-home observations gathered information about observed behaviors related to SNF use over 5 consecutive days. Descriptive statistics were calculated and stratified by study arm and by outcome to explore: consumption of the SNF by the target child, sharing and selling, and diversion of other household foods. Results A total of n = 949 caregivers completed an in-depth interview. Of these, n = 323 also had an in-home observation. Observed consumption of the SNF was high in all study arms (>60%), with no discernible differences among arms. Consumption of the study food by anyone other than the beneficiary child (i.e., sharing) was similar across arms (9–12% reported, 19–27% observed), with the lowest reported and highest observed in RUSF. Very few reported giving the SNF away or selling it to others (<1%). Sharing and displacement did not differ by recovery status, but children who recovered were observed consuming the SNF more often than those who failed (82% vs. 46%). Conclusions Sharing of the SNF was common among all arms but did not affect likelihood of recovery. Ensuring adequate consumption of the SNF by the beneficiary child is critical for effectiveness. Qualitative data can expand on these findings. Funding Sources Office of Food for Peace, United States Agency for International Development.

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Mahamane Laouali MANZO, Mahaman Elhadji HALLAROU, Maimouna DOUDOU HALIDOU, Daouda ALHOUSSEINI MAIGA, Paluku BAHWERE, Salimata WADE, Katia CASTETBON, Michèle WILMET-DRAMAIX, and Philippe DONNEN. "Effect of Moringa supplementation in the management of moderate malnutrition in children under 5 receiving ready-to-use supplementary foods in Niger: A randomized clinical trial." GSC Advanced Research and Reviews 8, no. 3 (September 30, 2021): 071–86. http://dx.doi.org/10.30574/gscarr.2021.8.3.0189.

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Each year in Niger, more than 40% of children under 5 years suffer from chronic malnutrition and more than 10% from acute malnutrition. The national nutrition rehabilitation protocol encourages the use of local foods. The objective of this work is to analyze the impact of supplementation in Moringa oleifera. We conducted a randomized double-blind clinical trial in 400 children with moderate acute malnutrition (MAM) aged 6 to 59 months admitted to outpatient nutritional recovery centers (CRENAM). The children were divided into two groups; one group received Ready-to-Use Supplemental Foods (RUSF) and dry leaf powder from Moringa oleifera and the other group received RUSF and placebo. We did not find any difference on average weight gain between the two groups or on mid-upper arm circumference and size. The median length of stay in CRENAM was 5 and 4 weeks for Moringa and placebo respectively, with no statistical difference (P=0.522). The cure rate was 82% (2.72) in the Moringa group with a RR of 1.03 (0.94 to 1.13) slightly in favor of Moringa. Renal and hepatic toxicity of Moringa was not observed. From this clinical trial, it could be held that Moringa supplementation, despite the presence of nutritional indices in favor of Moringa, does not have a significant effect on the nutritional recovery of MAM children but that Moringa has no renal or hepatic toxicity. Supplementation in subjects already on dietetic treatment, dose reduced to minimum and duration of supplementation seems to have played a role in this absence of effect of Moringa.

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Isanaka, Sheila, Dale A. Barnhart, Christine M. McDonald, Robert S. Ackatia-Armah, Roland Kupka, Seydou Doumbia, Kenneth H. Brown, and Nicolas A. Menzies. "Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali." BMJ Global Health 4, no. 2 (April 2019): e001227. http://dx.doi.org/10.1136/bmjgh-2018-001227.

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IntroductionModerate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.MethodsWe conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.ResultsCompared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.ConclusionMAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.Trial registrationNCT01015950.

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de Pee, Saskia, and Martin W. Bloem. "Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children." Food and Nutrition Bulletin 30, no. 3_suppl3 (September 2009): S434—S463. http://dx.doi.org/10.1177/15648265090303s305.

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Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources 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, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn–soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.

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Hendrixson, David Taylor, Kristie Smith, Patrick Lasowski, Meghan Callaghan-Gillespie, Jacklyn Weber, Peggy Papathakis, Per Ole Iversen, Aminata Shamit Koroma, and Mark J. Manary. "A novel intervention combining supplementary food and infection control measures to improve birth outcomes in undernourished pregnant women in Sierra Leone: A randomized, controlled clinical effectiveness trial." PLOS Medicine 18, no. 9 (September 28, 2021): e1003618. http://dx.doi.org/10.1371/journal.pmed.1003618.

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Background Innovations for undernourished pregnant women that improve newborn survival and anthropometry are needed to achieve the Sustainable Development Goals 1 and 3. This study tested the hypothesis that a combination of a nutritious supplementary food and several proven chemotherapeutic interventions to control common infections would increase newborn weight and length in undernourished pregnant women. Methods and findings This was a prospective, randomized, controlled clinical effectiveness trial of a ready-to-use supplementary food (RUSF) plus anti-infective therapies compared to standard therapy in undernourished pregnant women in rural Sierra Leone. Women with a mid-upper arm circumference (MUAC) ≤23.0 cm presenting for antenatal care at one of 43 government health clinics in Western Rural Area and Pujehun districts were eligible for participation. Standard of care included a blended corn/soy flour and intermittent preventive treatment for malaria in pregnancy (IPTp). The intervention replaced the blended flour with RUSF and added azithromycin and testing and treatment for vaginal dysbiosis. Since the study involved different foods and testing procedures for the intervention and control groups, no one except the authors conducting the data analyses were blinded. The primary outcome was birth length. Secondary outcomes included maternal weight gain, birth weight, and neonatal survival. Follow-up continued until 6 months postpartum. Modified intention to treat analyses was undertaken. Participants were enrolled and followed up from February 2017 until February 2020. Of the 1,489 women enrolled, 752 were allocated to the intervention and 737 to the standard of care. The median age of these women was 19.5 years, of which 42% were primigravid. Twenty-nine women receiving the intervention and 42 women receiving the standard of care were lost to follow-up before pregnancy outcomes were obtained. There were 687 singleton live births in the intervention group and 657 in the standard of care group. Newborns receiving the intervention were 0.3 cm longer (95% confidence interval (CI) 0.09 to 0.6; p = 0.007) and weighed 70 g more (95% CI 20 to 120; p = 0.005) than those receiving the standard of care. Those women receiving the intervention had greater weekly weight gain (mean difference 40 g; 95% CI 9.70 to 71.0, p = 0.010) than those receiving the standard of care. There were fewer neonatal deaths in the intervention (n = 13; 1.9%) than in the standard of care (n = 28; 4.3%) group (difference 2.4%; 95% CI 0.3 to 4.4), (HR 0.62 95% CI 0.41 to 0.94, p = 0.026). No differences in adverse events or symptoms between the groups was found, and no serious adverse events occurred. Key limitations of the study are lack of gestational age estimates and unblinded administration of the intervention. Conclusions In this study, we observed that the addition of RUSF, azithromycin, more frequent IPTp, and testing/treatment for vaginal dysbiosis in undernourished pregnant women resulted in modest improvements in anthropometric status of mother and child at birth, and a reduction in neonatal death. Implementation of this combined intervention in rural, equatorial Africa may well be an important, practical measure to reduce infant mortality in this context. Trial registration ClinicalTrials.gov NCT03079388.

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McDonald, Christine M., Robert S. Ackatia-Armah, Seydou Doumbia, Roland Kupka, Christopher P. Duggan, and Kenneth H. Brown. "Percent Fat Mass Increases with Recovery, But Does Not Vary According to Dietary Therapy in Young Malian Children Treated for Moderate Acute Malnutrition." Journal of Nutrition 149, no. 6 (April 9, 2019): 1089–96. http://dx.doi.org/10.1093/jn/nxz037.

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ABSTRACT Background Moderate acute malnutrition (MAM) affects 34.1 million children globally. Treatment effectiveness is generally determined by the amount and rate of weight gain. Body composition (BC) assessment provides more detailed information on nutritional stores and the type of tissue accrual than traditional weight measurements alone. Objective The aim of this study was to compare the change in percentage fat mass (%FM) and other BC parameters among young Malian children with MAM according to receipt of 1 of 4 dietary supplements, and recovery status at the end of the 12-wk intervention period. Methods BC was assessed using the deuterium oxide dilution method in a subgroup of 286 children aged 6–35 mo who participated in a 12-wk community-based, cluster-randomized effectiveness trial of 4 dietary supplements for the treatment of MAM: 1) lipid-based, ready-to-use supplementary food (RUSF); 2) special corn–soy blend “plus plus” (CSB++); 3) locally processed, fortified flour (MI); or 4) locally milled flours plus oil, sugar, and micronutrient powder (LMF). Multivariate linear regression modeling was used to evaluate change in BC parameters by treatment group and recovery status. Results Mean ± SD %FM at baseline was 28.6% ± 5.32%. Change in %FM did not vary between groups. Children who received RUSF vs. MI gained more (mean; 95% CI) weight (1.43; 1.13, 1.74 kg compared with 0.84; 0.66, 1.03 kg; P = 0.02), FM (0.70; 0.45, 0.96 kg compared with 0.20; 0.05, 0.36 kg; P = 0.01), and weight-for-length z score (1.23; 0.79, 1.54 compared with 0.49; 0.34, 0.71; P = 0.03). Children who recovered from MAM exhibited greater increases in all BC parameters, including %FM, than children who did not recover. Conclusions In this study population, children had higher than expected %FM at baseline. There were no differences in %FM change between groups. International BC reference data are needed to assess the utility of BC assessment in community-based management of acute malnutrition programs. This trial was registered at clinicaltrials.gov as NCT01015950.

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Banda, Theresa, Khataza Chawanda, Wakako Tsuchida, and Slyvester Kathumba. "Report of a Pilot Program Using a Milk-Free Ready-to-Use Therapeutic Food Made From Soya, Maize, and Sorghum to Treat Severe Acute Malnutrition." Food and Nutrition Bulletin 42, no. 1 (March 2021): 91–103. http://dx.doi.org/10.1177/0379572120968703.

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Background: Globally, ready-to-use therapeutic food (RUTF) with peanut and milk as the primary source of protein is used to treat children having severe acute malnutrition (SAM). Valid Nutrition in collaboration with Ajinomoto Co., Inc has developed a nonmilk RUTF from soybean, maize, and sorghum (SMS-RUTF) and demonstrated its efficacy. Objective: To pilot SMS-RUTF in treatment of SAM within Community-Based Management of Acute Malnutrition (CMAM) program in Malawi, Africa. Methods and Findings: This was implemented from January to July 2018 and its performance was based on the SPHERE criteria and Ministry of Health CMAM guidelines. A total of 742 children were treated with SMS-RUTF. Of these, 94.5% (95% CI: 92.6-96.0) were successfully discharged to supplementary feeding program (SFP) with middle upper arm circumference (MUAC) ≥115 mm or directly to their homes with MUAC ≥125 mm; 3.6% (95% CI: 2.4-5.3) defaulted, 1.9 % (95% CI: 1.0-2.1) died, and 0.0% nonresponders. Analysis of 222 children who were discharged home with MUAC ≥125 mm gave a recovery rate of 88.3% (95% CI: 88.3-92.2), a defaulter rate of 6.8 % (95% CI: 3.8-10.9), a mortality rate of 1.3% (95% CI: 0.3-3.9), and a nonresponders rate of 1.8% (95% CI: 0.5-4.5). These outcomes exceed SPHERE minimum performance standards. The mean (standard deviation) length of stay of children discharged to SFP and discharged directly home were 42.0 (20.9) and 46.1 (21.1) days, respectively. These outcomes are within the recommended average duration of <60 days. Conclusion: The pilot CMAM program using SMS-RUTF recipe that contains no milk or peanuts achieved SPHERE minimum standards. Based on this evidence, SMS-RUTF should be encouraged for treatment of SAM in children between 6 and 59 months in routine CMAM programs in Malawi and globally.

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McLellan, A. "Does the distribution of ready to use food products for the prevention of undernutrition meet the ultimate needs of the beneficiary?" African Journal of Food, Agriculture, Nutrition and Development 14, no. 63 (May 28, 2014): 8956–62. http://dx.doi.org/10.18697/ajfand.63.13590.

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Various nutrition products are increasingly being used to treat undernutrition in humanitarian and development interventions. The United Nations (UN), International Non-Governmental Organizations (INGOs), and donor agencies have increased their promotion of Ready to Use Foods (RUF) -both therapeutic and supplementary- for the prevention of undernutrition. Undernutrition is a major global public health problem and remains a leading cause of death of children worldwide. Irreversible changes on normal physical growth and cognitive development in undernourished children can have lasting consequences in terms of increased susceptibility to disease, threatened livelihoods, and shortened lifespans. Undernutrition is commonly found in low-income groups, in developing countries, and is strongly associated with poverty. Major consensus exists regarding the use of Ready to Use Therapeutic Foods (RUTF) in the treatment of Severe and Acute Malnutrition (SAM). There is, however, less evidence to support the use of RUF in the prevention of undernutrition. Some humanitarian actors worry that too great of a focus on the distribution of RUF in the prevention of undernutrition will detract from investments in preventative long-term and sustainable interventions that address the multiple causes of undernutrition and food insecurity. Sustainable interventions lie in the development of more productive local agricultural, a more diverse mix of nutritious crops, and a greater public awareness regarding feasible, low-cost, and local approaches to a healthy diet. RUF has little to no role to play in the prevention of undernutrition. Interventions implemented to prevent undernutrition need to focus on programs and not products as essential components of their design. This article examines RUF and its current indications for use, the evidence for the use of RUF in the prevention of undernutrition, and advocates for humanitarian actors and donor agencies to strongly support sustainable and empowering interventions over the importation and distribution of prepackaged foreign made solutions.

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Woeltje, Maeve, Anastasia Evanoff, Diana Culbertson, Beth Helmink, Kenneth Maleta, Mark Manary, and Indi Trehan. "Community-Based Management of Acute Malnutrition in Infants Under 6 Months of Age." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1102. http://dx.doi.org/10.1093/cdn/nzaa054_174.

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Abstract Objectives To examine the outcomes of acutely malnourished infants under 6 months (u6m) who could not be hospitalized or exclusively breastfed and were instead treated under the community management of acute malnutrition (CMAM) model using ready to use therapeutic food (RUTF) or a supplemental food. Methods The study was a retrospective chart review of 323 infants u6m with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) seen across 20 CMAM clinics in rural southern Malawi who could not be admitted to inpatient care, which is the established standard of care for acute malnutrition in infants u6m. Infants with SAM were given 175 kcal/kg/day of RUTF and those with MAM were given 75 kcal/kg/day RUTF or supplemental food, based on availability. Nutritional counseling was provided to the caregivers of all participants, and mothers were counseled about improved breastfeeding practices. Infants were reassessed every two weeks. Outcomes included successful nutritional recovery (achieving WHZ of ≥−2 without edema), failure to achieve recovery after 12 weeks, hospitalization, death, and loss to follow up. Demographic information was also collected. Continuous variables were compared using Student's t test. Categorical variables were compared using Fisher's exact test. Results 130 infants u6m with SAM and 193 with MAM were treated using the same CMAM model used in 6–59 month-old children. About 90% of children in both groups were breastfeeding. Mean duration of therapy was 31.5 days for SAM and 20.8 days for MAM. Recovery rates were high in both groups (SAM 75%; MAM 81%). Recovery rates and other outcomes were similar to older children who were being treated contemporaneously at the same sites in the context of randomized clinical trials. Conclusions When inpatient care is not possible, therapeutic and supplementary foods provided to infants u6m with acute malnutrition is a viable treatment option. Making this option available has the potential to massively scale up the number of infants treated, with acceptable recovery rates, and at a relatively low cost to the health care system. Funding Sources None.

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Schlossman, Nina. "Higher Levels of Dairy Result in Improved Physical Outcomes: A Synthesis of 3 Randomized Controlled Trials in Guinea-Bissau Comparing Supplements with Different Levels of Dairy Ingredients Among Children 6 to 59 Months, 5 to 19 Year Olds, and Mothers in Preschools, Primary Schools, and Villages, and the Implications for Programs." Food and Nutrition Bulletin 39, no. 2_suppl (September 2018): S35—S44. http://dx.doi.org/10.1177/0379572118795729.

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Background: This article synthesizes the results of 3 cluster randomized controlled trials of dairy-containing ready-to-use supplementary foods (RUSFs) to address malnutrition in primary schools, preschools and villages in Guinea-Bissau, one of the world’s poorest countries. Together, these studies document widespread malnutrition across infants, young children, adolescents, and pregnant and lactating women and point to intervention options that were not previously presented. Objective: To combine the evidence from the United States Department of Agriculture–funded pilot studies in Guinea-Bissau on the effects of dairy protein supplementation to gain a broader perspective on the role of dairy containing RUSFs in various age-groups, the importance of the mother–child dyad and family food dynamics for infant and child growth. Translate the results into action and the next generation of effective products. Methods: A comparative analysis of data and synthesis of evidence from 3 published studies and ongoing research conducted by our team in Guinea-Bissau. Results and Conclusions: Higher dairy supplements have the potential to achieve broad benefits for malnutrition, especially in mothers and early childhood (first 1000 days and 36-59 months). Higher levels of dairy protein also can prevent moderate acute malnutrition in children younger than 2 years, independent of the family food dynamic. Community-level nutrition behavior change education should target older children and adolescents at the community level and through the preschool/school platform.

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Subhashree, S., Jisha A. Prabha, Reegan Thomas, and VN Harisuthammal. "Innovative products using amrutham nutrimix and its popularization among young mothers." Journal of Nutrition Research 2, no. 1 (December 15, 2014): 17–22. http://dx.doi.org/10.55289/jnutres/v2i1.1.

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Under nutrition in children is a widespread health problem in our country. ICDS that addresses the problem of malnutrition has been unsuccessful even after three decades of implementation. Amrutham nutrimix - a nutritious supplementary food given for malnourished children is not utilized due to monotony in its preparation. Hence an attempt was made to formulate nutritious amrutham based recipes. Twenty common recipes including sweet dishes and savories were prepared. Acceptability of all the developed products was assessed by a taste panel. Iron and protein content was analysed for the 6 most accepted products. All the formulated products were affordable and ranged from 50p (murukku) to Rs.3/-(sweet balls) per 100g. The recipes were displayed and popularized among young mothers as they are the prime caregivers of young toddlers and are willing to change food behavior for the welfare of their children. Recipes and its health benefits were discussed with the participants. The education program was very effective in imparting nutrition knowledge as there was significance in the pre and post test scores. Hence, amrutham nutrimix can be an affordable and acceptable nutritional substitute to WHO recommended ready to use therapeutic food (RUTF) for Severe Acute Malnutrition (SAM) especially when used in diverse forms as suggested in the current study. Keywords: Amrutham nutrimix, Malnutrition, SAM, RUTF

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Schweitzer, Cindy. "Ready-to-Use Supplementary Foods and Ready-to-Use Therapeutic Foods." Food and Nutrition Bulletin 37, no. 1_suppl (February 10, 2016): S47—S50. http://dx.doi.org/10.1177/0379572116629255.

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Tekle, Abinet, Barbara Tembo, Masresha Tessema, Dilnesaw Zerfu, Biniyam Tesfaye, Tibebu Moges, Aregash Samuel, et al. "Sensory Acceptability Trial for a Chickpea-based Ready-to-use Supplementary Food." European Journal of Nutrition & Food Safety 5, no. 5 (January 10, 2015): 979–80. http://dx.doi.org/10.9734/ejnfs/2015/21196.

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Wright, Charlotte, Antonina Mutoro, Eleanor Grieve, Ada Garcia, Hermann P. Donfouet, and Elizabeth Kimani-Murage. "The Cost of a Counseling-Based Intervention for Moderate Acute Malnutrition (MAM) in Kenya Compared to Treatment with Ready-to-Use Foods (RUF)." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 926. http://dx.doi.org/10.1093/cdn/nzaa053_131.

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Abstract Objectives Supplementary feeding with RUF is currently the recommended treatment for MAM in Kenya, although trials suggest it produces only modest medium-term benefits. An alternative counseling-based approach which identified and addressed the varied underlying causes for MAM would involve increased staff time. In order to model the future cost of providing a targeted, problem solving intervention for MAM instead of supplementary foods, we aimed to estimate the current staff and facility cost of managing acute malnutrition using RUF. Methods We studied 6 health facilities in Nairobi, Kenya in 2019, assessing the amount of staff time spent in treatment of AM and managing RUF supplies, via interview and observation. Information was collected on: time spent per child per visit, number of children with AM seen by nutritionists annually, time spent by staff per year on requisition and management of RUF and in relevant training, staff wage rates and RUF transport costs. Costs were calculated in US$, per child/month, assuming each child was seen once and supplied with 28 RUF sachets. Results Centers saw 7–80 children per clinic and staff spent 5–9 minute seeing each child. The contact cost per child visit was $0.14–0.25 and the dispensing cost $0.02–0.34, giving a mean (range) total cost of $0.24 (0.17 – 0.59). The hourly pay for nutritionists was $1.67. The exact cost of RUF varies, depending on supplier and purchaser, but was estimated to vary from $0.25 to $0.50 per sachet, giving a monthly cost of $7–14. This represents 96–98% of total current MAM treatment costs. Conclusions Very little time is currently spent speaking to mothers of malnourished children. An intervention for MAM could involve up to 8 hours counseling per month per child and still be cheaper to provide than supplementary RUTF. Well-staffed trials of the efficacy of problem-oriented counseling interventions need to be undertaken. Funding Sources Scottish Funding Council (Global Challenges Research Fund).

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Maleta, Kenneth, Juha Kuittinen, Maureen B. Duggan, André Briend, Mark Manary, Jerry Wales, Teija Kulmala, and Per Ashorn. "Supplementary Feeding of Underweight, Stunted Malawian Children With a Ready-To-Use Food." Journal of Pediatric Gastroenterology and Nutrition 38, no. 2 (February 2004): 152–58. http://dx.doi.org/10.1097/00005176-200402000-00010.

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Davis, Thomas, Edward Fischer, Peter Rohloff, and Douglas Heimburger. "Chronic Malnutrition, Breastfeeding, and Ready To Use Supplementary Food in a Guatemalan Maya Town." Human Organization 73, no. 1 (April 2014): 72–81. http://dx.doi.org/10.17730/humo.73.1.y4h5512h801p5vj0.

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Iannotti, Lora L., Nicole M. Henretty, Jacques Raymond Delnatus, Windy Previl, Tom Stehl, Susan Vorkoper, Jaime Bodden, et al. "Ready-to-Use Supplementary Food Increases Fat Mass and BMI in Haitian School-Aged Children." Journal of Nutrition 145, no. 4 (February 11, 2015): 813–22. http://dx.doi.org/10.3945/jn.114.203182.

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Grellety, Emmanuel, Susan Shepherd, Thomas Roederer, Mahamane L. Manzo, Stéphane Doyon, Eric-Alain Ategbo, and Rebecca F. Grais. "Effect of Mass Supplementation with Ready-to-Use Supplementary Food during an Anticipated Nutritional Emergency." PLoS ONE 7, no. 9 (September 12, 2012): e44549. http://dx.doi.org/10.1371/journal.pone.0044549.

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Litkowski, P. E., H. C. Stobaugh, I. Trehan, and M. J. Manary. "The addition of whey permeate to ready-to use supplementary food improves recovery from moderate acute malnutrition." Annals of Global Health 82, no. 3 (August 20, 2016): 393. http://dx.doi.org/10.1016/j.aogh.2016.04.644.

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Kudhayer, Nedhal, and Sawsan Habib. "Ready to-Use Supplementary Food in the Outpatient Management of Children with Acute Malnutrition in Basrah." Medical Journal of Basrah University 39, no. 2 (December 15, 2021): 120–27. http://dx.doi.org/10.33762/mjbu.2021.130966.1085.

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Azimi, F., A. Esmaillzadeh, E. Alipoor, M. Moslemi, M. Yaseri, and M. J. Hosseinzadeh-Attar. "Effect of a newly developed ready-to-use supplementary food on growth indicators in children with mild to moderate malnutrition." Public Health 185 (August 2020): 290–97. http://dx.doi.org/10.1016/j.puhe.2020.06.025.

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Lagrone, L., S. Cole, A. Schondelmeyer, K. Maleta, and M. J. Manary. "Locally produced ready-to-use supplementary food is an effective treatment of moderate acute malnutrition in an operational setting." Annals of Tropical Paediatrics 30, no. 2 (June 2010): 103–8. http://dx.doi.org/10.1179/146532810x12703901870651.

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Pillay, K., M. Siwela, Fj Veldman, Eo Amonsou, and Bp Mabaso. "Acceptance of a ready-to-use supplementary food by stable HIV-treated and HIV and tuberculosis (co-infected)-treated patients." South African Journal of Clinical Nutrition 27, no. 1 (January 2014): 31–37. http://dx.doi.org/10.1080/16070658.2014.11734482.

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Huybregts, Lieven, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, and Patrick Kolsteren. "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." PLoS Medicine 9, no. 9 (September 18, 2012): e1001313. http://dx.doi.org/10.1371/journal.pmed.1001313.

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Borg, Bindi, Seema Mihrshahi, Mark Griffin, Chhoun Chamnan, Arnaud Laillou, and Frank T. Wieringa. "Crossover trial to test the acceptability of a locally produced lipid-based nutrient supplement (LNS) for children under 2 years in Cambodia: a study protocol." BMJ Open 7, no. 9 (September 2017): e015958. http://dx.doi.org/10.1136/bmjopen-2017-015958.

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IntroductionThe acceptability and efficacy of existing ready-to-use supplementary and therapeutic foods has been low in Cambodia, thus limiting success in preventing and treating malnutrition among Cambodian children. In that context, UNICEF and IRD have developed a locally produced, multiple micronutrient fortified lipid-based nutrient supplement. This food is innovative, in that it uses fish instead of milk as the animal source food. Very few supplementary foods have non-milk animal source foods, and in addition they have not been widely tested. This trial will assess the novel food’s acceptability to children and caregivers.Methods and analysisThis is a cluster-randomised, incomplete block, 4×4 crossover design with no blinding. It will take place in four sites in a community setting in periurban Phnom Penh. Healthy children aged 9–23 months (n=100) will eat each of four foods for 3 days at a time. The amount they consume will be measured, and at the end of each 3-day set, caregivers will assess how well their child liked the food. After 12 days, caregivers themselves will do a sensory test of the 4 foods and will rank them in terms of preference.Ethics and disseminationEthical clearance was received from the University of Queensland Medical Research Ethics Committee (2014001070) and from Cambodia’s National Ethics Committee for Health Research (03/8 NECHR).RegistrationClinicalTrials.gov, identifier: LNS-CAMB-INFANTS;NCT02257437. Pre-results.

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Ivers, Louise C., Jessica E. Teng, J. Gregory Jerome, Matthew Bonds, Kenneth A. Freedberg, and Molly F. Franke. "A Randomized Trial of Ready-to-Use Supplementary Food Versus Corn-Soy Blend Plus as Food Rations for HIV-Infected Adults on Antiretroviral Therapy in Rural Haiti." Clinical Infectious Diseases 58, no. 8 (February 17, 2014): 1176–84. http://dx.doi.org/10.1093/cid/ciu028.

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Griswold, Stacy, Beatrice Rogers, and Patrick Webb. "Factors Associated With Failure to Respond to Treatment for Moderate Acute Malnutrition in Sierra Leone." Current Developments in Nutrition 6, Supplement_1 (June 2022): 573. http://dx.doi.org/10.1093/cdn/nzac060.031.

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Abstract Objectives To assess factors associated with failure to respond to treatment for moderate acute malnutrition (MAM) while enrolled in a supplementary feeding program (SFP) in Pujehun District, Sierra Leone. Methods This was a secondary analysis of a cluster-randomized trial. The main study examined the cost-effectiveness of four specialized nutritious foods (SNFs) for treating MAM in children 6–59 months. Each SNF (Corn Soy Blend Plus, Corn Soy Whey Blend, Super Cereal Plus with Amylase, and Ready to Use Supplementary Food) was provided to caregivers in 14-day isocaloric rations for 12 weeks or until reaching an outcome. Outcomes were: Recovery (mid-upper arm circumference [MUAC]≥12.5cm), Failure (11.5 > MUAC < 12.5 after 12 weeks of treatment), severe acute malnutrition [SAM] (MUAC ≤ 11.5), Default (3 consecutive missed visits), or Death. Beneficiary caregivers provided standard demographic information at enrollment. Height, weight, and MUAC were taken every 14 days during a clinical visit as was information on illness (incidence of diarrhea, fever, cough, and vomit). Multinomial logistic regression assessed demographic and illnesses’ influence on the relative risk of Failure or developing SAM compared to Recovery. Results Of enrolled children (N = 2682), 1675 (63%) recovered, 498 (19%) worsened to SAM, and 259 (10%) failed to respond. In the 2 weeks prior to enrollment, more children who recovered experienced fever (30%), cough (23%), diarrhea (9%), or vomit (7%) than children who did not recover. By exit, a larger % of children who developed SAM reported fever (30%), cough (27%), diarrhea (16%), or vomit (10%) in the 2 preceding weeks than children who failed or recovered. In both adjusted and unadjusted models, children who entered the program with higher MUACs or reported any illness in the 2 weeks preceding enrollment were at significantly lower risk of worsening to SAM or failing to recover. Children who were transferred from a SAM treatment program were at significantly greater risk of worsening to SAM and failing to respond as were children with any illness in the 2 weeks preceding exit. Conclusions Underlying infections or illness may explain why some children with MAM fail to recover. Illness at enrollment may signal a transitory condition remedied with treatment. Funding Sources Bureau for Humanitarian Assistance, U.S. Agency for International Development.

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Stobaugh, H. C., K. N. Ryan, J. A. Kennedy, J. B. Grise, A. H. Crocker, C. Thakwalakwa, P. E. Litkowski, K. M. Maleta, M. J. Manary, and I. Trehan. "Including whey protein and whey permeate in ready-to-use supplementary food improves recovery rates in children with moderate acute malnutrition: a randomized, double-blind clinical trial." American Journal of Clinical Nutrition 103, no. 3 (February 10, 2016): 926–33. http://dx.doi.org/10.3945/ajcn.115.124636.

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Lubis, Iskandar Z. "Risk Factors of Infantile Diarrhea (A Case-Control Study)." Paediatrica Indonesiana 32, no. 5-6 (January 29, 2019): 125–34. http://dx.doi.org/10.14238/pi32.5-6.1992.125-34.

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From March thru April 1990 an unmatched case-control study had been conducted at the pediatric out-patient Clinic of Dr. Pirngadi Hospital Medan to assess risk factors of infantile diarrhea. The study population were infants, aged younger than 21 months. The mothers of the infants were interviewed, using structured questionnaires. Sample size, calculated by means of formula, with 95 % level of confidence, 90 % power of study, 50% estimated proportion of exposure in the control-group and 2.0 estimated odds ratio, was 121. All infants with diarrhea were included in the case-group until a total number of 124 infants were reached. One control, an infant without diarrhea, was taken for each case from the nearest sequence of attendance after the case. A total of 20 risk factors were tested. Exposure was indicated from the last day before illness. Computerized statistical analysis was performed to calculate odds ratio, 95 % confidence interval and two tailed significance testing for qualitative dichotomic data by means of Chi square test. A total of nine factors were confirmed as risk factors of infantile diarrhea i.e mothers age than 20 years, working mother, not cleaning nipple before suckling the baby bottle feeding, having only one nursing botlle/teat, not ready for use nursing bottle/teat, giving left over supplementary food without reheating, no band-washing before giving supplementary food and malnutrition. The result of this study can be emphasized in health education, especially in diarrheal disease control of infancy; Further well-designed studies are needed.

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Mallewa, Jane, Alexander J. Szubert, Peter Mugyenyi, Ennie Chidziva, Margaret J. Thomason, Priscilla Chepkorir, George Abongomera, et al. "Effect of ready-to-use supplementary food on mortality in severely immunocompromised HIV-infected individuals in Africa initiating antiretroviral therapy (REALITY): an open-label, parallel-group, randomised controlled trial." Lancet HIV 5, no. 5 (May 2018): e231-e240. http://dx.doi.org/10.1016/s2352-3018(18)30038-9.

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Karakochuk, Crystal, Tina van den Briel, Derek Stephens, and Stanley Zlotkin. "Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial." American Journal of Clinical Nutrition 96, no. 4 (September 5, 2012): 911–16. http://dx.doi.org/10.3945/ajcn.111.029744.

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Marks, Jonathan. "Granadilla swimwear: finding opportunity in times of crisis." Emerald Emerging Markets Case Studies 10, no. 3 (July 22, 2020): 1–9. http://dx.doi.org/10.1108/eemcs-05-2020-0164.

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Learning outcomes The main learning outcomes that can develop from this case are as follows. These have been articulated for an approximately 90-min class discussion. Opportunity identification in times of crisis: at a macro-level, the case serves to illustrate the nature of identifying and exploiting opportunities in times of crisis. In particular, it shows how an agile small team and quickly respond to need and develop a sustainable and scalable business. Pivoting the business model: the case raises an interesting and important debate as regards what constitutes a “pivot”. While the classical interpretation would be a change in direction without a change in strategy, this case within the context of Covid-19 challenges this definition. Resource use and allocation: The case illustrates well how existing resources, networks and skills can be used in a very different business venture to alleviate immediate cash flow needs and potentially build another business venture. Case overview/synopsis This case study explores how two Cape Town-based entrepreneurs, Josh Meltz and Adam Duxbury, responded to the Covid-19 crisis and the subsequent lockdown in South Africa. The pair had built a successful swimwear brand – Granadilla Swimwear – and two other businesses: a function venue and a kombucha brand sold at a well-known food market. As the Covid-19 lockdown tool effect, the entrepreneurs saw not only declining revenue in their food and function venue business but were about to enter a six-month period of negative cash flow on their seasonal swimwear business. The entrepreneurs saw an opportunity to deliver food boxes of fresh fruit, vegetables, bread and other staples within the Cape Town metropolitan area. Their kombucha brand had a ready-made food processing and handling facility (including cold storage) and existing relationships with customers, suppliers and other vendors at the food market gave them ready access to a range of locally produced food products available immediately and on consignment. Meltz & Duxbury quickly launched an online shop and started marketing via Instagram. Within 48 h, they were delivering food boxes, with little risk and upfront capital investment. As the lockdown continued and other competitors entered the market, the team wondered at the longevity of the pivot and whether this was a business that would sustain itself or whether it was just a short-term fix for their immediate cash flow problems. Complexity academic level Undergraduate and postgraduate Supplementary materials Teaching Notes are available for educators only. Subject code CSS: 3 Entrepreneurship.

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Ranjan, Sobhana, Santosh J. Passi, and Som N. Singh. "Impact of Crude Palm Oil Fortified Cookies Supplementation on Anthropometry, Vitamin A and Hematological Status of School Children in India." International Journal for Vitamin and Nutrition Research 89, no. 5-6 (November 2019): 321–30. http://dx.doi.org/10.1024/0300-9831/a000478.

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Abstract. Objectives: Food-based strategies remain the most sustainable solutions for combating micronutrient deficiencies. Crude palm oil being the richest natural source of β-carotene, the study aimed to assess the impact of crude palm oil fortified cookies supplementation on anthropometry, vitamin A and hematological status of school children. Methods: 444 children (boys-226, girls-218), aged 5-13 years from two Municipal Corporation of Delhi primary schools were enrolled. By draw of lot, children from one of the schools formed the experimental (n = 224; boys-119, girls-105) while other formed the placebo group (n = 220; boys-107; girls-113). Children from the experimental group received six crude palm oil fortified cookies providing 2152 μg of β-carotene while the placebo group received similar but non-fortified cookies each day for 50 school days. Anthropometry, vitamin A, and hematological status were assessed at baseline and post supplementation. Results: Post supplementation, the number of stunted subjects reduced significantly (p < 0.05) in the experimental group. There was a significant increase in plasma retinol (170.9%; mean change: 1.55 ± 1.30 μmol/L - experimental group vs. 0.45 ± 0.99 μmol/L - placebo group) and β-carotene (p < 0.01; median change from 0.55 to 0.76 μmol/L - experimental group vs. 0.59 to 0.55 μmol/L -placebo group) concentrations of the experimental group. The increase in hematological parameters (mean change in Hemoglobin: 1.64 g/dL in experimental group vs. 2.10 g/dL in placebo group) of both the groups were however, comparable. Conclusion: To address micronutrient deficiencies particularly in developing nations, the use of crude palm oil should be encouraged through supplementary feeding programs by way of ready-to-eat snacks.

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Pradhan, Swapna, and Smeeta Bhatkal. "DMart: driving growth in a changed business environment." Emerald Emerging Markets Case Studies 11, no. 3 (August 31, 2021): 1–31. http://dx.doi.org/10.1108/eemcs-10-2020-0371.

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Learning outcomes The learning outcomes of this paper are as follows: to comprehend the unique features of the DMart business model, to understand the dynamics of the Indian food and grocery market, to analyse the reasons for the success of DMart, to analyse the financial health of a business by using financial ratios and to appreciate the effect of business and operating strategy on financial statements. Case overview/synopsis In September 2020, the management team of Pegasus Consulting (PS) – a boutique strategy consulting firm headquartered in Mumbai, India had convened a meeting to evaluate business options for future growth. Post the COVID −19 pandemic outbreak in India in March 2020; many industry sectors had been experiencing a general slowdown in business. Retail was one such sector identified, which had faced a slowdown. A recent Edelweiss report suggested a 39% dip in revenues of DMart stores that were owned and operated by Avenue Supermarts Limited (ASL). The PS team had been following the impressive growth story of DMart since 2017 when they had made a historic market debut with the initial public offering. Over the years the company had grown and emerged as one of the most valued listed retailers in the Indian retail space in the fiscal year 2019–2020. However, much had changed, as the imposition of the countrywide lockdown in March 2020. Based on the Government of India and local government directives nearly 50% of the stores had to be temporarily shut. The case highlights the dynamics of the Indian retail market with multiple players and formats and the changes in consumer behaviour. ASL had used its DMart Ready online app and DMart on Wheels to service the needs of its customers during the period of the lockdown. The PS team wanted to make a business consulting pitch to DMart to help them revive their growth trajectory. What could be the best advice that the PS team could offer to DMart in their pitch? Complexity academic level The case has been written with the objective of enabling the students to understand the dynamics of a rapidly changing emerging market. It is structured for use at a Master’s level course and an MBA audience in the subject of business strategy and/or retail strategy. Supplementary materials Teaching Notes are available for educators only. Subject code CSS 11: Strategy.

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"Ready-to-use Therapeutic Food (RUTF) and Ready-to-use Supplementary Food (RUSF)." Sight and Life Magazine: Product Innovation, August 13, 2018. http://dx.doi.org/10.52439/qrfk2388.

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Griswold, Stacy, Breanne Langlois, Devika Suri, Ye Shen, Shelley Walton, Kenneth Chui, and Beatrice Rogers. "Self-Reported Adherence to Ration Guidance During Preparation or Feeding of Four Specialized Foods May Not Predict Recovery from Moderate Acute Malnutrition (MAM) (P10-143-19)." Current Developments in Nutrition 3, Supplement_1 (June 1, 2019). http://dx.doi.org/10.1093/cdn/nzz034.p10-143-19.

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Abstract Objectives Fortified blended flours (FBFs) require preparation with boiling water, sometimes with fortified vegetable oil (FVO), using prescribed quantities and ratios. Lipid-based nutrient supplements (LNS) are ready-to-eat, individually packaged, and prescribed for consumption without adding other ingredients/foods. This study assessed compliance with recipe and ration instructions and whether this influenced treatment effectiveness for moderate acute malnutrition (MAM). Methods A cluster-randomized clinical-effectiveness trial in Sierra Leone compared four isocaloric foods in treating children 6–59 mos with uncomplicated MAM: Corn-Soy Blend Plus with FVO (CSB +), Corn-Soy Whey Blend with FVO (CSWB), Super Cereal Plus with amylase (SC + A), or ready-to-use-supplementary food (RUSF). Caregivers were advised bi-weekly by trained nurses on ingredients, quantities, and daily rations. A random sub-sample participated in in-depth interviews on ingredients used at the last preparation. Respondents were categorized in two ways: (for FBFs) using too little, the correct amount or too much or (for RUSF) correct if eaten without other food; or using the recommended ratios of ingredients. Unadjusted logistic regression evaluated the relationship between compliance and graduation from treatment. Results Graduation rates among 958 respondents: 70% CSB + , 67% CSWB, 66% SC + , and 66% RUSF. Reported use of correct ingredients was: 99% of CSB +, 97% of CSWB, and 99% of SC + A and 86% RUSF reported eating without mixing. Reported use of correct amount of flour: 34% in CSB + , 27% in CSWB, and 43% in SC + A of those, 95% in CSB + and 96% in CSWB also used the correct amount of oil. Among all caregivers, 86% in CSB + and 92% in CSWB used the correct amount of oil. In unadjusted models, the relationships between compliance behaviors and graduation were not statistically significant. Conclusions Reported use of correct ingredients was high for all study foods; among FBFs, amount of flour was often different from the recommendation while amount of oil was often correct. Further research may explain apparent low importance of emphasizing ration guidance when designing information, education, and communication for MAM treatment programs. Funding Sources Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, U.S. Agency for International Development.

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Journal articles on the topic 'Ready-to-use supplementary food (RUSF)'

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