The Specialized Food Aid Community of Practice is a group of experts across government, the academy, industry, donors, and international food aid programming agencies that meets monthly to discuss emerging issues in food aid evidence and programming. It is organized by members of USAID and includes individuals from UNICEF, World Food Programme, the Bill and Melinda Gates Foundation, as well as academics and physicians. This was the second in-person meeting in Washington DC and focused on alternative ready-to-use therapeutic food (RUTF) formulations. Several individuals outside of the CoP were invited to give lectures on this topic. Dr. Kevin Stephenson was asked to discuss two novel RUTF recipes which were designed with high protein quality in mind.
RUTF revolutionized the care of children with severe acute malnutrition (SAM) by allowing treatment to occur safely and effectively at home, by the child’s caregiver. The formulation – roughly one-quarter each of skim milk powder, peanut paste, vegetable oil, and sugar, + a micronutrient mix – was designed for safety, high energy density, taste, high protein quality, in a form consumable by even 6-month-old children, and to be “ready to use”, i.e. not require further food preparation by the end-user. Skim milk powder (SMP) is comprised of balanced amino acids in sufficient quantity for most children to rebuild their bodies and recover. SMP is also relatively pricey and requires import to the countries where RUTF is used, thereby limiting local production and increasing costs/reducing coverage. Since the first deployment of RUTF, there has been interest in replacing SMP to improve affordability and allow for local production in-country. Formulations which have replaced SMP with lower protein-quality/less expensive plant-based protein sources have thus far failed to demonstrate equivalency in effectiveness. High protein-quality alternatives must be sought and tested rigorously.
Dr. Stephenson stated, “On behalf of my research group, I presented 2 novel alternative RUTF recipes which use mycoprotein or spirulina to replace milk. Mycoprotein is composed of microorganisms with 40-50% protein content. These require a carbon source to grow. The taste is umami, mild and, we suspect, acceptable. Price point remains too high currently but will improve with production scaling. Spirulina is a microalgae that is 60-70% protein content. These microalgae require sunlight and minerals to grow; no carbon source is needed, only sunlight. They impart a dark green color to RUTF with a mild seaweed flavor, and formal acceptable testing is necessary. Scaling production has begun but the price point is still too high. The main reason to be interested in these options is that both mycoprotein and spirulina have very high quality, digestible protein of relatively good amino acid balance. Protein or, more correctly, amino acid content, is the main determinant of physical rebuilding in children with SAM. When added to RUTF with peanut, the overall amino acid profile of both is favorable. The environmental footprint of both protein sources is far smaller than milk. These are both candidates for alternative RUTFs which could ultimately allow for local production. I also brought samples of both recipes to the meeting and all attendees tried them, which yielded many opinions of uncertain relevance (I have found that my taste buds’ perceptions do not correlate well with those of malnourished children in sub-Saharan Africa).”