Abstract
The development of ready-to-use therapeutic food (RUTF) for the treatment of uncomplicated cases of severe acute malnutrition in young children from 6 months to 5 years old has greatly improved survival through the ability to treat large numbers of malnourished children in the community setting rather than at health facilities during emergencies. This success has led to a surge in demand for RUTF in low income countries that are frequently food insecure due to environmental factors such as cyclical drought. Worldwide production capacity for the supply of RUTF has increased dramatically through the expansion and development of new manufacturing facilities in both low and high income countries, and new business ventures dedicated to ready-to-use foods have emerged not only for emergencies, but increasingly, for supplementing caloric intake of pregnant women and young children not experiencing acute undernutrition. Due to the lack of evidence on the long term health impact these products may have, in the midst of global nutrition transitions toward obesity and metabolic dysfunction, the increased use of manufactured, commercial products for treatment and prevention of undernutrition is of great concern. Using a framework built on the life course health development perspective, the current research presents several drawbacks and limitations of RUTF for nutrition of mothers and young children, especially in non-emergency situations. Recommendations follow for potential strategies to limit the use of these products to the treatment of acute undernutrition only, study the longer term health impacts of RUTF, prevent conflict of interests arising for social enterprises, and where possible, ensure that whole foods are supported for life-long health and nutrition, as well as environmental sustainability.
Highlights
Undernutrition in children worldwide is considered the direct or indirect cause of mortality in approximately 45% of all deaths among children younger than five [1], and has lifelong consequences for physical and cognitive wellbeing
ready-to-use therapeutic food (RUTF) have allowed for the treatment of uncomplicated cases of Severe acute malnutrition (SAM) with appetite in the home/community, with care provided by mothers and supervision by community health workers, commonly through the community-based management of acute malnutrition (CMAM) program which was officially endorsed by the World Health Organization and other international agencies in 2007 [8]
These include: exclusive breastfeeding for the first six months of life, followed by continued breastfeeding and the use of appropriate complementary foods for children 6–24 months; micronutrient supplementation for vulnerable groups; and advocating best practices for child nutrition, health and hygiene. It is in the context of this important statement and ethical obligation that we argue the use of RUTF and related ready-to-use-foods in situations other than therapeutic treatment of child undernutrition does not constitute use of appropriate complementary foods nor best practices for child nutrition and health
Summary
Undernutrition in children worldwide is considered the direct or indirect cause of mortality in approximately 45% of all deaths among children younger than five [1], and has lifelong consequences for physical and cognitive wellbeing. RUTFs do not require water for preparation, and are shelf stable for up to 2 years, which are advantages over the former inpatient treatment, and are generally palatable to children with an appetite, as the usual form of RUTF is a sweet, peanut-based, nutrient-enriched paste [9]. These have proven effective at treating SAM and moderate acute malnutrition (MAM) in many settings [10,11,12,13,14,15], there is evidence that. The present review, referring primarily to non-emergency situations, considered the following: (1) important drawbacks and limitations to RUTFs; (2) increased demand for and use of these products; (3) investigation of the sustainability of RUTFs, both for long-term human health during global nutrition transitions, and environmental sustainability; and (4) strategies which may prevent or mitigate any future health issues arising from the use of RUTF in mothers and children
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