TREATING MALNUTRITION WITH RUTFs

TREATING MALNUTRITION WITH RUTFs
Nutritional Hope for Starving Children

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Why Treating Malnutrition is Important


Treating malnutrition is critically important because it directly impacts a child’s survival, growth, and future potential. Malnutrition weakens the immune system, making children more vulnerable to disease and increasing the risk of death, especially in the first five years of life. It also stunts physical growth and impairs brain development, leading to long-term consequences in learning, productivity, and overall health. Without proper treatment, the effects of malnutrition can be irreversible, trapping individuals and communities in a cycle of poverty and poor health. Addressing malnutrition not only saves lives but also lays the foundation for stronger, healthier, and more resilient societies.

Global Prevalence of Stunting and Wasting Among Children

The global burden of child malnutrition remains a pressing concern, affecting millions of children under the age of five. According to the 2024 Joint Child Malnutrition Estimates by UNICEF, WHO, and the World Bank, the data highlights the alarming scale of the crisis: over 150 million children are stunted, nearly 43 million suffer from wasting, and more than 12 million experience severe wasting, a life-threatening condition requiring urgent treatment. In cases of severe wasting, Ready-to-Use Therapeutic Foods (RUTFs) have become a critical tool in saving lives. These nutrient-dense, easy-to-use products are specifically designed to treat acute malnutrition and can be administered at home through community-based programs. The widespread use of RUTFs has proven to dramatically improve recovery rates and reduce child mortality, making them an essential part of the global response to malnutrition.

Stunting refers to children who are too short for their age, indicating chronic undernutrition. Wasting refers to children who are too thin for their height, indicating acute undernutrition. Severe wasting is a more serious form of wasting, posing a higher risk of mortality. Overweight refers to children who are too heavy for their height, which can lead to health issues.

TREATING MALNUTRITION WITH READY-TO-USE THERAPEUTIC FOODS

RUTFs are high-energy, nutrient-dense pastes made from ingredients such as peanuts, milk powder, vegetable oil, sugar, and essential vitamins and minerals. Designed to meet all the dietary needs of a severely malnourished child, these products are easy to use, portable, and effective in reversing malnutrition in a matter of weeks.

KEY CHARACTERSTICS OF RUTFs

  • Ready-to-eat with no preparation required
  • Rich in calories, protein, and vital micronutrients
  • Shelf-stable and safe for use in hot climates
  • Individually packaged for easy dosing and transport
  • Enables home-based care in community health programs

THE BENIFITS OF RUFTs

  • Rapid weight gain and health restoration
  • Full recovery from SAM in most cases within 6 – 8 weeks
  • Significantly reduced risk of death from malnutrition-related complications
  • Improved immune function and energy
  • Support for physical and cognitive development
  • Empowerment of caregivers through home-based treatment

Ready-to-Use Therapeutic Foods (RUTFs) are one of the vital components of Food For The Poor’s nutrition programs, enabling us to effectively treat children suffering from severe acute malnutrition.

Food Distribution and Nutrition Partners

Partnering with World Food Program U.S.A and Biofortik in El Salvador
In collaboration with World Food Program USA and the U.N. World Food Programme, Food For The Poor is addressing chronic malnutrition by supporting school meal programs in El Salvador. Through this partnership, we are providing Biofortik, a highly effective iron-fortified supplement, to 60,000 children in the Sonsonate region. Additionally, we are working to replace imported foods in school meals with locally grown produce, fostering both better nutrition and stronger local economies.

Partnership with Feed My Starving Children and MannaPack in Honduras
In 2023, Food For The Poor teamed up with Feed My Starving Children and local partners in Honduras to pack 100,000  MannaPack rice meals, sending over 62,208 meals in one event alone to food-insecure families. Volunteers—250 in one session—helped prepare soy‑ and rice‑based fortified meals for children facing acute hunger.
Food For The Poor also used MannaPack for its Feeding Programs in Ukraine, Jamaica, and Haiti.

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Types of RUTFs Used to Treat Malnutrition


Several types of Ready-to-Use Therapeutic Foods (RUTFs) are used both globally and locally to treat severe malnutrition effectively. While all are designed to meet international nutritional standards and serve the same life-saving purpose, they vary in formulation, ingredients, and region of origin. Some are peanut- and milk-based, while others use alternative ingredients such as soy, chickpeas, lentils, cereals, or fish to better suit local diets, reduce costs, or avoid allergens. Within the context of a nutrition program, it is important to ensure that RUTFs are tailored to local cultural preferences, agricultural resources, and logistical realities. Adapting formulations in this way improves acceptance, supports local economies, and enhances the efficiency and effectiveness of malnutrition treatment efforts.

Here is a list of RUTF options:

  • Biofortik – is a fortified beverage developed in El Salvador that's primarily made from locally sourced corn and sorghum, enriched with essential vitamins and minerals to combat malnutrition in children.
  • MannaPack – A high-energy therapeutic food used in emergencies and humanitarian nutrition programs.
  • Plumpy’Nut – The most widely recognized peanut-based RUTF.
  • BP-100 – A compressed high-energy bar alternative.
  • EEZEEpaste – A therapeutic peanut paste similar to Plumpy’Nut.
  • ReSoMal – A rehydration solution for children with SAM.
  • Chiponde – A locally produced RUTF in Malawi.

The Use of Therapeutic Foods in Our Programs:

Ready-to-Use Therapeutic Foods (RUTFs) are typically administered over a 6 to 8-week period. Caregivers give the child prescribed daily doses—usually one to three sachets per day—depending on the severity of malnutrition. Because these foods are ready-to-eat, they remove the need for clean water or complex preparation, reducing risks of contamination and simplifying the treatment process.

1

Community-Based Management of Acute Malnutrition (CMAM)

Ready-to-Use Therapeutic Foods (RUTFs) are typically administered over a 6 to 8-week period. Caregivers give the child prescribed daily doses—usually one to three sachets per day—depending on the severity of malnutrition. Because these foods are ready-to-eat, they remove the need for clean water or complex preparation, reducing risks of contamination and simplifying the treatment process.

2

Emergency Nutrition Responses

Ready-to-Use Therapeutic Foods (RUTFs) are a cornerstone of CMAM programs, which allow children with severe acute malnutrition (SAM) to be treated at home rather than in hospitals. RUTFs make this possible because they are shelf-stable, nutrient-dense, and require no preparation. This decentralized approach empowers caregivers, reduces the burden on health facilities, and improves access to treatment in remote or underserved communities.

3

Long-Term Recovery and Resilience-Building Programs

RUTFs are a critical tool in humanitarian emergencies such as drought, displacement, or natural disasters, where access to food and healthcare is severely disrupted. Their portability, long shelf life, and complete nutritional profile make them ideal for rapid deployment in crisis zones. RUTFs quickly stabilize malnourished children while preventing further health deterioration during emergencies.



Your Support Makes Life-Saving Nutrition Possible


Ready-to-Use Therapeutic Foods (RUTFs) are a cornerstone of Food For The Poor’s nutrition initiatives, offering a simple, scientifically validated way to treat severe childhood malnutrition at home and in communities. These nutrient-dense, shelf-stable packets give children the vital calories, protein, and micronutrients they need—without cooking, refrigeration, or clean water—ensuring timely and scalable treatment in remote areas. With cure rates often exceeding 90% in community settings, RUTFs have revolutionized the fight against severe malnutrition worldwide.

However, the success of these programs ultimately depends on generous donations and sustained funding. By funding our Food Distribution programs, you make it possible to purchase or locally produce RUTF supplies, support agricultural partnerships, and deliver these life-saving rations to vulnerable children in need. Donors become part of a powerful, evidence-based solution—helping Food For The Poor save lives, restore health, and nurture hope for thousands of at-risk children in Latin America and the Caribbean.


THE EVIDENCE BEHIND RUTFs ADVANCING RESEARCH IN MALNUTRITION TREATMENT

Academic research on Ready-to-Use Therapeutic Foods (RUTFs) has played a crucial role in validating their effectiveness in treating severe acute malnutrition, particularly in children under five. Studies have examined their nutritional composition, clinical outcomes, cost-effectiveness, and adaptability across diverse cultural and geographic settings. This growing body of evidence supports the widespread use of RUTFs in community-based treatment programs and continues to inform innovations in formulation, delivery, and local production to improve impact and accessibility.

Ready-to-Use Therapeutic Food (RUTF) Containing Low or No Dairy Compared to Standard RUTF for Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis

Summary

This systematic review and meta-analysis evaluated the effectiveness of ready-to-use therapeutic foods (RUTF) with low or no dairy content compared to standard RUTF (which contains at least 50% of its protein from dairy) in treating children aged six months and older with severe acute malnutrition (SAM). Analyzing data from six studies involving over 6,000 children, the review found that low- or no-dairy RUTFs led to slightly lower weight gain, lower recovery rates, and lower weight-for-age z-scores at discharge compared to standard RUTF. However, there were no significant differences in mortality, time to recovery, default rates, or nonresponse. Some alternative RUTFs showed improved iron and anemia outcomes, likely due to enhanced micronutrient content, and one study found better fat-free mass in children consuming standard RUTF. Overall, while lower-dairy RUTFs may be more cost-effective, they appear to be less effective in promoting optimal recovery and growth. The authors recommend further research into improving the nutritional quality of alternative formulations and assessing their long-term impacts on child health and development.

Authors

Isabel Potani, Carolyn Spiegel-Feld, Garyk Brixi, Jaden Bendabenda, Nandi Siegfried, Robert H J Bandsma, André Briend, and Allison I Daniel

Publisher

Advances in Nutrition

Source

Science Direct

Takeaway

  • Effectiveness: RUTFs with less than 50% dairy protein are generally less effective than standard RUTFs in supporting weight gain, recovery, and weight-for-age outcomes in children with severe acute malnutrition.
  • No Significant Difference in Mortality: There was no significant difference in mortality, default rates, or nonresponse between low-/no-dairy and standard RUTF groups.
  • Micronutrient Advantage: Some low-dairy RUTF formulations improved iron status and reduced anemia, likely due to enhanced iron and vitamin C content.
  • Need for Further Research: Additional studies are needed to explore cost-effective, nutritionally optimized RUTF alternatives that can maintain or improve clinical outcomes, especially in diverse child populations and over longer follow-up periods.
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Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age

Summary

This Cochrane systematic review, conducted by Schoonees et al. (2019), assessed the effectiveness of ready-to-use therapeutic food (RUTF) for home-based treatment of severe acute malnutrition (SAM) in children aged six months to five years. Analyzing 15 studies involving nearly 8,000 children, the review found that standard RUTF—meeting total daily nutritional requirements—probably improves recovery rates and may slightly increase the rate of weight gain compared to locally prepared or alternative dietary approaches. However, the evidence regarding its effects on relapse and mortality was very uncertain. When comparing standard RUTF to alternative formulations (e.g., those using local ingredients or reduced milk content), the studies showed little to no difference in recovery, weight gain, or mortality, although standard RUTF slightly reduced relapse rates.The quality of evidence ranged from high for recovery outcomes to very low for mortality and relapse. The authors conclude that while standard RUTF is an effective tool for community-based treatment of SAM, especially in low-resource settings, more rigorous and targeted research is needed to optimize its use and evaluate long-term outcomes, including among children with HIV and in relation to diarrhea and cost-effectiveness.

Authors

Anel Schoonees, Martani J. Lombard, Alfred Musekiwa, Etienne Nel, Jimmy Volmink

Publisher

John Wiley & Sons, Ltd.

Source

Cochrane Library

Takeaway

  • Improved Recovery: Standard RUTF likely increases recovery rates in children with severe acute malnutrition when compared to locally prepared or alternative dietary approaches.
  • Weight Gain Benefit: It may also slightly improve the rate of weight gain during home-based rehabilitation, though the evidence quality is low.
  • Relapse and Mortality Uncertain: The effects of RUTF on reducing relapse and mortality are unclear due to very low-quality evidence across studies.
  • Alternative Formulations Comparable: RUTFs made with alternative ingredients (e.g., less milk or local foods) generally perform similarly to standard RUTF, except that standard formulations may slightly reduce relapse rates.
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Optimising locally made Ready-to-use Therapeutic Food (RUTF) formulations. MSc Thesis. Nutrition for Global Health, London School of Hygiene and Tropical Medicine

Summary

This MSc thesis, titled "Optimising Locally Made Ready-to-use Therapeutic Food (RUTF) Formulations for Sierra Leone" by Aurélie Bechoff, explores the feasibility of creating cost-effective, nutritionally adequate, and food-safe RUTF using locally available ingredients. With severe acute malnutrition (SAM) affecting a significant percentage of children in Sierra Leone and imported RUTFs being costly and sometimes logistically challenging, the study aimed to identify sustainable alternatives using ingredients that are accessible within the country. Using linear programming (LP), the researcher evaluated 22 local ingredients for their nutritional composition, protein quality, cost, and potential contamination with aflatoxins—a major food safety concern, especially with groundnuts. The study found that all viable RUTF formulations meeting WHO nutritional and safety standards included animal-source foods like dried eggs and dried fish. Vegan formulations failed to meet key nutrient requirements, particularly omega-3 fatty acids, due to limited availability of high-quality plant oils like soybean oil. Aflatoxin contamination was a significant limiting factor in the use of groundnuts, a staple RUTF ingredient, which restricted their use in the optimized models. The research also emphasized the importance of vitamin and mineral fortification, given that local foods alone could not meet micronutrient requirements. Overall, the thesis concludes that while there are promising local ingredients, more research and investment in processing technology and food safety measures are needed to make local RUTF production viable and scalable in Sierra Leone.

Authors

Aurélie Bechoff

Publisher

London School of Hygiene & Tropical Medicine

Source

ResearchGate

Takeaway

  • Local Ingredients Are Viable but Limited: Several locally available ingredients in Sierra Leone—such as dried fish, eggs, cassava, and millet—can be used to formulate RUTF that meets nutritional and cost requirements, though none of the successful models were vegan.
  • Aflatoxin Contamination Is a Major Barrier: Groundnuts, a common RUTF ingredient, often exceed acceptable aflatoxin levels in Sierra Leone, limiting their safe use and emphasizing the need for rigorous food safety controls.
  • Animal Products Were Essential: All nutritionally adequate and cost-effective formulations identified through linear programming required the inclusion of animal-based products (e.g., eggs, fish) to meet protein quality and omega-3 fatty acid requirements.
  • Further Research and Support Needed: Local RUTF production holds promise for cost reduction and sustainability, but it requires investment in processing technology, ingredient safety monitoring, and tailored micronutrient fortification to ensure effectiveness and scalability.
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Expert Meeting on Ready-to-Use Therapeutic Foods (RUTF)

Summary

The 2019 UNICEF Expert Meeting on Ready-to-Use Therapeutic Foods (RUTF) brought together global health and nutrition experts to address two key issues: the development of alternative RUTF formulations using local ingredients like cereals and legumes, and the degradation of vitamin A during storage.
The meeting aimed to create clear guidance for evaluating and approving new RUTF recipes through clinical trials and sensory testing.
It also highlighted the significant loss of vitamin A in RUTF over time, especially in hot climates, and recommended increasing the acceptable vitamin A range in product specifications to ensure therapeutic effectiveness.
The outcomes of the meeting provide a roadmap for improving the quality, diversity, and nutritional reliability of RUTFs in treating child malnutrition globally.

Authors

it’s officially produced by UNICEF Supply Division and credits the following individuals for organizing and contributing to the meeting report:
  • A. Fleet
  • R. Kshirsagar
  • M.-E. Forteza

Publisher

UNICEF Supply Division

Source

UNICEF Supply Division

Takeaway

  • Need for Alternative RUTF Formulations: Experts agreed that while standard peanut-based RUTF is effective, new formulations using local ingredients (e.g., cereals, legumes) could improve sustainability, cultural acceptability, and affordability. Clear guidance was provided for how to test and validate these alternatives.
  • Standardized Evaluation of New Products: For alternative RUTFs to be accepted, they must pass clinical effectiveness trials and sensory acceptability tests. The meeting proposed a standardized pathway for developers to follow, ensuring safety and therapeutic efficacy.
  • Vitamin A Stability is a Critical Issue: Vitamin A content in RUTF significantly declines during storage, especially in hot climates. Many batches tested before delivery already showed vitamin A below recommended levels, raising concerns about their therapeutic reliability.
  • Recommendation to Revise Vitamin A Specifications: To address vitamin A loss over time, participants recommended increasing the upper limit of vitamin A in RUTF formulations from 1.1 mg/100 g to 1.6 mg/100 g, ensuring potency throughout the product’s shelf life.
  • Collaborative Action Needed: The report emphasized the importance of coordination between UN agencies, manufacturers, governments, and researchers to update specifications, improve formulations, and expand access to life-saving RUTFs for malnourished children.
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