What is a RUTF?
A Ready-to-Use Therapeutic Food, or RUTF, is a high-energy, fortified food product formulated specifically for the dietary management of severe acute malnutrition (SAM). The most common formulation, often described as a modified peanut-butter paste, consists of basic ingredients like peanut paste, sugar, vegetable oil, and milk powder, fortified with a specific mix of vitamins and minerals. This composition makes it a potent tool for rapid weight gain and nutritional recovery in children aged 6 to 59 months.
Unlike traditional therapeutic foods that require mixing with water, a RUTF is designed to be eaten directly from its packaging. This simple preparation method eliminates the risk of bacterial contamination from unsafe water, a significant problem in many areas where malnutrition is rampant. The World Health Organization (WHO), alongside other global organizations like UNICEF and the World Food Programme (WFP), endorses RUTF for the outpatient, or home-based, treatment of children with uncomplicated SAM.
History and Development of RUTF
The concept of RUTF was pioneered in the late 1990s by pediatric nutritionist André Briend and Nutriset, a French company specializing in nutritional products for humanitarian relief. This innovation emerged as a direct response to the limitations of previous inpatient feeding methods, such as the F-100 therapeutic formula, which required hospital supervision and clean water. The development of RUTF revolutionized SAM treatment by enabling safe and effective care in the child's home, drastically expanding access to treatment in remote and impoverished communities.
Important Features of a RUTF
To be effective, a RUTF must possess several key features that address the specific challenges of treating severe malnutrition in resource-limited settings. These features are critical for its safety, efficacy, and practicality.
Nutritional Density
- High Energy and Protein: RUTF is energy-dense, with a typical 92g sachet providing around 500 kcal. This high caloric and protein content is essential for promoting rapid catch-up growth in malnourished children.
- Fortified with Micronutrients: Beyond macronutrients, RUTF is packed with a crucial mix of vitamins and minerals, including iron, zinc, potassium, and various B vitamins. This helps correct the severe micronutrient deficiencies common in children with SAM.
Safety and Stability
- Long Shelf Life: A low moisture content and the inclusion of stable lipids give RUTF a long shelf life, often up to two years, without needing refrigeration. This makes it ideal for prepositioning in warehouses and distributing to remote areas, circumventing logistical challenges.
- Microbiologically Safe: The low water activity of RUTF inhibits bacterial growth, ensuring it is safe to consume directly from the packet, even in environments with poor hygiene. It eliminates the risk of contamination from unsafe water sources.
Practicality and Acceptability
- Ready-to-Use Format: RUTF requires no cooking, mixing, or dilution. This simplicity is vital for caregivers in crisis situations who may lack access to fuel, clean water, or cooking equipment.
- Easy to Administer: The paste or biscuit texture is suitable for young children as old as six months, who may have a poor appetite or limited energy to eat. The appealing taste also encourages consumption, a common hurdle in treating severely ill children.
- Portion Controlled: Each sachet or packet is portion-controlled, which helps caregivers monitor dietary intake and ensure the correct dosage is administered throughout the treatment period.
Comparison Table: RUTF vs. Traditional Inpatient Treatment (F-100)
| Feature | RUTF (Ready-to-Use Therapeutic Food) | Traditional Treatment (e.g., F-100) |
|---|---|---|
| Location of Treatment | Home-based (outpatient) care for uncomplicated cases. | Hospital-based (inpatient) care for stabilization phase. |
| Preparation Required | None; consumed directly from the packet. | Must be mixed with clean water by trained staff. |
| Bacterial Risk | Low due to low moisture content and sealed packaging. | High if prepared with contaminated water. |
| Storage Needs | No refrigeration required; stable in varying climates. | Requires refrigeration once opened; limited shelf life. |
| Cost | Generally more cost-effective as it reduces hospital stays. | Higher costs associated with facility-based care and staff. |
| Access and Scalability | High; community health workers can distribute widely. | Limited by the availability of hospital facilities and staff. |
Local Production and Alternatives
While the standard peanut-based RUTF (e.g., Plumpy'nut) is widely used, efforts are underway to develop more affordable and culturally acceptable alternatives using locally available ingredients. These alternative formulations might replace or reduce milk and peanuts with other protein sources like soy, fish, or other cereals. Local production can reduce costs, support local economies, and increase the sustainability and resilience of supply chains. Rigorous testing is performed to ensure these alternatives meet the same nutritional and safety standards as the standard formulation. However, local production introduces new challenges related to quality control, ingredient consistency, and managing potential allergens or anti-nutritional factors. The World Health Organization has issued updated guidelines regarding the dairy protein content in RUTFs to facilitate the development and use of these alternative, locally-sourced products.
Conclusion
A RUTF is a life-saving, ready-to-use therapeutic food that has fundamentally changed the approach to treating severe acute malnutrition in children. Its critical features—high nutritional density, extended shelf life, safety from contamination, and ease of use—make it an indispensable tool for humanitarian relief and public health programs worldwide. By enabling effective outpatient treatment, RUTF allows more children in remote and crisis-affected regions to receive the nutrition they desperately need without prolonged hospital stays. The ongoing development of locally produced RUTFs continues to improve accessibility, affordability, and cultural acceptance, further strengthening the global fight against child malnutrition.
How You Can Help Fight Malnutrition
If you would like to contribute to efforts to end child malnutrition, consider supporting organizations like Action Against Hunger or UNICEF, who distribute RUTF to children in need across the globe. Your support can make a direct impact on a child's recovery and long-term health.
Note: The effectiveness of RUTF is endorsed by organizations like the World Health Organization and UNICEF.
