Location: Children's Nutrition Research CenterTitle: A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: An application to Ethiopia
|RYAN, KELSEY - Washington University School Of Medicine|
|ADAMS, KATHERINE - University Of California|
|VOSTI, STEPHEN - University Of California|
|ORDIZ, M ISABEL - Washington University School Of Medicine|
|CIMO, ELIZABETH - Washington University School Of Medicine|
|MANARY, MARK - Children'S Nutrition Research Center (CNRC)|
Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/24/2014
Publication Date: 12/1/2014
Citation: Ryan, K.N., Adams, K.P., Vosti, S.A., Ordiz, M., Cimo, E.D., Manary, M.J. 2014. A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: An application to Ethiopia. American Journal of Clinical Nutrition. 100(6):1551-1558.
Interpretive Summary: Ready-to-use therapeutic food (RUTF) is the standard of care for children suffering from noncomplicated severe malnutrition. A spreadsheet formulator was created with a comprehensive database of food ingredients to determine multiple recipes for RUTF, which is used to treat severe malnutrition. The spreadsheet uses linear programming, a mathematical model to achieve the proper composition and the lowest price. Test recipes were created for Ethiopia and made in the food lab, which seemed acceptable. These new RUTF formulations are now ready for field testing and may serve as a means to permit more children with severe malnutrition to be nourished.
Technical Abstract: Ready-to-use therapeutic food (RUTF) is the standard of care for children suffering from noncomplicated severe acute malnutrition (SAM). The objective was to develop a comprehensive linear programming (LP) tool to create novel RUTF formulations for Ethiopia. A systematic approach that surveyed international and national crop and animal food databases was used to create a global and local candidate ingredient database. The database included information about each ingredient regarding nutrient composition, ingredient category, regional availability, and food safety, processing, and price. An LP tool was then designed to compose novel RUTF formulations. For the example case of Ethiopia, the objective was to minimize the ingredient cost of RUTF; the decision variables were ingredient weights and the extent of use of locally available ingredients, and the constraints were nutritional and product-quality related. Of the new RUTF formulations found by the LP tool for Ethiopia, 32 were predicted to be feasible for creating a paste, and these were prepared in the laboratory. Palatable final formulations contained a variety of ingredients, including fish, different dairy powders, and various seeds, grains, and legumes. Nearly all of the macronutrient values calculated by the LP tool differed by <10% from results produced by laboratory analyses, but the LP tool consistently underestimated total energy. The LP tool can be used to develop new RUTF formulations that make more use of locally available ingredients. This tool has the potential to lead to production of a variety of low-cost RUTF formulations that meet international standards and thereby potentially allow more children to be treated for SAM.