Therapeutic Foods (RUTF)
Introduction
Developing interventions to treat severe-acute malnutrition (SAM)
and moderate- acute malnutrition (MAM) is a vital part of
community-based care programmes. This often involves the
manufacture of ready-to-eat therapeutic foods (RUTF). To date, the
most successful RUTFs have contained peanuts, vegetable oil,
sugar and skimmed milk powder, providing an ideal balance of
protein and energy for recovery from acute malnutrition. At present,
most peanut-based RUTFs such as PlumpyNutTM are made
centrally in highly controlled conditions that ensure excellent
product quality and shelf life, yet the export of these products does
little to stimulate the local economy of the affected population and,
much more importantly, is not always available in the quantities
required at an affordable cost. Efforts are therefore underway to
derive a successful RUTF formula that can be produced from locally
available food produce in areas where malnutrition is prevalent.
An ideal RUTF formulation must have the following attributes:
? Good nutritional quality (i.e. protein, energy and micronutrient
content)
? Long shelf life
? Highly palatable with a good taste
? A consistency and texture suitable for feeding to children
? Require no additional processing prior to feeding, including cooking
? Amino acid complementation for maximum protein quality and
digestibility ? Low anti-nutrient content and low risk of contamination
with toxins
? Product stability (long shelf life without refrigeration)
? Ingredients should be easily available in developing countries
Aims of the practical session
? In six teams of n=5, you will design and produce small samples of
therapeutic foods that are not peanut-based. There will be two inclass
sessions to discuss and finalise the ingredients you are going
to use during the practical.
!
!
? You will evaluate the sensory properties of these foods and
consider how these might affect their palatability, acceptability and
safety.
? Using Nutritics software, you will derive the nutrition information of
the formulated RUTF.
? In doing the practical and the associated tasks, you will gain an
understanding of the importance of concepts underpinning the
design of these foods, such as energy density, micronutrient quality,
consistency, palatability, and microbiological risk.
Your group will design a detailed proposal setting out a plan to
tackle acute malnutrition in children in a less developed or
transitional country. You are free to be as creative as you like in
designing your intervention, but please note that it must be
corroborated by evidence from the literature of its efficacy in
achieving significant improvements in nutritional status and health
outcomes. Any proposed intervention must be designed to achieve
long-term and sustainable improvements to the health of the target
population.
Country of target : Bolivia
Ingredients:
Puffed Quinoa:54g
Syrup,Agave nectar:80g
Apricots,dried:31g
Almond butter:113g
100g per serving
Sensory data: sweet 4.5,bitter 1,sour 1,salty 1,smooth 1,pasty
2.5,mouthfeel 1,palatable 3
Stage one: Identifying and assessing the target population
1. Identify and describe the target population (must be infants
and children in less developed or transitional country)
2. Assess the nutritional status of this population
3. Identify the most urgent nutritional requirements to reduce risk
of morbidity and mortality in the target population.
500 words 25 marks
Stage two: Applying the use of the RUTF developed during the
practical
4. Using Nutritics, calculate the energy and nutrient composition
of your group’s alternative RUTF and compare these values
with other commonly used RUTFs for infants and children.
5. Briefly discuss why is it so difficult to find a palatable recipe
with the desired energy and nutrient composition that does not
contain peanuts?
6. Why is it so important to ensure adequate intake of
micronutrients in order to facilitate recovery from so-called
‘protein-energy malnutrition’?
7. Your answer should include a discussion of the principles and
benefits of community-based management of malnutrition
(CMAM).
500 words 25 marks
Stage three: Evaluation and monitoring
8. Can you foresee any potential obstacles or risks to effective
implementation of the intervention? How might these risks be
managed and minimised?
9. What indicators do you intend to use to evaluate the impact and
effectiveness of your intervention?
10.How do you plan to achieve observable and sustainable
improvements in this population’s health over the long-term
Group draft proposals should be submitted in week 8 for inclass
formative feedback from peers and the module leader.
Marking Criteria for coursework
Level
Description
Excellent 70% or above
Firm evidence of knowledge in all areas assessed. Demonstrates
an excellent grasp of a wide range of sources and a high level of
understanding of the subject area. Excellent awareness of relevant
practical issues. Provides a well-argued and referenced answer,
with evidence of outstanding ability to analyse ideas critically and to
think in a creative and original manner.
Very good 60-69%
Knowledge is demonstrated across a broad range of topics with
evaluative analysis of a good order. Demonstrates a good grasp of
a range of sources and utilises them in a scholarly fashion that
indicates understanding of current relevant practical issues.
Provides a clear, well-organised answer with some evidence of
original thinking.
Good 50-59%
Satisfactory evidence of sound knowledge and understanding and
fluent expression of ideas. Demonstrates knowledge of a few
sources and utilises them satisfactorily. Provides an adequate
answer but has some theoretical and/or methodological
weaknesses and/or does not show a complete grasp of relevant
current issues.
Satisfactory 40-49%
The level of knowledge and understanding achieved is limited.
Basic knowledge and skills have been acquired, but the quality of
the performance is just adequate to pass. Limited grasp of sources;
not well organised answer; limited understanding of theory and/or
methods.
FAIL 0-39%
Core knowledge and skills have not been acquired and basic
understanding has not been achieved. Demonstrates an inadequate
grasp of sources or inappropriate use of sources. Fails to provide a
coherent answer; shows inadequate understanding of theory and/or
methods.
Developing interventions to treat severe-acute malnutrition (SAM)
and moderate- acute malnutrition (MAM) is a vital part of
community-based care programmes. This often involves the
manufacture of ready-to-eat therapeutic foods (RUTF). To date, the
most successful RUTFs have contained peanuts, vegetable oil,
sugar and skimmed milk powder, providing an ideal balance of
protein and energy for recovery from acute malnutrition. At present,
most peanut-based RUTFs such as PlumpyNutTM are made
centrally in highly controlled conditions that ensure excellent
product quality and shelf life, yet the export of these products does
little to stimulate the local economy of the affected population and,
much more importantly, is not always available in the quantities
required at an affordable cost. Efforts are therefore underway to
derive a successful RUTF formula that can be produced from locally
available food produce in areas where malnutrition is prevalent.
An ideal RUTF formulation must have the following attributes:
? Good nutritional quality (i.e. protein, energy and micronutrient
content)
? Long shelf life
? Highly palatable with a good taste
? A consistency and texture suitable for feeding to children
? Require no additional processing prior to feeding, including cooking
? Amino acid complementation for maximum protein quality and
digestibility ? Low anti-nutrient content and low risk of contamination
with toxins
? Product stability (long shelf life without refrigeration)
? Ingredients should be easily available in developing countries
Aims of the practical session
? In six teams of n=5, you will design and produce small samples of
therapeutic foods that are not peanut-based. There will be two inclass
sessions to discuss and finalise the ingredients you are going
to use during the practical.
? You will evaluate the sensory properties of these foods and
consider how these might affect their palatability, acceptability and
safety.
? Using Nutritics software, you will derive the nutrition information of
the formulated RUTF.
? In doing the practical and the associated tasks, you will gain an
understanding of the importance of concepts underpinning the
design of these foods, such as energy density, micronutrient quality,
consistency, palatability, and microbiological r