The wonder food? Tackling malnutrition with ready-to-use therapeutic food

In the midst of food insecurity in numerous parts of the world, ready-to-use therapeutic food brings hope for malnourished people.

If you have ever thrown out food, maybe next time you should think twice.

Food insecurity is a major problem in many parts of the world, especially with the troubles brought about by the ongoing global pandemic. While the Food and Agriculture Organization of the United Nations (FAO) defines food security as the simultaneous fulfillment of four dimensions—physical availability of food, economic and physical access to food, food utilization, and stability of these three dimensions over time—only one of three Filipino households are considered food secure.

With the presence of systemic food insecurity and poverty across the country, it is no wonder that malnutrition, a condition categorized by improper nutrient intake, also affects thousands of Filipinos. Although it comes in varying types, including overnutrition, undernutrition, and micronutrient deficiency, the majority of children are affected by the latter two conditions. In 2019, it was estimated that 95 children die from malnutrition per day, and many others are affected by stunting or wasting—measures of chronic and acute nutritional deficiency.

Given this, a cheap yet accessible treatment was developed to tackle malnutrition in the country called ready-to-use therapeutic food (RUTFs). Known as a “wonder food”, RUTFs are distributed in malnourished countries to provide sufficient nutrition for young children. 

Dr. Rene Gerard Galera, a UNICEF nutrition specialist, explains that different types of RUTFs are used to treat malnutrition. “Ready-to-use therapeutic food [is] the specific food item that we use to treat children with severe acute malnutrition (SAM). We also have ready-to-use supplementary food (RUSFs). That’s the food that we use…to treat moderate acute malnutrition,” he emphasizes.

Tried-and-true formula

The life-saving nutrition packet was invented in 1996 by French pediatrician André Briend. Inspired by a jar of Nutella, a chocolate spread, Briend developed his own calorie-dense paste—a mix of peanut butter, skimmed milk powder, sugar, and vegetable oil—and fortified it with the right vitamins and minerals that a malnourished child needs to recover, such as iron and zinc. 

His recipe has since been refined into a product called Plumpy’Nut. Because it is oil-based, the paste can be stored in a foil packet for months without refrigeration and eaten directly without being cooked. In contrast, other treatments for acute malnutrition are water-based, which may serve as a breeding ground for dangerous bacteria.

Apart from their long shelf life, Galera adds that RUTFs are revolutionary because they allow parents to help feed their children at home instead of taking them to hospitals where they may be exposed to other diseases. “With RUTFs, we get to shift the key point of care and bring it closer to home,” he explains.

Expanding and investing

With the Philippines’ high rate of malnutrition, the distribution of RUTFs began as early as 2013, after the onslaught of Typhoon Yolanda. More recently, RUTFs were also distributed to malnourished kids in Leyte last February 2022, after Typhoon Odette. 

Galera outlines plans for distribution in the country, clarifying that the RUTFs and RUSFs are distributed depending on the number of children who are severely malnourished in a particular region. “There are plans to expand coverage, and [the] DOH has been actively…building capacities. I think [they] procure around 50,000 boxes [yearly].”

However, Galera also underlines the importance of investing in health facilities, rural health units, and capacity building to ensure the sustainability of the treatment. “[Giving RUTFs] really needs skill and knowledge [so the] health worker [can teach the mother] how to correct the feeding practices, how to correct inappropriate care practices, [and] how to improve dietary intake after the child recovers,’’ he says.

Growing pains

Despite the increasing popularity of RUTFs, only 25 percent of children with SAM can access treatment globally. One reason for this low treatment coverage is the high price tag. According to Galera, the average cost of one box of RUTF is USD50 or P2923. This does not include the antibiotics that an acutely malnourished child may need to recover, putting it out of reach for many health programs. The Philippines is one of the few countries that has been investing more money to procure RUTF.

The scant supply of ingredients is also concerning. Most RUTFs contain peanuts because they are a powerhouse for nutrition, as they have more plant protein per ounce than any other nut. Milk is also present because it is a source of several micronutrients. However, these ingredients are often imported by developing countries, which impedes their ability to increase local production of RUTFs.

Many companies have made new recipes to meet the needs of malnourished children, but only one of them has passed clinical trials. In 2018, the RUTF supplier Valid Nutrition released the first successful alternative to the peanut and milk-based RUTF. Its main ingredients—soya, maize, and sorghum—were 25 percent less expensive than the mainstream formula but were equally effective.

Apart from the costs of producing RUTFs, Galera emphasizes the existing limitations in their distribution. The nutritional packets are often given only during emergencies such as natural disasters and war. To improve measures against malnutrition, the government has been finding ways to forecast the needs of children and direct resources before a crisis strikes.

The 1000-day window of opportunity

While RUTFs may succeed in chipping away at the symptoms of acute malnutrition, they fail to address its root cause. “[RUTF] is not a magic bullet. It’s an effective treatment, but we have to do more to ensure that the child will not revert to being acutely malnourished,” Galera asserts.

Proper nutrition starts before birth. When a pregnant woman does not get sufficient calories, nutrients, and proteins, her child’s health is already at risk for developmental delays and disabilities. For this reason, Galera believes that the child’s first 1,000 days—the time between their conception and second birthday—is the key to preventing malnutrition.

Intervention goes further than the mass distribution of packets of peanut paste. Likewise, raising awareness of the importance of nutritious food is also not enough. Malnutrition is a complex problem, and the way poverty contributes to the issue cannot be ignored. It is not fair to educate people on what to eat when they do not have access to healthy food to begin with.

Adopting a systemic approach to malnutrition is necessary because not one entity can solve this problem. It needs the commitment of both the private sector and the public sector, along with the spirit of volunteerism from individuals. Through collective effort, society can ensure that every child will have a strong start in life.

Liv Licardo

By Liv Licardo

Amanda Palmera

By Amanda Palmera

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