Geneva, March 2015
Saskia de Pee

• Improve sourcing and programming through harmonisation of product specifications and packaging (among agencies and suppliers)
• Bring RUSF composition in-line with WHO technical note on foods for treatment of MAM
• Support local production through
– Defining the premix
– Using the same premix for RUSF and LNS-MQ
– Having one premix for different raw materials
• Increase flexibility to respond to supply chain issues (emergencies)

• Same nutrient density for RUSF & LNS-MQ
(nutrient/1000 kcal or nutrient/100 g)
• Comply with WHO technical note for MAM foods
• Provide approx 1 RNI in 50 g, for complementing diet of children at-risk of acute malnutrition
• Take RUTF composition into consideration
– Min target met
– Max not exceeded, except for nutrients for linear growth
• Note, nutrients without max in RUTF & RUSF and no
UL, meet highest minimum requirement (LNS-MQ /
RUTF / RUSF)

• 100g sachet in line with management of MAM requirements Above min and below max of WHO technical note for MAM treatment foods for all nutrients
• 50 g to provide a good contribution to daily requirement of essential nutrients
At or above recommended nutrient intake for normal healthy individuals [RNI] for all vitamins, Iron, Zinc, Magnesium and Copper;
Half of RNI for
– Calcium: max = max of WHO MAM food
– Phosphorus: max = max of WHO MAM food
– Manganese: max = max of WHO MAM food
– Iodine: min = min of WHO MAM food; max = RUTF ; note the use of iodized salt in diet also provides iodine
– Selenium: min & max from RUTF; note that blending must be homogenous
– Potassium: No RNI, just DRI, 57% for 7-12 mo, 13% for 1-3 y, wide range & taste impact

• 100g sachets almost in line with management of SAM requirement
A bove the min for most nutrients, except:
– Protein: requirement higher for RUTF than for RUSF, ratio of milk powder to other ingredients higher in RUTF – can be maintained
– Potassium: at 80% of the min because of max of WHO for MAM foods; also taste reasons
Below the max in 100g for most nutrients, except:
– Calcium, Phosphorus and Magnesium: in line with WHO MAM foods, because of linear growth
– Vitamin A: max for RUTF = min for RUSF & heat sensitive (staying within target over 24 mo is very challenging); RUTF intake >100 g/d
– Vitamin K: max for RUTF = min for RUSF; no max for RUSF, no UL, why max for
RUTF?

 RUSF: ready-to-use supplementary food
 for children 6 months and above with moderate acute malnutrition
 100g sachets
 Colour: Pantone 151
 LNS-MQ: lipid-based nutrient supplement - medium quantity
 for children 6 months and above at risk of acute malnutrition
 50g sachets
 Colour: Pantone 109

• Discussions among WFP, UNICEF, USAID and MSF & supplier interaction
• Checked with WHO for RUTF composition, any change likely?
• Decision to first align RUSF & LNS-MQ, while also taking RUTF into account
• Shelf-life test, harmonized premix v0, tested retention over time (WFP,
GAIN, DSM)
• Nutrient goals set
• Raw material contribution estimated using food composition tables
• Premix proposed
– Target nutrient content for consumption & labelling = min
– Max includes overage for loss over time & respects max of nutrient content target
• Proposed specification circulated for feedback:
– Harmonized premix
– Nutrient targets RUSF & LNS-MQ
– Harmonized packaging
– Microbiological criteria

Macronutrients
Protein
Fat n-6 fatty acids n-3 fatty acids
Vitamins
Retinol (Vit A)
Thiamin (Vit B1)
Riboflavin (Vit B2)
Niacin (Vit B3)
Pantothenic Acid (Vit B5)
Pyridoxine (Vit B6)
Biotin (Vit B7)
Folates DFE (Vit B9)
Cobalamine (Vit B12)
Ascorbate (Vit C)
Cholecalciferiol (Vit D)
Alpha Tocopherol (Vit E)
Phytomenadione (Vit K)
Target per 100g
Min Label Max
WHO MAM in 1000kcal
RNI Codex
CAC/GL 8-
1991 in 50g
WHO SAM in
100g mcg mcg mcg mg mcg mg mcg mg mg mg mg g g g
11
26
2.6
0.3
g g mcg 800 1100 1600 mg 1.0
2.0
16
36
6.1
1.8
2.1
13
4.0
1.8
4.2
26
8.0
3.6
60
340
2.7
60
15
14
27
120
660
5.4
120
20
28
54
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
80%
√
√
√
√ except max
√
√
√
√
√
√
√
√
√
√
√
√ except max

Minerals
Calcium (Ca)
Copper (Cu)
Iodine (I)
Iron (Fe)
Magnesium (Mg)
Manganese (Mn)
Phosphorus (P)
Potassium (K)
Selenium (Se)
Sodium (Na)
Zinc (Zn)
Ca/P
Zn/Cu
Zn/Fe
Vitamin C/Fe
mg mg mcg mg mg mg mg mcg mg mg mg
Target per 100g
535
1.4
80
10
150
1.2
450 750
800 1200
20
11
40
270
14
750
1.9
140
14
225
2.4
WHO MAM in 1000kcal
RNI Codex
CAC/GL 8-
1991 in 50g
WHO SAM in
100g
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
Half n.a
Half n.a
√
Half
√
Half
√
√
Half
√ except max
√
√
√
√ except max
√
√ except max
80%
√
√
√