Introduction
Methodology
The Need for Alternative RUTF
Various Forms of RUTF
The Potential and Effectiveness of Non-Peanut–Based RUTFs
Cost-Effectiveness of RUTFs
Constituents of RUTF | SS | Study design | Parameters tested | Result | Conclusion | References |
---|---|---|---|---|---|---|
Replaces milk with soybeans | ||||||
Soya, maise and sorghum | 1927 | Non-blind, parallel, cluster-randomised equivalent trial | Recovery rate, Adjusted risk difference (ARD) | SMS-RUTF has a lower recovery rate than P-RUTF | The result was inconclusive in their equality with recovery rates | [25] |
225 | Non-blinded 3 arm, parallel-group, simple randomised control trials | LOS, haemoglobin, iron store | FSMS-RUTF was not inferior to PM-RUTF in recovery rates in both groups. FSMS-RUTF was superior in haemoglobin and body iron stored recovery | FSMS-RUTF is more effective in treating and remedying iron deficiency anaemia in severe acute malnourished children | [42] | |
389 | Simple randomised controlled non-inferiority trials | Anaemia, Iron status, Retinol-binding protein, Gut inflammation | SMS-RUTF increased body iron stores while P-RUTF had the highest recovery rate | SMS-RUTF is more potent in correcting BIS and treating anaemia than P-RUTF | [52]; | |
Soy-based with soy protein isolate | 260 | Randomised double-blind intervention trial | Acceptability, weight and MUAC gain, TBW, fat | The two samples showed similar taste acceptability trial improvements in anthropometric indices, body composition, total body water, fat-free mass and fat mass | There is a need for a multi-centre study to generalise the findings | [41•] |
Rice, mung beans and soy | 200 | Randomised crossover trials/design | Acceptability trial, weight and BMI (children and adults) | 69% and 91% of HEBI and 65% and 81% of Plumpy’Nut were consumed by children and adults, respectively. There were statistical differences in weight and BMI gain between adults who consumed RUTF and the control | Both HIV-positive children and adults preferred and accepted HEBI. The weight gain translated significantly in BMI but not in MUAC | [89] |
Unprocessed soy flour | 1874 | Randomised double-blind, clinical trial | Weight and height gain, recovery rate | Weight gain, height gain and recovery rate were higher in children receiving 25% milk RUTF than 10% milk RUTF | 10% milk RUTF is less effective than 25% milk RUTF in the treatment of SAM | [55] |
Milk-free and reduced milk | 499 | Non-blinded, 3-arm, parallel-group simple randomised control trial | Plasma amino acid, anthropometric measurements | FSMS-RUTF and MSMS-RUTF were not less in plasma leucine, methionine, cystine and EAA concentration in 6–59 months SAM children at discharge | There were sufficient functional metabolites of plasma amino acids by the three RUTF, a non-inferior in plasma methionine and cysteine in both FSMS-RUTF and MSMS-RUTF | |
Fish and insects replace milk | ||||||
Fish-based | 121 | A single-blinded randomised controlled trial | Weight gain, anthropometry measurement | No statistical difference in weight gain and anthropometry measurement between the two groups | None of the RUTF was superior to the other and can serve as an alternative to milk based RUTF | [38] |
Other pulses and cereal used in replacing peanut | ||||||
Chickpeas, soy and maise | 2425 | Cluster-randomised controlled trial | The recovery rate for MAM children, Cost-effectiveness | Super Cereal PLUS children showed a higher overall recovery rate. Children less than 24 months recovered more than those older than 24 months | Formula 2 is the most cost-effective of the four samples | [26] |
Crystalline AA, Zn and vitamin C | 1650 | A non-blinded, parallel-group, simple randomised controlled trial | Changes in haemoglobin, PAA profile, Recovery rate, Weight gain, LOS, BIA | Both products met the minimum international standard for the 24–59 months group on ITT. SMS-RUTF was not inferior to P-RUTF in both groups’ weight gain and LOS. There was no difference in FM, FMI and BIA among the groups and control at discharge. P-RUTF was more consumed | Both SMS-RUTF and P-RUTF replenished all AA except methionine. SMS-RUTF was not inferior to P-RUTF in ≥ 24 months with recovery rate, LOS and weight gain. SMS-RUTF can correct anaemia | [90] |
Whey protein concentrate | 600 | Blinded, randomise, clinical trial | Average weight gain, recovery rate, and LOS | WPC-RUTF was not inferior to P-RUTF | WPC34 is cheaper and more effective than P-RUTF. Also, the same processes are used in the production of both RUTF | [24] |
Reduced quantity | 802 | Non-random sampling | Body composition, FFMI, FFM, FM | FFM, FMI and FM were similar in both reducing and standard RUTF but a higher FFMI and a lower Z. There was an incomplete FM recovery. There was no effect of a reduced dose of RUTF on the body composition of children by recovery | FFM was the highest weight gain during SAM treatment. A reduced dose of RUTF does not affect tissue creation compared to standard dose treatment | [91] |
Moisture (%) | Protein (%) | Fat (%) | Ash (%) | Crude fibre (%) | Carbohydrate (%) | Total energy(kcal/100 g) | References | |
---|---|---|---|---|---|---|---|---|
Phumpy’nut | NR | 13.6 | 35.7 | NR | NR | 43.48 | 545 | [15] |
Metu2 | 9.8 | 11.8 | 35.1 | 1.4 | 1.2 | 40.6 | 528.0 | [83] |
Chickpea RUTF (100%) | 5.33 | 12.87 | 24.41 | 2.04 | 1.97 | NR | NR | [88] |
Mung bean RUTF (100%) | 3.00 | 13.74 | 23.21 | 2.29 | 1.76 | NR | NR | [88] |
AOB | 2.73 | 22.7 | 43.04 | 3.5 | NR | 19.67(g) | 555 | [67] |
BOC | 0.63 | 24.11 | 45.11 | 4.38 | NR | 17.83(g) | 573 | [67] |
PCO | 0.59 | 21.70 | 32.14 | 2.92 | NR | 36.73(g) | 523 | [67] |
RUTF (25% milk) | NR | 15(g/100 g) | 40(g/100 g) | NR | NR | NR | 2000(KJ/100 g) | [55] |
RUTF (10%) | NR | 15(g/100 g) | 40(g/100 g) | NR | NR | NR | 2000(KJ/100 g) | [55] |
SMS-RUTF | NR | 13.6 g | 30.5 g | NR | NR | 55.0 g | 503.5 | [92] |
Novel RUTF | 2.07 | 12.42 | 31.33 | 3.51 | 2.17 | NR | 530 | [84] |
Product 1 | 4.98 | 14.47 | 19.05 | 5.27 | 9.32 | 11.64 | 1137.65(KJ) | [57] |
Product 2 | 7.65 | 15.43 | 18.00 | 7.74 | 9.51 | 39.75 | 1584.62(kj) | [57] |
Product 3 | 6.80 | 12.30 | 19.21 | 4.24 | 8.65 | 23.67 | 1308.69(kj) | [57] |
L-RUTF/(92 g) | NR | 14 | 33 | NR | NR | 53 | 565(Kcal) | [93••] |
K (mg/100 g) | Mg (mg/100 g) | Zn | Fe | Cu | Na | Vit A μg/100 g | Ca | Ref | |
---|---|---|---|---|---|---|---|---|---|
Phumphy’nut | 1111 | 92 | 14 | 11.5 | 1.78 | 189 | o.91(mg) | 320 | [15] |
Metu2 | 410.95 | 114.32 | 1.70 | 5.53 | 0.38 | 101.05 | 0.52 | Nil | [83] |
Chickpea RUTF (100%) | 875.0 | 189.0 | 3.40 | 6.10 | NR | 24.0 | NR | 128.0 | [88] |
L-RUTF | 1111 | 92 | 14 | 11.5 | 1.8 | < 267 | 0.91(mg) | 320(mg) | [93••] |
Mung bean RUTF (100%) | 1246.0 | 176.4 | 3.08 | 5.80 | NR | 15.0 | NR | 134.0 | [88] |
RUTF (25% milk) | 1111 | 92 | 14 | 11.53 | 1.78 | NR | 910 | NR | [55] |
RUTF (10%) | 1110 | 92 | 14 | 11.50 | 1.74 | NR | 913 | NR | [55] |
SMS-RUTF | NR | NR | 18.7 | 52.4 | NR | NR | NR | NR | [92] |
CS-RUTF | 935.6 | NR | 12.4 | 10.5 | 1.7 | NR | 816.9 | 304.1 | [94] |
Cost of Dietary Treatment for Malnutrition
Comparisons of Anti-nutritional Factors in RUTF Made from Different Local Foods Sources
Comparisons of Macronutrients and Micronutrients of Some Already Produced Non-Milk RUTF with P-RUTF
Consumer Acceptability of Most Locally Produced RUTF
Appearance/colour | Flavour/aroma | Texture/consistency | Mouthfeel/taste | Smoothness | Overall acceptability | References | |
---|---|---|---|---|---|---|---|
Chickpea RUTF (100%) | 7.89 | 7.96 | 7.48 | 7.68 | 7.69 | 7.78 | [88] |
Mung bean RUTF (100%) | 6.16 | 6.12 | 5.80 | 6.16 | 5.68 | 5.88 | [88] |
AOB | 3.56 | 3.5/5 | NR | 3.48 | NR | NR | [67] |
BOC | 3.76 | 3.88/5 | NR | 3.88 | NR | NR | [67] |
PCO | 3.50 | 3.68/5 | NR | 3.24 | NR | NR | [67] |
Product 1 | 6.50 | 6.50 | 6.10 | NR | NR | NR | [57] |
Product 2 | 7.94 | 5.08 | 6.58 | NR | NR | NR | [57] |
Product 3 | 6.90 | 6.40 | 5.82 | NR | NR | NR | [57] |
L-RUTF | 8.0 | 8.1 | 7.9 | 7.9 | NR | NR | [93••] |