Therapeutic food

The 1999 standard treatment of childhood malnutrition was administered in two phases. Phase one (stabilization) 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. When an improvement in the child's appetite and clinical condition is observed, the child is entered into phase two (rehabilitation) 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". The child is in phase two until he/she is no longer wasted [weight-for-height z score (WHZ) 2]. 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. The World Health Organization's 1999 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. F-75 and F-100 remain in use in the inpatient field in the 2023 WHO Guideline. The two-phase framework remains, with the change that RUTF may be used in lieu of F-100 in the rehabilitation phase. ==Ready-to-use therapeutic food==

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. The paste form allows feeding of children as young as 6 months. In addition to pastes and spreads, the 2023 WHO Guideline includes compressed biscuits/bars like BP-100 in the definition of RUTF. The size of the particles in the mixture has to be less than 200 μm for the mixture to maintain its consistency. RUTFs are used by UNICEF Kid Power malnutrition program, which employ celebrities to raise awareness about the issue. Dietary method When used at home, RUTF paste is generally provided to malnorished children from 6 months to five years of age, usually for a period of 2 to 4 months. The daily amount is usually based on body mass at 175 kcal/kg/d. There is a detailed rule in which some children (no danger signs, in stable condition, less severe edema, good appetite for RUTF) may be wholly treated at home using RUTF. RUTFs 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. The effectiveness of ready to use therapeutic food on potential relapses or on overall mortality is not clear as of 2019. == Less-severe wasting ==

The UNICEF uses supplementary food in cases of moderate acute malnutrition. Unlike therapeutic food which is used alone in a diet (with water and in infants, breastmilk), supplementary food are intended for addition to existing diets. • Ready-to-Use Supplementary Food (RUSF) spread, for use in moderate acute malnutrition in children 6 months and older. The UNICEF also makes use of complementary food to improve the nutrition of children and adults, as an addition to their diets. The UNICEF uses the following kinds of complementary food: • Emergency food ration, a standard fortified high energy biscuit. Acceptable for 6 months (when mixed with water into porridge) and older. • Fortified biscuits, intended as general food distribution, school feeding, and use in emergencies. Can help complement the lack of micronutrients in other ration foods and prevent micronutrient deficiency in school-aged children. • Super Cereal CSB+, a fortified blend of maize and defatted soy flours with 10% added sugar for cooking into a porridge or gruel. For 3-year-olds and older. • Super Cereal Plus CSB++, a fortified blend of maize, defatted soy flours and skimmed milk with 10% added sugar for cooking into a porridge or gruel. For 6 months and older. • Liquid-based Nutritional Supplement (LNS-SQ) "lipid nut", fortified food rich in proteins, fat, vitamins, and minerals for prevention of malnutrition in at-risk children 6 months and older. The UNICEF also has a Ready-to-Use Infant Formula (RUIF) for replacement of breastmilk in orphans. It is packaged in liquid form. Fortified blended foods (which includes the CSB+/CSB++) and lipid-based nutritional supplements (LNS, which includes RUTF, RUSF, and "lipid nut") are included in the WHO Guideline as acceptable for moderate wasting. LNS is the preferred option. The WHO recommends targeted use of all these specially-formulated foods in prevention of malnutrition. ==Examples==

• Non-RU TFs • K-Mix 2, a high energy food, developed by UNICEF in the 1960s • RUTFs • Citadel spread, a paste of peanuts, oil, sugar and milk powder in use since 1971 • Plumpy'nut, a solid RUTF, made in France since 1996 for treatment of severe acute malnutrition • Medika Mamba, an enriched peanut butter therapeutic food produced and distributed by Meds and Food for Kids in Haiti since 2003 • BP-100, a nutrient-fortified wheat-and-oat bar designed to provide a similar nutritional profile to F-100 by the World Health Organization • Complementary food • Nutribun, a fortified bread product developed by United States Agency for International Development and distributed at schools under the Food for Peace program ==References==