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Therapeutic foods are foods designed for specific, usually nutritional, therapeutic purposes as a form of dietary supplement. The primary examples of therapeutic foods are used for emergency feeding of malnourished children or to supplement the diets of persons with special nutrition requirements, such as the elderly.
| Nutrition composition | |
|---|---|
| Moisture content | 2.5% maximum |
| Energy | 520-550 Kcal/100 g |
| Proteins | 10 to 12% total energy |
| Lipids | 45 to 60% total energy |
| Sodium | 290 mg/100 g maximum |
| Potassium | 1100 to 1400 mg/100 g |
| Calcium | 300 to 600 mg/100 g |
| Phosphorus (excluding phytate) | 300 to 600 mg/100 g |
| Magnesium | 80 to 140 mg/100 g |
| Iron | 10 to 14 mg/100 g |
| Zinc | 11 to 14 mg/100 g |
| Copper | 1.4 to 1.8 mg/100 g |
| Selenium | 20 to 40 μg |
| Iodine | 70 to 140 μg/100 g |
| Vitamin A | 0.8 to 1.1 mg/100 g |
| Vitamin D | 15 to 20 μg/100 g |
| Vitamin E | 20 mg/100 g minimum |
| Vitamin K | 15 to 30 μg/100 g |
| Vitamin B1 | 0.5 mg/100 g minimum |
| Vitamin B2 | 1.6 mg/100 g minimum |
| Vitamin C | 50 mg/100 g minimum |
| Vitamin B6 | 0.6 mg/100 g minimum |
| Vitamin B12 | 1.6 μg/100 g minimum |
| Folic acid | 200 μg/100 g minimum |
| Niacin | 5 mg/100 g minimum |
| Pantothenic acid | 3 mg/100 g minimum |
| Biotin | 60 μg/100 g minimum |
| n-6 fatty acids | 3% to 10% of total energy |
| n-3 fatty acids | 0.3 to 2.5% of total energy |
Therapeutic foods are usually made of a mixture of protein, carbohydrate, lipid and vitamins and minerals. Therapeutic foods are usually produced by grinding all ingredients together and mixing them. The mixing process allows for the protein and carbohydrate components of the food to be embedded in the lipid matrix. [1] The size of the particles in the mixture has to be less than 200 μm for the mixture to maintain its consistency. [1] Using this method, the therapeutic food is produced and packaged without using water, which would eliminate the issue of spoilage. Some therapeutic foods require the addition of water before administering, while others can be consumed as-is. Therapeutic foods are designed and manufactured to ensure that they are ready to eat straight from the packaging. Those foods resist bacterial contamination and require no cooking. [1]
A subset of therapeutic foods, ready-to-use therapeutic foods (RUTFs), are energy-dense, micronutrient-enriched pastes that have a nutritional profile similar to the traditional F-100 milk-based diet used in inpatient therapeutic feeding programs and are often made of peanuts, oil, sugar and milk powder. [2]
RUTFs are a "homogeneous mixture of lipid-rich and water-soluble foods." [1] The lipids used in formulating RUTFs are in a viscous liquid form. The other ingredients are in small particles and are mixed through the lipid. The other ingredients are protein, carbohydrate, vitamins and minerals. The mixture needs to be homogeneous for it to be effectively consumed. To do this, a specific mixing process is needed. [1] The fat/lipid component of the RUTF is heated and stirred first. The heat should be maintained for the lipid to remain in the optimum form for mixing in the other ingredients. The powdered protein, carbohydrate, and vitamins and minerals are then slowly and gradually added to the lipid, while the lipid is being vigorously stirred. After all the ingredients are added and vigorous stirring is maintained, the mixture is then stirred with more speed and for several minutes. [1] If the powdered ingredients have a particle size that is larger than 200 μm, the mixture starts to separate; the particle size needs to be maintained at less than 200 μm. [1]
The most common RUTFs are made of four ingredients: sugar, dried skimmed milk, oil, and vitamin and mineral supplement (CMV). Other qualities that RUTFs should have included a texture that is soft or crushable and a taste that is acceptable and suitable for young children. RUTFs should be ready to eat without needing to be cooked. A very important characteristic is that the RUTFs have a long shelf-life and that they are micro-organism contamination resistant, without the need for expensive packaging. Since the ingredients need to be suspended in liquid, the liquid used in producing RUTFs needs to be fat/lipid. 50% of the protein forming RUTFs should come from dairy products.
UNICEF specifications for RUTFs say that the vitamin and mineral premix must be sourced from one of the following vendors authorized by the World Food Program: DSM Nutrition/Fortitech, Nicholas Piramal Healthcare Ltd (now Piramal Group), Hexagon Nutrition, BASF (SternVitamin), and the GAIN premix facility. [3]
RUTFs are used by UNICEF Kid Power malnutrition program, which uses celebrities to go on "global missions" to help save impoverished areas in Africa. [4]
The standard treatment of childhood malnutrition is administered in two phases. [5] Phase one usually deals with children who are severely malnourished and very ill as a result. The therapy used in this phase is F-75, a milk-based liquid food containing modest amounts of energy and protein (75 kcal/100 mL and 0.9 g protein/100 mL) and the administration of parenteral antibiotics. [6] When an improvement in the child's appetite and clinical condition is observed, the child is entered into phase two of the treatment. This phase uses F-100. F-100 is a "specially formulated, high-energy, high-protein (100 kcal/100 mL, 2.9 g protein/100 mL) milk-based liquid food". [6] The child is in phase two until he/she is no longer wasted [weight-for-height z score (WHZ) 2]. [6] Phase two starts while the child is at the hospital but is usually completed after the child goes home. The parent is then responsible for feeding the child a flour supplement made of cereal and legumes as a replacement for the milk-based foods used in phases one and two. [6]
The World Health Organization's standards for the treatment of malnutrition in children specify the use of two formulas during initial treatment, F-75 and F-100. These formulas contain a mixture of powdered milk, sugar, and other ingredients designed to provide an easily absorbed mix of carbohydrates and essential micronutrients. They are generally provided as powdered mixes which are reconstituted with water. The WHO recommends the use of these formulas, with the gradual introduction of other foods, until the child approaches a normal weight. [5]
Ready to use therapeutic food within the person's own home for the treatment of severe acute malnutrition in children under five years of age may be effective at improving weight gain and recovery when compared to alternative dietary approaches. [7] The effectiveness of ready to use therapeutic food on potential relapses or on overall mortality is not clear. [7]
As of 2013, Plumpy'Nut had been used to relieve malnutrition in thousands of African children, gaining approval as a therapeutic food from the World Health Organization. [8]
An emulsion is a mixture of two or more liquids that are normally immiscible owing to liquid-liquid phase separation. Emulsions are part of a more general class of two-phase systems of matter called colloids. Although the terms colloid and emulsion are sometimes used interchangeably, emulsion should be used when both phases, dispersed and continuous, are liquids. In an emulsion, one liquid is dispersed in the other. Examples of emulsions include vinaigrettes, homogenized milk, liquid biomolecular condensates, and some cutting fluids for metal working.
Kwashiorkor is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates. It is thought to be caused by sufficient calorie intake, but with insufficient protein consumption, which distinguishes it from marasmus. Recent studies have found that a lack of antioxidant micronutrients such as β-carotene, lycopene, other carotenoids, and vitamin C as well as the presence of aflatoxins may play a role in the development of the disease. However, the exact cause of kwashiorkor is still unknown. Inadequate food supply is correlated with occurrences of kwashiorkor; occurrences in high income countries are rare. It occurs amongst weaning children to ages of about five years old.
Infant formula, also called baby formula, simply formula, baby milk or infant milk, is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid. The U.S. Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk".
Human nutrition deals with the provision of essential nutrients in food that are necessary to support human life and good health. Poor nutrition is a chronic problem often linked to poverty, food security, or a poor understanding of nutritional requirements. Malnutrition and its consequences are large contributors to deaths, physical deformities, and disabilities worldwide. Good nutrition is necessary for children to grow physically and mentally, and for normal human biological development.
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition. Malnutrition is increasing in children under the age of five due to providers who cannot afford or do not have access to adequate nutrition.
Famine relief is an organized effort to reduce starvation in a region in which there is famine. A famine is a phenomenon in which a large proportion of the population of a region or country are so undernourished that death by starvation becomes increasingly common. In spite of the much greater technological and economic resources of the modern world, famine still strikes many parts of the world, mostly in the developing nations.
Powdered milk, also called milk powder, dried milk, or dry milk, is a manufactured dairy product made by evaporating milk to dryness. One purpose of drying milk is to preserve it; milk powder has a far longer shelf life than liquid milk and does not need to be refrigerated, due to its low moisture content. Another purpose is to reduce its bulk for the economy of transportation. Powdered milk and dairy products include such items as dry whole milk, nonfat (skimmed) dry milk, dry buttermilk, dry whey products and dry dairy blends. Many exported dairy products conform to standards laid out in Codex Alimentarius.
Plumpy'Nut is a peanut-based paste in a plastic wrapper for treatment of severe acute malnutrition manufactured by Nutriset, a French company. Feeding with the 92-gram packets of this paste reduces the need for hospitalization. It can be administered at home, allowing more people to be treated.
André Briend is a French pediatric nutritionist best known for his 1996 co-formulation of Plumpy'nut, a Ready-to-Use Therapeutic Food (RUTF), with Dr. Mark Manary. Starting in 1994, Briend, who at the time worked at Institut de recherche pour le développement, worked with Michel Lescanne to develop variants of renutrition products in solid form. At the time, the WHO-recommended diet for the treatment of severe malnutrition required clean water, a commodity only available in hospitals in most developing countries. These trial products were ultimately discarded for not meeting the requirements of good shelf-life, pleasant taste, or logistic simplicity. In 1996, inspired by a jar of chocolate spread which had a similar composition of proteins, energy, and lipids as the diet recommended by the WHO, Briend came up with the idea of replacing part of the dry skim milk in the existing recipe with peanut butter and eventually created Plumpy'nut. Briend also served as a medical officer for the Department of Child & Adolescent Health and Development at the World Health Organization.
A milk substitute is any substance that resembles milk and can be used in the same ways as milk. Such substances may be variously known as non-dairy beverage, nut milk, grain milk, legume milk, mock milk and alternative milk.
Atmit is a nutritional supplement used to fight famine in impoverished countries. Historically, atmit was used regularly to nourish and support women in their post-partum periods. The richness of protein and calories would help encourage milk production and restore strength to the mother after the exhaustion of labour and significant bloodloss post-delivery. It was later found that the cultural and traditional dish that is still used today for women in Ethiopia and across the diaspora could also be used to support undernourished people worldwide. The creamy, nutritious food is indigenous to Ethiopia and is now used to feed the severely malnourished and weakened adults and children. The word atmit originated in Ethiopia and refers to a kind of "thin, nourishing porridge." Traditionally, Atmit can contain over 20 different cereals and recipes can vary widely.
F-100 and F-75 are therapeutic milk products designed to treat severe malnutrition. The formula is used in therapeutic feeding centres where children are hospitalized for treatment. F-75 is considered the "starter" formula, and F-100 the "catch-up" formula. The designations mean that the product contains respectively 75 and 100 kcals per 100 ml. F-75 provides 75 kcal and 0.9 g protein per 100 mL, while F-100 provides 100 kcal and 2.9 g protein. Both are very high in energy, fat, and protein, and provide a large amount of nutrients. Ingredients include concentrated milk powder, food oil, and dextrin vitamin complexes. The formulas may be prepared by mixing with the local water supply. There are other variants like Low Lactose F-75 and Lactose Free F-75, which are used in case of persistent diarrhoea in severe acute malnutrition. F-75 may be cereal-based in place of milk.
Meds & Food for Kids is a nonprofit organization dedicated to treating and preventing child malnutrition in Haiti by producing fortified peanut-based foods. Meds & Food for Kids uses a peanut-based feeding approach called Ready-to-Use Therapeutic Food (RUTF), known as Medika Mamba.
Unimix is an enriched maize and bean flour designed and used to fight malnutrition. It contains maize (corn) flour, soy beans, oil, milk powder, and sugar; plus vitamins and minerals. The standard use is to make into porridge by cooking it with water and having this in addition to whatever other food is available. It can also be used in place of flour to make bread or other foods according to local customs. Humanitarian organizations ship Unimix in large quantities to starving people in order to fight severe malnutrition, especially in children, who need substantial protein to grow.
Instant breakfast typically refers to breakfast food products that are manufactured in a powdered form, which are generally prepared with the addition of milk and then consumed as a drink. Some instant breakfasts are produced and marketed in liquid form. The target market for instant breakfast products includes consumers who tend to be busy, such as students and working adults.
Citadel Spread is a paste made of peanut butter, oil, sugar and milk powder. First developed as a trail food for hikers, a Citadel Spread resembles common ready-to-use therapeutic food (RUTF) formulations, such as Plumpy'nut.
Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.
Nutribun, also referred to as Nutri-bun or Nutriban, is a bread product used in elementary school feeding programs in the Philippines to combat child malnutrition, initially as part of the United States Agency for International Development (USAID)'s Food for Peace program from 1971 to 1997, and later as part of the child health programs of various Philippine cities.
Child health and nutrition in Africa is concerned with the health care of children through adolescents in the various countries of Africa. The right to health and a nutritious and sufficient diet are internationally recognized fundamental human rights protected by international treaties and conventions on the right to life, as well as in charters, strategies and declarations. Millennium Development Goals (MDGs) 1, 4, 5 and 6 highlight, respectively, how poverty, hunger, child mortality, maternal health, the eradication of HIV/AIDS, malaria, tuberculosis and other diseases are of particular significance in the context of child health.
Nutritional immunology is a field of immunology that focuses on studying the influence of nutrition on the immune system and its protective functions. Part of nutritional immunology involves studying the possible effects of diet on the prevention and management on developing autoimmune diseases, chronic diseases, allergy, cancer and infectious diseases. Other related topics of nutritional immunology are: malnutrition, malabsorption and nutritional metabolic disorders including the determination of their immune products.
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