Milk ingredients help in the fight against childhood malnutrition
There is global recognition of the debilitating effects of malnutrition, particularly in the first 1,000 days of life, between conception and age two. Undernutrition and stunting in the first two years of life can reduce a child’s chance of survival and can have long-term implications, including lower cognitive ability and school performance, shorter adult height, and lower adult wages.
For the most vulnerable children, who have been diagnosed with severe acute malnutrition (SAM) who require hospitalization, the milk-based, powdered supplements, F-75 and F-100, are used to stabilize and provide “catch-up” growth, respectively.
However, community-based in-home treatment of SAM has been adopted by the World Health Organization and UNICEF as well as other organizations for children who do not require hospitalization and have an appetite. Community-based treatment of SAM has been very successful, less costly than in-patient therapy, and features the use of ready-to-use therapeutic food (RUTF). Following a recommendation from a food aid quality review, RUTF was incorporated into USAID’s program making it available to food aid partners.
RUTF is a nutrient-dense, highly fortified paste designed to provide the same nutritional profile as F-100 therapeutic milk. It is provided in packets that can be easily distributed and consumed without additional preparation. It may also sometimes be found in a bar form. It is commonly made from powdered milk, peanut butter, vegetable oil, sugar, and a mix of vitamins, salts and minerals. RUTF provides the appropriate energy, protein, fat, vitamins and minerals needed to treat SAM in children six to fifty-nine months. Dairy ingredients comprise approximately 25-30 percent by weight of RUTF with whole and skim milk powder most often used. Research has shown that RUTF made with whey protein can be as effective as RUTF made with skim milk powder.
It is noteworthy that recommendations by policy groups and end users of this product recognize the importance of dairy ingredients like skim milk powder or whey in RUTF. For example, the USDA specifications for RUTF call for 10-12 percent protein by weight with 50 percent of the protein derived from non-fat dry milk, whole milk powder, sweet whey or whey protein concentrate. UNICEF and Doctors-Without-Borders’ specifications indicate that products should contain 13-16 grams of protein by weight and that 50 percent of this protein should come from milk powder or whey.
Dairy proteins’ benefits in RUTF are recognized because studies have shown they have high nutritional value; they are high quality proteins that provide essential amino acids for the growth of lean muscle mass. Furthermore, when added to protein sources of lesser quality, they complement these proteins which mean less total protein is needed to meet the nutritional needs for recovery and growth. Evidence further suggests that milk products, likely via milk protein, may help stimulate linear growth, thus helping in the prevention of stunting.
“Key investments in nutrition that happen in the first 1,000 days can be a game changer in a child’s life” says Dacia Whitsett-Morrow at the U.S. Dairy Export Council. “Additional research is underway to determine how not only milk proteins, but other dairy components such lactose and milk minerals, may help in the fight on childhood malnutrition and prevention of stunting. Further development of our understanding of how nutrients in dairy ingredients promote healthy growth will help produce better and more cost-effective products in the fight against malnutrition”.
Other populations of children have moderate acute malnutrition (MAM), a less severe form of malnutrition which, nonetheless, causes increased risk for infection, delayed cognitive development, decreased adult stature and productivity. Children may experience MAM, for example, during seasonal food shortages. The cost for using RUTF in these children is high. For that reason, the use of Ready-to-Use Supplemental Foods (RUSF) and fortified blended foods is often more desirable. RUSF are often similar to RUTF in composition but are intended to supplement the diet, thus are provided in smaller portions. Our understanding of the nutritional needs for the prevention and treatment of MAM remain less clear than those for SAM. USAID’s report for improving food aid products recommends the addition of dairy proteins to its products. The World Health Organization, in its recent technical report, indicates the inclusion of dairy products improves the amino acid profile and it is a good contributor of calcium and potassium. Children are currently being tested to determine the benefits of these improved products in our fight against childhood malnutrition.
The USAID product portfolio, including product names, descriptions and purposes can be found here.