New Codex guidelines pave the way for innovation for ready-to-use therapeutic food (RUTF)
The guidelines could enable the development of new versions of this life-saving product that helps millions of children under 5 suffering from severe wasting each year.
Codex guidelines for ready-to-use therapeutic food (RUTF) were adopted at the 45th session of the Codex Alimentarius Commission on 21 November and are set to pave the way for new innovative versions of the life-saving product. They will also enable governments to regulate safety effectively as manufacturers scale up production to tackle the malnutrition crisis affecting millions of children, especially in Africa and Asia.
“Until now, there was no internationally accepted standard or category for RUTF,” explains Alison Fleet, a technical specialist at UNICEF Supply Division’s Medicines and Nutrition Centre. “Now, with these guidelines, RUTF has a clear regulatory category as a food for special medical purposes (FSMP). The new rules set out, among other things, provisions for food safety and requirements for nutritional composition. There are countries where RUTF is not used because the product is not adapted to their population. The guideline will help with the creation of local versions of RUTF and allow access to treatment for many more children.”
Protecting quality and safety
The adoption of the guidelines is the culmination of seven years of hard work, and Alison Fleet describes the development as providing freedom to innovate while protecting quality and safety.
“Having these guidelines defines food safety controls and makes it easier for governments to oversee and regulate local producers as they scale up or as new producers emerge. It also limits the amount of sugar that can be included in the product and ensures there are good fats for brain development to help recovery.”
One significant new freedom for RUTF producers concerns the protein source. At present milk powder and peanuts are the usual protein source for RUTF, but sometimes these are not locally available and have to be imported, which can be costly. The new guidelines specify a protein quality score rather than limiting protein sources. This allows producers and researchers to propose other high quality protein sources that could be less expensive and still well-liked by babies and infants.
Nutritious, delicious and practical
“Milk is an excellent source of protein but there are other sources that can be explored without any compromise on safety or quality,” says Alison Fleet. “Young children in Africa seem to like peanuts, in South Asia many like chickpeas and in Southeast Asia little ones seem to enjoy mung beans. We enjoy a good relationship with suppliers and, with the adoption of these guidelines, we are looking forward to receiving proposals for products that are adapted to local situations and tastes.”
The adoption of the guidelines is timely as the global food and hunger crisis is driving one child into severe malnutrition every minute in the worst affected 15 countries. This is in addition to high levels of undernutrition that already affected around 13.6 million children even before the current crisis. The condition is on the increase in a number of areas affected by conflict and climate shock.
UNICEF is doubling its annual RUTF procurement to keep up with demand. In July 2022 USAID announced a US$200 million contribution to UNICEF to combat wasting, with US$120 million for RUTF procurement and US$80 million for implementation. Additional funding has been pledged by other donors since then, bringing the total financial resources raised for wasting to nearly half a billion. A range of measures have also been put in place to help suppliers to ramp up production.
