What is RUTF?
ReadytoUse Therapeutic Food (RUTF) is a highenergy, nutrientdense paste that can be eaten directly from its sachet without cooking, water, or refrigeration. It was developed to treat severe acute malnutrition (SAM) in children aged 6months to 5years. RUTF delivers the protein, fat, vitamins and minerals required for rapid weight gain and recovery while being safe, palatable, and easy to distribute in emergency and community settings.
Composition
Typical RUTF formulations contain:
- Peanut butter provides most of the energy and essential fatty acids.
- Milk powder supplies highquality protein and calcium.
- Sugar improves taste and adds quickrelease carbohydrates.
- Vegetable oil increases energy density and essential fatty acids.
- Vitaminmineral premix ensures adequate micronutrient intake, including vitaminA, zinc, iron, and iodine.
One 92gram sachet supplies roughly 500kcal, 20g protein, 45g fat and meets >100% of the Daily Recommended Intake for most micronutrients.
How It Is Used
RUTF is administered in communitybased management of acute malnutrition (CMAM). The protocol is simple:
- Identify a child with SAM using a midupper arm circumference (MUAC)<115mm or weightforheight<3SD.
- Confirm no medical complications requiring inpatient care.
- Provide 12 sachets per day (200400kcal/kg body weight).
- Monitor weight weekly; continue until the child reaches 85% of the median weightforheight or a MUAC125mm.
Because it does not need water, RUTF can be given in settings with limited sanitation, reducing the risk of diarrhea.
Effectiveness
Multiple randomized trials and field evaluations have demonstrated cure rates of 8095% when RUTF is used according to WHO guidelines. Recovery is usually achieved within 46weeks, and relapse rates are low (<10%). Compared with traditional inpatient feeding (e.g., F75/F100 formulas), RUTF shortens hospital stays, cuts costs, and empowers families to treat children at home.
| Study | Setting | Cure Rate | Average Duration |
|---|---|---|---|
| WHO MultiCountry Survey (2015) | 8 African nations | 87% | 5.2weeks |
| Bangladesh RUTF Trial (2018) | Rural clinics | 91% | 4.8weeks |
| Cameroon Community Study (2020) | Community health workers | 94% | 4.3weeks |
Production & Supply
RUTF can be produced locally or imported. The main steps are:
- Ingredient sourcing peanuts, milk powder, oil, sugar, and premix are procured, often from regional suppliers.
- Roasting & grinding peanuts are roasted, cooled, then milled to a fine paste.
- Mixing all dry and liquid ingredients are blended under hygienic conditions.
- Packaging the paste is filled into airtight sachets (typically 92g) and sealed.
- Quality control each batch is tested for microbial safety, nutrient content, and shelf stability.
Because the product is shelfstable for up to 24months at ambient temperatures, it can be stockpiled for emergencies.
Challenges & Future Directions
Despite its success, RUTF faces several hurdles:
- Allergenicity Peanutbased RUTF may not be suitable for children with severe peanut allergy.
- Cost While cheaper than inpatient care, the price per sachet can still be a barrier in lowincome settings.
- Supply chain disruptions Political instability or natural disasters can interrupt ingredient deliveries.
- Acceptability Cultural preferences affect willingness to consume a peanutflavored paste.
Research is ongoing to develop alternative formulations (e.g., soybased, lupinbased, or insectprotein RUTF) and to improve local manufacturing capacity. Innovations such as biodegradable sachets and solarpowered processing units aim to reduce environmental impact and increase resilience.
To maximise impact, stakeholders are encouraged to:
- Strengthen national procurement policies that prioritize local production.
- Integrate RUTF distribution with broader nutritionsensitive interventions (e.g., vaccination, hygiene promotion).
- Invest in monitoring systems that track treatment outcomes and supply chain performance.
Further Reading
For more detailed information, consult:
- World Health Organization. Guidelines for the treatment of severe acute malnutrition, 2022.
- UNICEF. ReadytoUse Therapeutic Foods: A Technical Manual, 2021.
- Stobaugh et al. Efficacy of RUTF in CommunityBased Management of Malnutrition, Nutrition Journal, 2020.
