Plumpy’nut®
Ready-to-use therapeutic food (RUTF)
Recommendations for use
Quantities to use for the rehabilitation of a child suffering from severe acute malnutrition :
- 200 kcal/d/kg until the children reaches target weight, which should be in 6 to 10 weeks.
- For the treatment of a child weighing 7 kg and suffering from severe acute malnutrition : about one carton of Plumpy’nut®, or 13.8 kg (calculated on the basis of 200 kcal / kg / day, or 2.8 sachets / day for 8 weeks).
Packaging and conservation
- Primary packaging : Plumpy’nut® is available in individual 92 g sachets.
- Secondary packaging : cartons of 150 x 92 g sachets (net weight : 13.8 kg ; gross weight : 14.7 kg)
- Palletisation : pallets with 56 cartons (for container transport, 843.2 kg) or 48 cartons (for air transport, 725.6 kg)
- Where possible, to be stored in a dry, cool area, at a temperature of less than 30°C.
Plumpy’nut® was developed in 1996 by Nutriset and the IRD. It was the first ready-to-use food intended specifically for the treatment of severe acute malnutrition. It corresponds to the definition of RUTFs (Ready-to-Use Therapeutic Food), recommended by the World Health Organisation (WHO) for the home treatment of severe acute malnutrition.
Main characteristics, target population and benefits obtained
Plumpy’nut® has a nutritional value equal to that of F-100 therapeutic milk. It is especially dedicated to the nutritional rehabilitation of people (children from 6 months of age up and adults) suffering from severe acute malnutrition.
It consists of a peanut-based paste, with sugar, vegetable fat and skimmed milk powder, enriched with vitamins and minerals (technical data sheet available upon request). It is available in 92 g sachets which provide 500 kcal, and it can be used for up to 24 months after the date of manufacture without refrigeration.
As a ready-to-use food, Plumpy’nut® requires no preparation, no dilution in water prior to use, no cooking, and it can be consumed direct from the sachet.
Because it can be used at home without any preparation, under the supervision of the mother or another member of the family, Plumpy’nut® makes it possible to treat the majority of children suffering from severe acute malnutrition without them needing to be hospitalised. This has made it possible to considerably increase the number of malnourished children treated, while improving adherence to the regularity of the treatment, and the recovery rate.
Ready-to-use therapeutic foods (RUTF) like Plumpy’nut® are a real revolution compared with therapeutic milks and, since May 2007, they have been recommended by the WHO, UNICEF, the WFP and the UN Standing Committee on Nutrition, in the joint declaration on community-based management of severe acute malnutrition.
Plumpy’nut® is produced by Nutriset at its Malaunay (Normandy, France) site, but it is also produced by Nutriset's partners in the PlumpyField network.
References
- Ready-to-Use therapeutic food for treatment of marasmus. André Briend et al. The Lancet, Volume 353, Issue 9166, Pages 1767 - 1768, 22 May 1999 ; doi:10.1016/S0140-6736(99)01078-8.
http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736%2800%29X0142-0 - Changing the way we address malnutrition during famine. Steve Collins, The Lancet, Volume 358, Issue 9280, Pages 498 - 501, 11 August 2001 ; doi:10.1016/S0140-6736(01)05630-6
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2801%2905630-6/abstract - Outpatients care for severely malnourished children in emergency relief programmes: a retrospective cohort study. Steve Collins, Kate Sadler, The Lancet, Volume 360, Issue 9348, Pages 1824 - 1830, 7 December 2002; doi:10.1016/S0140-6736(02)11770-3
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2802%2911770-3/abstract - Comparison of the efficacy of solid ready-to-use and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomised trial. El Hadji Issakha Diop, Nicole Idohou Dossou, Marie Madeleine Ndoour, André Briend, Salimata Wade. American Journal of Clinical Nutrition, Vol. 78, No. 2, 302-307, August 2003
http://www.ajcn.org/cgi/content/abstract/78/2/302 - Ambulatory treatment of severe malnutrition, Dr. Steve Collins, Field Exchange, Issue No 19, July 2003. p16.
http://fex.ennonline.net/19/treatment.aspx - Home-Based Treatment of Malnourished Malawian Children with Locally Produced or Imported Ready-to-Use Food, Sandige, Heidi; Ndekha, MacDonald J.; Briend, André; Ashorn, Per; Manary, Mark J. Journal of Pediatric Gastroenterology and Nutrition: August 2004 - Volume 39 - Issue 2 - pp 141-146
http://journals.lww.com/jpgn/Abstract/2004/08000/Home_Based_Treatment_of_Malnourished_
Malawian.3.aspx - Home based therapy for severe malnutrition with ready-to-use food M J Manary, M J Ndkeha, P Ashorn, K Maleta, A Briend Archive of Disease in Childhood 2004;89:557-561 doi:10.1136/adc.2003.034306
http://adc.bmj.com/content/89/6/557.abstract - Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial, Michael A Ciliberto, Heidi Sandige, MacDonald J Ndekha, Per Ashorn, André Briend, Heather M Ciliberto and Mark J Manary American Journal of Clinical Nutrition, Vol. 81, No. 4, 864-870, April 2005 © 2005 American Society for Clinical Nutrition
http://www.ajcn.org/cgi/content/abstract/81/4/864 - Home-based therapy with ready-to-use therapeutic food is of benefit to malnourished, HIV-infected Malawian children. Ndekha MJ, Manary MJ, Ashorn P, Briend A. Acta Paediatr. 2005 Feb;94(2):222-5.
http://www.ncbi.nlm.nih.gov/pubmed/15981758 - Key issues in the success of community-based management of severe malnutrition, Collins S, Sadler K, Dent N, Khara T, GuerreroS, Myatt M, Saboya M, Walsh A. Food Nutr Bull 2006; 27: S49-S82
http://www.who.int/nutrition/topics/comm_based_malnutrition/en/index.html
http://www.unu.edu/unupress/food/FNB_v27n3_suppl.pdf - Efficacy and effectiveness of community-based management of severe malnutrition, Ashworth A. Food Nutr Bull 2006; 27 (suppl): S24-S48
http://www.who.int/nutrition/topics/comm_based_malnutrition/en/index.html
http://www.unu.edu/unupress/food/FNB_v27n3_suppl.pdf - Home-based therapy for oedematous malnutrition with ready-to-use therapeutic food. Ciliberto MA, Manary MJ, Ndekha MJ, Briend A, Ashorn P. Acta Paediatr. 2006 Aug;95(8):1012-5.
http://www.ncbi.nlm.nih.gov/pubmed/16882579 - A large-scale operational study of home-based therapy with ready-to-use therapeutic food in childhood malnutrition in Malawi, Zachary Linneman, Danielle Matilsky, MacDonald Ndekha, Micah J. Manary, Ken Maleta and Mark J. Manary, Maternal & Child Nutrition, Volume 3 Issue 3, Pages 206 – 215, Published Online: 29 May 2007
http://www3.interscience.wiley.com/journal/118500334/abstract - WHO child growth standards and the identification of severe acute malnutrition in infants and children // Normes de croissance OMS et identification de la malnutrition aiguë sévère chez l'enfant A Joint Statement by the World Health Organization and the United Nations Children's Fund // Déclaration commune de l'Organisation mondiale de la santé et du Fond des Nations Unies pour l'Enfance
http://www.who.int/nutrition/publications/severemalnutrition/9789241598163/en/index.html - Complementary Food Supplements to achieve Micronutrient Adequacy for infants and young children. P. Nestel, A. Briend, B. de Benoist, E. Deckeer, E. Fergusson, O. Fontaine, A. Micardi and R. Nalubola. Journal of Pediatric Gastroenterology and Nutrition: March 2003 - Volume 36 - Issue 3 - pp 316-328
http://journals.lww.com/jpgn/Abstract/2003/03000/Complementary_
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