Table 1 Summary of studies on the potential of alternative ready-to-use therapeutic foods in managing acute malnutrition

Replaces milk with soybeans

    Soya, maise and sorghum

1927

Non-blind, parallel, cluster-randomised equivalent trial

Recovery rate, Adjusted risk difference (ARD)

SMS-RUTF has a lower recovery rate than P-RUTF

The result was inconclusive in their equality with recovery rates

[25]

225

Non-blinded 3 arm, parallel-group, simple randomised control trials

LOS, haemoglobin, iron store

FSMS-RUTF was not inferior to PM-RUTF in recovery rates in both groups. FSMS-RUTF was superior in haemoglobin and body iron stored recovery

FSMS-RUTF is more effective in treating and remedying iron deficiency anaemia in severe acute malnourished children

[42]

389

Simple randomised controlled non-inferiority trials

Anaemia, Iron status, Retinol-binding protein, Gut inflammation

SMS-RUTF increased body iron stores while P-RUTF had the highest recovery rate

SMS-RUTF is more potent in correcting BIS and treating anaemia than P-RUTF

[52];

    Soy-based with soy protein isolate

260

Randomised double-blind intervention trial

Acceptability, weight and MUAC gain, TBW, fat

The two samples showed similar taste acceptability trial improvements in anthropometric indices, body composition, total body water, fat-free mass and fat mass

There is a need for a multi-centre study to generalise the findings

[41•]

    Rice, mung beans and soy

200

Randomised crossover trials/design

Acceptability trial, weight and BMI (children and adults)

69% and 91% of HEBI and 65% and 81% of Plumpy’Nut were consumed by children and adults, respectively. There were statistical differences in weight and BMI gain between adults who consumed RUTF and the control

Both HIV-positive children and adults preferred and accepted HEBI. The weight gain translated significantly in BMI but not in MUAC

[89]

    Unprocessed soy flour

1874

Randomised double-blind, clinical trial

Weight and height gain, recovery rate

Weight gain, height gain and recovery rate were higher in children receiving 25% milk RUTF than 10% milk RUTF

10% milk RUTF is less effective than 25% milk RUTF in the treatment of SAM

[55]

    Milk-free and reduced milk

499

Non-blinded, 3-arm, parallel-group simple randomised control trial

Plasma amino acid, anthropometric measurements

FSMS-RUTF and MSMS-RUTF were not less in plasma leucine, methionine, cystine and EAA concentration in 6–59 months SAM children at discharge

There were sufficient functional metabolites of plasma amino acids by the three RUTF, a non-inferior in plasma methionine and cysteine in both FSMS-RUTF and MSMS-RUTF

[53, 54]

Fish and insects replace milk

    Fish-based

121

A single-blinded randomised controlled trial

Weight gain, anthropometry measurement

No statistical difference in weight gain and anthropometry measurement between the two groups

None of the RUTF was superior to the other and can serve as an alternative to milk based RUTF

[38]

Other pulses and cereal used in replacing peanut

    Chickpeas, soy and maise

2425

Cluster-randomised controlled trial

The recovery rate for MAM children, Cost-effectiveness

Super Cereal PLUS children showed a higher overall recovery rate. Children less than 24 months recovered more than those older than 24 months

Formula 2 is the most cost-effective of the four samples

[26]

    Crystalline AA, Zn and vitamin C

1650

A non-blinded, parallel-group, simple randomised controlled trial

Changes in haemoglobin, PAA profile, Recovery rate, Weight gain, LOS, BIA

Both products met the minimum international standard for the 24–59 months group on ITT. SMS-RUTF was not inferior to P-RUTF in both groups’ weight gain and LOS. There was no difference in FM, FMI and BIA among the groups and control at discharge. P-RUTF was more consumed

Both SMS-RUTF and P-RUTF replenished all AA except methionine. SMS-RUTF was not inferior to P-RUTF in ≥ 24 months with recovery rate, LOS and weight gain. SMS-RUTF can correct anaemia

[90]

    Whey protein concentrate

600

Blinded, randomise, clinical trial

Average weight gain, recovery rate, and LOS

WPC-RUTF was not inferior to P-RUTF

WPC34 is cheaper and more effective than P-RUTF. Also, the same processes are used in the production of both RUTF

[24]

    Reduced quantity

802

Non-random sampling

Body composition, FFMI, FFM, FM

FFM, FMI and FM were similar in both reducing and standard RUTF but a higher FFMI and a lower Z. There was an incomplete FM recovery. There was no effect of a reduced dose of RUTF on the body composition of children by recovery

FFM was the highest weight gain during SAM treatment. A reduced dose of RUTF does not affect tissue creation compared to standard dose treatment

[91]