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RUTF for stunted children

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Anonymous 1278

Normal user

27 Sep 2015, 17:18

Hello everyone,

I am looking for any programmatic evidence where organizations have tried RUTF on stunted children. Would be great if someone could share program data and outcomes on the dosage, number of days RUTF was fed, weight gain, etc. Any articles that show a link between RUTF for stunted children and metabolic syndrome later in life will also be a great support!

Mark Myatt

Consultant Epideomiologist

Frequent user

5 Oct 2015, 11:59

Just to clarify ... this is RUTF for low HAZ children? We have plenty of data / experience with low HAZ children selected by low MUAC.

I think you will not have much luck WRT metabolic syndrome as this tends not be identified until late middle-age. We do not have exposure to RUTF at scale long enough to detect cases as these, if the link is there, will be 15 or 20 year away. The oldest exposed cases might now be in their early twenties. I'd suspect anything written on an RUTF - metabolic syndrome to by highly speculative. I think the "best" that could be shown would be excess adiposity in young adults.

There is a sort of anti-RUTF movement out there. I wonder why they pick on "RUTF" when RUTF is just another F100 product (easier to use and store than F100 milks and probably safer than BP100 "biscuits"). Perhaps it is because RUTF facilitates large-scale programming. The point is ... F100 has been used for long enough that we might be able to establish an F100 - metabolic syndrome link. I advise you to expand your search to include F100.

Just me tuppence.

André BRIEND

Frequent user

6 Oct 2015, 07:27

Dear Anonymous 1278,

The association between high fat RUTF and the risk of later metabolic syndrome is largely speculative. In rich countries where the metabolic syndrome has been extensively investigated, its link with a high fat intake is not clearly established. One can even argue that the current obesity epidemic in rich countries grew even faster once people started to consume low fat foods.

See an article in Time magazine discussing the origin of the low fat diet and its lack of effect on the current obesity epidemics:

http://time.com/3702058/dietary-guidelines-fat-wrong/

This is based on many articles currently being published in the scientific literature and challenging the low fat diet paradigm.

When it comes to the specific question of the risk associated with high fat diet in children, the available evidence points the other way: the most at risk adults got low fat diet when they were children. See:

Rolland-Cachera MF, Maillot M, Deheeger M, Souberbielle JC, Péneau S, Hercberg S.
Association of nutrition in early life with body fat and serum leptin at adult age. Int J Obes (Lond). 2013 Aug;37(8):1116-22

Note the effect of RUTF on health later in life will be very difficult to test. A simple association between RUTF and later metabolic syndrome will not be enough to show causality as pre-existing malnutrition will be a confounding factor. The only approach would be to give low fat high fat diet to randomly selected stunted children and look at what happens 20 years later. Not easy to do. And I am not sure it is a priority given the absence of evidence now linking fat intake in children and later obesity or metabolic syndrome later in life.

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