Here is a short training video on the RUTF appetite test (following the WHO guidelines)
Community-based management of severe acute malnutrition: Assessing Appetite
Local production of RUTF
There are four basic ingredients in RUTF:
Dried Skimmed Milk
Vitamin and Mineral Supplement (CMV)
In addition, up to 25% of a product's weight can come from oil-seeds, groundnuts or cereals like oats.
As well as containing the necessary proteins, energy and micronutrients, RUTF should also have the following attributes:
Taste and texture suitable for young children
No need for cooking before consumption
Resistant to contamination by micro-organisms and long shelf-life without sophisticated packaging. Product should be oil-based
WHO/UNICEF/WFP/SCN DRAFT specifications for RUTF
Ready-to-Use Therapeutic Food
High energy, fortified ready to eat food suitable for treatment of severely malnourished children.
This food should be soft or crushable, palatable and easy for children to eat without any preparation. At least half of the proteins contained in the product should come from milk products.
10 to 12 % total energy
45 to 60 % total energy
290 mg/100g maximum
1100 to 1400 mg/100g
300 to 600 mg/100g
Phosphorus (excluding phytate)
300 to 600 mg/100g
80 to 140 mg/100g
10 to 14 mg/100g
11 to 14 mg/100g
1.4 to 1.8 mg/100g
20 to 40 µg
70 to 140 µg/100g
0.8 to 1.1 mg/100g
15 to 20 µg/100g
20 mg/100g minimum
15 to 30 µg/100g
0.5 mg/100g minimum
1.6 mg/100g minimum
50 mg/100g minimum
0.6 mg/100g minimum
1.6 µg/100g minimum
200 µg/100g minimum
5 mg/100g minimum
3 mg/100g minimum
60 µg/100g minimum
n-6 fatty acids
3% to 10% of total energy
n-3 fatty acids
0.3 to 2.5% of total energy
Commercial Pre-packed Plumpy'Nut
Plumpy'Nut is a ready-to-use therapeutic spread produced by Nutriset and presented in individual sachets. It is a paste of groundnut composed of vegetable fat, peanut butter, skimmed milk powder, lactoserum, maltodextrin, sugar, mineral and vitamin complex.
Plumpy'Nut is specifically designed to treat acute malnutrition without complications and has the following characteristics:
It is nutritionally equivalent to F-100 (therapeutic milk used for in-patient care in Phase 2)
One sachet has an energy value of 500Kcal
One sachet has a weight of 92 g
Each carton of Plumpy'Nut contains 150 sachets (around 15.1 kg)
Benefits and composition of Plumpy'Nut
The quantity distributed to each child is easy to calculate based on the weight
One simply needs to open the sachet by cutting one corner and eat the paste
No preparation or cooking is necessary
Does not need to be diluted with water. This eliminates risk of contamination
Can be used at home with supervision from the health centre
Reduces length of stay in hospital or Therapeutic Feeding Centre
Reduces number of staff necessary for preparation and distribution of therapeutic food
Has a faster recovery rate and higher acceptability than F100
Can be stored at room temperature for long periods of time
Has a long shelf life, even without refrigeration (24 months)
Nutrients and Energy Composition of Plumpy'Nut
Per sachet of 92 g
Per sachet of 92 g
1 022 mg
< 267 mg
Management of Plumpy'Nut
Who should receive Plumpy'Nut?
A child over six months and/or an adolescent according to the following criteria:
Severely malnourished without medical complications, have passed the appetite test, and have been enrolled in outpatient care.
HIV positive, moderately malnourished without medical complications, have passed the appetite test, and have been enrolled in outpatient care.
Can drink liquids.
Not allergic to milk or nuts.
What should be the dosing for Plumpy'Nut be?
The number of packets per day to be given to a child/adolescent depends on the weight of the child. The table below provides the accurate dosing based on the weight range of the child/adolescent:
Packets / day
Packets / w
3.5 - 3.9
4.0 - 5.4
5.5 - 6.9
7.0 - 8.4
8.5 - 9.4
9.5 - 10.4
10.5 - 11.9
How should Plumpy'Nut be administered?
The Plumpy'Nut should be given to the child in small amounts and frequently (e.g. ½ sachet * 8 times per day) provided that the daily amount is according to prescription.
Always have safe drinking water nearby whenever the child is eating Plumpy'Nut.
Make sure that the child consumes and finishes the Plumpy'Nut before eating their porridge.
A family food meal can be gradually introduced as the child's health improves.
Children should be supervised while they consume their Plumpy'Nut and meals.
Allergic Reaction to Plumpy'Nut:
Although it is unlikely, there is a small chance of a child having an allergic reaction to the peanut butter in Plumpy'Nut. It is important to ask for a history of allergy to the ingredients in Plumpy'Nut.
The allergy may cause reactions in the form of:
Skin changes: hives, rashes and infections
Shortness of breath
If the child develops any of these symptoms, discontinue administering Plumpy'Nut. The child should be treated for allergic reaction in the nearest health facility immediately.
Messages for caregivers on Plumpy'Nut
Is only for malnourished children and should not be shared with other members of the family who are hungry.
Should be kept in a secure place and out of reach of children in the house. It should be kept away from the sun to preserve nutrients.
Should be given soon after a feed if the child breastfeeds.
Should always be given before any other family food.
Should be given to the child in small amounts and frequently.
After eating, the remaining amount in the sachet should be kept for the next feed. The top of the sachet should be rolled down for safety.
May cause chocking. Therefore, a generous amount of clean water must always be given to the child, at least 1 cup (100ml) of clean water for each dose of Plumpy'Nut. If choking persists the child should be taken to the nearest health facility.
A balanced, nutritious meal can be given after the correct amount of Plumpy'Nut.
May cause complications such as diarrhoea, vomiting, fevers, swelling, rashes, hives, skin infections, and shortness of breath or shock. If these symptoms are present, the caregiver must stop giving Plumpy'Nut and take the child to the OTC or nearest health facility.
Empty sachets should be kept and presented at each bi-weekly visit.
Plumpy'Nut is a treatment for malnourished children. Only the malnourished children should eat it.