Menu ENN Search

Informal workshop on bioavailability of micronutrients in RUTF

Summary of workshop report1

Ready to use therapeutic foods (RUTFs) and ready to use supplementary foods (RUSFs) are two types of ready to use food (RUF) or more specifically, examples of lipid-based nutrient supplements (LNS). They are critical in the community-based treatment of severe and moderate acute malnutrition (SAM & MAM) and are currently largely used in feeding programmes. Since 2008, therapeutic feeding programmes worldwide have employed 8000 tons of RUTFs, with a trend of demand rapidly increasing.

Important aspects regarding the bioavailability of micronutrients in these products are not fully known and need more research. RUTFs and RUSFs require a specific micronutrient profile to enable rehabilitation of acutely malnourished children, however the absorption of the micronutrients from such products is not clearly understood. Most available evidence on bioavailability of micronutrients is based on supplementation interventions, which differ from RUTF interventions in two aspects. First, supplementation studies are based on drops or tablets, which are non food matrixes. Secondly, studies are conducted using non SAM (or non-MAM) subjects, however absorption and metabolic systems of the malnourished are generally compromised. Furthermore, no evidence is available on the effect of enhancers or inhibiting factors (i.e. anti-nutritional factors) on the bioavailability of the micronutrients from these kinds of products, which contain relatively high levels of phytate. Bioavailability studies are costly and undertaking research in the settings where SAM occurs is often challenging. Nevertheless, generating evidence on these aspects is important as it may lead to improvements of the impact of these therapeutic products, as well as to a better understanding of micronutrient absorption mechanisms in acutely malnourished children.

In January 2010, an informal workshop was organised by Valid International and the UCL Centre for International Health and Development (CIHD) focused solely on the questions related to the bioavailability of micronutrients from RUTF in SAM children. University and private sector researchers, together with nutrition practitioners interested in the rehabilitation from malnutrition, met in London, UK for a half-day of brainstorming activities about the bioavailability of micronutrients when using energy-dense food matrixes (currently called RUTF, RUSF or LNS). During the workshop, ideas were exchanged on how to measure and increase micronutrients bioavailability in RUTF, to treat SAM in children. The main questions raised, basis of discussions and suggestions/ inputs for possible follow-up research ideas are presented below.

Research questions 1: Which changes could be made to the formulation of RUTF to improve bioavailability of micronutrients?

RUTF is composed of pre-processed food-based ingredients, mixed with a chemical premix of vitamins and minerals. More cereal and pulsebased formulations, as alternatives to peanut-based ones, are expected in the near future. The chemical forms of the vitamins and minerals in available premixes differ. Understanding the bioavailability of micronutrients in RUTF requires collecting evidence on food-based ingredients, as well as the specific chemical forms and dosages of added vitamins and minerals.

A number of activities and research questions were identified:

Question 2: What are the physiological-related factors influencing the bioavailability of micronutrients in SAM subjects?

It is not clear how SAM affects the ability to absorb and utilise micronutrients available from RUTF. Current knowledge on the metabolism of absorption and utilisation of micronutrients among both healthy children and children with micronutrient deficiencies may not apply to children with SAM. Phytic acid is among the main anti-nutritional factors influencing the bioavailability of a few micronutrients in RUTF (e.g. iron, zinc). A new form of phytase enzyme has been successfully tested in healthy adults.

Activities and research questions identified:

Question 3: Which micronutrients should the research focus on?

The rehabilitation from SAM is achieved only if ALL the micronutrients required are not only present and bio-available, but also, for some of them, when combined according to pre-determined ratios between them. However, the complexity and the cost of measuring the bioavailability of micronutrients limit the choice for research to a few nutrients.

Given this, the group agreed to focus the research on the micronutrients which are required to be in specific ratios with others, since these coincide also with the most crucial ones: Ca, Cu, Fe, K, Mn, Mg, Ph, Se, Zn, vitamin E (and vitamin A eventually).

Study designs and research context

The workshop participants had experience in measuring bioavailability on a limited number of micronutrients (namely iron, zinc, vitamin A and iodine). Participants proposed a few study designs outlined below, which need to be expanded and reviewed by bioavailability experts. For example, it was noted that stable isotopic studies on iron can be realistically undertaken under field settings (e.g. refugee camps) as cold chain transport is not critical (therefore no need for liquid nitrogen), and sophisticated lab equipment can be used elsewhere for blood sample processing and analysis. On the other hand, the participants did not know about the challenges related to studying other types of micronutrients bioavailability (e.g. isotope balance).

Two trial designs were proposed:

Phase 1 study in healthy young children (crossover, bioavailability study) to test (a) impact of phytase on bioavailability of micronutrients and/or (b) to compare the bioavailability of micronutrients from different food formulations of RUTF. Points for consideration were:

Phase 2 study in SAM children to test efficacy of best formulation(s) identified in phase 1 measuring micronutrient status and recovery from SAM.

Next steps

Participants expressed interest in taking these research topics forward and shared possible ideas and funding sources to do this.

For more information, contact: Filippo Dubari email: filippo@validinternational.org or Mélody Tondeur, email: m.tondeur@ich.ucl.ac.uk

Show footnotes

1Dibari. F and Tondeur. M (2010). What is the bioavailability of micronutrients form RUTFs in children affected by SAM. Brainstorming workshop Report. 18th January 2010.

More like this

FEX: Developing food supplements for moderately malnourished children: lessons learned from RUTF

Summary of research1 Location: Global What we know: RUTF is as effective as F100 in treating SAM, where weight gain is the recovery outcome. Food supplements for moderate...

en-net: Plumpy nut Vis-à-vis Supplementary plumpy

Based on the nutritional information of the two products, there is no difference in nutritional composion (energy,protein, Fat, and micronutritient) except plumy nut has animal...

en-net: RUTF FDA Approved

Is Plumpy Nut RUTF approved by FDA? Can anyone forward me the link. Thanks Judy Canahuati. Really it was a new question for me, i don't know how much is this applicable...

FEX: Bioavailability of iron, zinc and provitamin A carotenoids in biofortified staple crops

Summary of study1 Location: Global What we know: Biofortification of staple foods is one potential way of increasing micronutrient intake in resource limited populations....

en-net: Provision of monthly RUTF in hard to reach areas

I would like to seek guidance from the experts whether is it possible to provide a monthly ration of RUTF in hard to reach areas. I work in Northeast Nigeria where we screen...

FEX: Use of LNS to improve food rations in emergencies

WFP/Alejandro Chicheri, Nicaragua, 2007 Summary of review1 A recent review focuses on the potential role of lipid-based nutrient supplements (LNS)' in meeting the nutritional...

en-net: Treatment of SAM children in the absence of RUTFs

In an area where there is targeted feeding programme for moderately undernourished children and PLW with supercereal plus and supercereal and oil respectively but no RUTF for...

FEX: Towards the Overdue Elimination of Deficiency Disease Epidemics

By André Briend Andre Briend is a medical doctor, working for the Institut de Recherche pour le Développement (IRD), a French public research institution with a mandate to...

FEX: Alternative RUTF formulations (Special Supplement 2)

By Steve Collins & Jeya Henry Developing CTC programmes that use Ready to Use Therapeutic Food (RUTF) made locally, from locally available produce, and used to treat...

en-net: nutritional value and impact of moringa - the 'miracle tree'

Moringa is a nutritious tree grown in the tropics, sometimes called the ‘miracle tree’. Does anyone have any good programming examples that they can share with us at Save the...

FEX: Biofortification: Helping meet nutrition needs worldwide

News By Dr Erick Boy, Nutrition Head, HarvestPlus Dr Erick Boy is a public health practitioner and has a doctoral degree in nutrition from University of California, Davis. He...

en-net: Bioavailability of micronutrients in breast milk

It seems to be assumed that breast milk has a higher bioavailability compared with infant formulas but can anyone reccommend any more extensive research in this area that I...

en-net: MNPs and RUTF at the same time?

Hello, I am wondering if there is any official WHO recommendation contraindicating MNP use at the same time as RUTFs? (i.e. risk of exceeding RDAs/RDIs) Thank...

FEX: DFID launches Nutrition Strategy

The Department for International Development (DFID) UK has just launched its new Nutrition Strategy (March 2010). This 20 page document sets out a range of immediate and...

FEX: Derivation of nutrient requirements for disaster-affected populations - Sphere Project 2011

Summary of research1 Location: Global What we know: The Sphere Handbook defines minimum standards and indicators for assessing humanitarian responses, including food and...

FEX: Integration of CTC with strategies to address HIV/AIDS (Special Supplement 2)

By Paluku Bahwere, Saul Guerrero, Kate Sadler & Steve Collins (Valid International) The district health officer of Dowa, Malawi, briefs clinic and community workers about the...

FEX: Impact of local RUTF manufacture on farmers’ incomes in Malawi

By Marta Ortiz Nunez Marta Ortiz Nunez is a recent Masters graduate in International Development. In 2006 she co-founded a Spanish non-governmental organization focusing on...

en-net: Upto what extend iron flour fortification can increase the Hb level of anemic adolescent women if iron fortified wheat flour is feed to these anemic adolescent women for 3 months?

i am doing my Mphil research on iron wheat flour fortification for anemic adolescent women. can any one have any information or relevant site or paper that how much it will...

FEX: Current evidence on anaemia and micronutrient supplementation strategies in school-age children and adolescents

View this article as a pdf Lisez cet article en français ici By Elena Hemler, Wafaie Fawzi and Stephanie Wrottesley Elena Hemler is senior project coordinator for the...

Collective Statement of Support for multiple micronutrient supplements (MMS)

We've joined global experts & practitioners calling for urgent scale-up of MMS ensuring mothers receive more effective prenatal care & in turn babies have the best chance...

Close

Reference this page

Informal workshop on bioavailability of micronutrients in RUTF. Field Exchange 38, April 2010. p21. www.ennonline.net/fex/38/informal

(ENN_4014)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.