TABLE 2.
Comparison of standard ready-to-use therapeutic foods formulations compared with experimental modified formulas/dietary approaches
| Study/objective/country/duration | Study design/ participants / sample size | Dietary formulations (RUTFs vs. control) | Recovery after intervention | Anthropometric gain (g/kg/d) during intervention | Mortality during intervention | Summary of findings |
|---|---|---|---|---|---|---|
| Bhandari et al. (116)compare the efficacy of RUTF-C or RUTF-L with A-HPFIndia16 wk or until recovery (whichever was earlier) | RCTchildren 6–59 mo with SAMN = 906 | RUTF-C (543 kcal/100 g, peanut-based with sugar, milk, vegetable oil with vitamins and mineral mixRUTF-L (528 kcal/100 g, same mix as RUTF-C)A-HPF (cereals, pulses, sugar, oil, milk, eggs) | The recovery rates with A-HPF, RUTF-C, and RUTF-L were 42.8%, 47.5% and 56.9%, respectively | The mean (SD) weight gain in the A-HPF, RUTF-C, and RUTF-L groups were 2.64 (3.47), 3.05 (3.41) and 3.52 (3.92), respectively | A-HPF = 0RUTF-C = 2RUTF-L = 1 | Use of RUTF-L results in higher recovery rates than feeding nutrient-dense and calorie-dense home foods |
| Hsieh et al. (115)effect of RUTF and high oleic RUTF (HO-RUTF) on DHA and EPA statusMalawi4 wk | Randomized, blinded trialN = 141 | Both RUTF (175 kcal/kg/d) and standard RUTF (peanuts, palm oil, soy oil, dry skimmed milk)HO-RUTF (high oleic peanut, palm oil, linseed oil, dry skimmed milk) | The recovery rate in the RUTF group was 71%, and the HO-RUTF group was 68% | Mean weight & MUAC gain in RUTF and HO-RUTF groups were (2.0 ± 2.6 g/kg/d & 0.15 ± 0.28 cm) and (2.8 ± 3.1 g/kg/d & 0.22 ± 0.31cm), respectively | RUTF group = 5HO-RUTF group = 1 | RUTF vs. HO-RUTF caused different changes in DHA (−25% vs. +4%) and EPA (−24% vs. +63%) statusAnthropometric recovery was similar in both groups |
| Irena et al. (109)compare the effectiveness of SMS-RUTF and P-RUTF (standard RUTF)Zambia1 wk | The nonblind, randomized trial, children aged 6–59 mo with SAM plus HIV (in some cases)SMS-RUTF group—14.2% HIV+P-RUTF group—14.7% HIV+N = 1927 | SMS-RUTF (521 kcal/100 g, soybean, maize, sorghum, palm oil, sugar)P-RUTF (530 kcal/100 g, peanut paste, dried skim milk, soybean oil, sugar)The RUTFs to provide 200 kcal/kg/d | Recovery rates for SMS-RUTF and P-RUTF were 53.3% and 60.8% for the intention-to-treat (ITT) analysis | Children in the SMS-RUTF, the arm had a lower weight gain than those in P-RUTF arm (P = 0.007) in both edematous (P = 0.018) and nonedematous (P = 0.091) cases. | SMS-RUTF = 13.7%P-RUTF = 12.5% | The study could not confirm their hypothesis of equivalence between SMS-RUTF and P-RUTF in nutrition management of SAM |
| Sigh et al. (106)to evaluate the effectiveness of BP-100™ (imported milk-based RUTF) compared to NumTrey (locally produced fish-based RUTF)Cambodia8 wk | Single-blinded RCTchildren aged 6–59 mo with SAMN = 121 | NumTrey paste (531 kcal/100 g, milk-based)BP-100™ (529 kcal/100 g, fish-based) both for 2 wkBoth RUTFs to provide 200 kcal/kg/d | NA | Weight gain for BP-100™ and NumTrey was 1.06 g/kg/d and 1.08 g/kg/d, respectively | BP-100™ = 2NumTrey = 0 | The trial did not find superiority in any of the 2 products in weight gain (g/kg/d) |
| Jones et al. (127)develop a RUTF with elevated short-chain n–3 PUFA and measure its impact, with and without fish oil supplementationKenya84 d | RCTchildren aged 6–50 moN = 61 | S-RUTF standard RUTF (S-RUTF)F-RUTF [(RUTF + flaxseed oil containing elevated short-chain n–3 PUFA ALA)]FFO-RUFT [(RUTF + flaxseed oil + fish oil capsules containing long-chain n–3 PUFA EPA and DHA)] | NA | No detectable differences in MUAC, WHZ | S-RUTF = 1F-RUTF = 3FFO-RUTF = 2 | Standard RUTF or F-RUTF (RUTF with flaxseed oil) formulations did meet the PUFA requirements of children except for FFO-RUTF |
| Jadhav et al. (111)determine the efficacy of indigenously prepared RUTFIndia8 wk | RCTchildren aged 6 mo–5 y with SAMN = 242 | Indigenous RUTF (540 kcal/100 g), peanut past (25%), skimmed milk powder (24%), powdered sugar (28%), soya bean oil (21%) & micronutrients (2%). The diet provides 175 kcal/kg/d | The recovery rate in the indigenous RUTF group was 84.8% after 6 mo Standard RUTF group not reported | Rate of weight gain in indigenous RUTF = 3.45 g/kg/d. Standard RUTF = 2.38 g/kg/d | N/A | Indigenously prepared RUTF was superior in promoting rapid initial weight gain and maintaining the rate of weight gain |
| Thapa et al. (128)compare acceptability and efficacy of locally produced RUTF (nutreal) with defined foodIndia42 d | RCTchildren 8–45 mo with SAM | Nutreal (545 kcal/100 g, milk powder, vegetable oil, sugar, roasted peanuts, vitamins & minerals mixDefined food (precooked foods of different types containing cereals, pulses, and oil) | N/A | The rate of weight gain N/A, but the difference in the baseline and end-line weight of the nutreal group seems higher than the defined food group | N/A | Nutreal was well accepted by SAM children and showed weight gain when compared to defined food |
| Mallewa et al. (129)effect of RUSF on mortalityKenya, Malawi, Uganda, & Zimbabwe12 wk | RCTHIV+ children 5–12 y & adults | Peanut-based RUSF (100 kcal/d, 92 g foil packets) | RUSF did not improve CD4 cell count recovery | Children ≥13 y in RUSF had significantly greater gains in weight, BMI, and MUAC through 48 weeks than ‘no-RUSF’ group | RUSF = 96 (10.9%)No-RUSF = 92 (10.3%) | RUSF only improved short-term weight gain but not mortality at ART initiation in severely immunocompromised HIV-infected individuals. Provision of lipid-based nutritional supplements to all severely immunocompromised individuals starting ART not warranted |
| Sunguya et al. (113)association between RUTF and malnutritionTanzania∼4 mo | Cross-sectionalHIV+ children <5 y | RUTF plumpy'nut (200 kcal/kg/d) | N/A | The percentages of underweight and wasting in RUTF group was 3.0% & 2.8% whereas non-RUTF group was 12.4% & 16.5%, respectively | N/A | The provision of RUTF for ≥4 mo was associated with low proportions of undernutrition status |
| Rao et al. (130)effect of nutrition supplementation in children with HIVIndia1 y | Prospective observational studyHIV+ children aged 1– 18 y | 2 scoops of protein powder and 1 serving of peanut chikki. 360 kcal | N/A | Improvement in height-for-age, weight-for-age and the z-scores of height-for-age, weight-for-age and BMI-for-age from baseline to 1 y after nutritional supplementation | N/A | The mean values of BMI-for-age were not statistically significant |
ALA, α-linoleic acid; A-HPF, augmented energy-dense home-prepared; ART, antiretroviral therapy; MUAC, midupper arm circumference; N/A, not available; P-RUTF, peanut-based RUTF; RCT, randomized control trial; RUTF, ready-to-eat-therapeutic foods, RUTF-C, centrally produced RUTF; RUTF-L, locally prepared RUTF; SAM, severe acute malnutrition; SMS-RUTF, milk-free soy-maize-sorghum-based RUTF; RUSF, ready-to-eat supplementary foods; WHZ, weight-for-height z-score.