The efficacy of ‘ready-to-use therapeutic food - RUTF’ without milk to modulate severe acute malnutrition (SAM) in low- and middle-income countries (LMICs): a scoping review

Abstract Background Inpatient rehabilitation for children with severe acute malnutrition is not consistently preferred or practicable because of its financial constraints on carers and health facilities. Community-based malnutrition management, employing home-based therapy with ready-to-use therapeutic food (RUTF), has significantly altered the approach to treating severe acute malnutrition (SAM) cases. However, only 15% of SAM cases received treatment due to inconsistency in the supply and high-cost production of the standard RUTF. Therefore, identifying a more economical alternative is imperative worldwide. Aim This review examined the efficacy of RUTF with locally prepared ingredients without milk in treating children with SAM. Methods We scrutinised databases such as PubMed Central, ProQuest Central, and Web of Science. Eligible studies were trials that compared ‘standard RUTF’ with RUTF produced with locally available ingredients and without milk products. Results Five trials were included in this review. Three of five trials found non-milk RUTF (soy–maize–sorghum, fish-based) non-inferior to standard RUTF for weight gain, with differences ranging from − 0.7 g/kg/day to + 1.9 g/kg/day. Recovery rates ranged from 54 to 90%, with higher non-inferiority in children ≥ 24 months. Haemoglobin increased by 0.67–2.1 g/dL in anaemic children receiving non-milk RUTF; iron stores also improved. Mortality (0–13.7%) and morbidity rates were similar between groups. Conclusion Non-milk RUTF can achieve comparable weight gain, recovery, and survival to standard RUTF in older children, with added benefits for iron status. More research is needed to optimise formulations for children < 24 months and to assess household-level production feasibility.