From treatment to the prevention of malnutrition

Transcription

1 From treatment to the prevention of malnutrition

2 From treatment to the prevention of malnutrition Severe Acute (SAM) p 4-9 Therapeutic Milks F-75 and F-100 Plumpy Nut CMV ReSoMal Moderate Acute (MAM) p Plumpy Sup Plumpy Doz Plumpy Soy Plumpy Mum Chronic p Enov Nutributter Enov Mum QBmix Acute Diarrhoea p ZinCfant Enov, Nutributter, Plumpy, PlumpyField, Plumpy Nut, ZinCfant, Enov Nutributter and QBmix are registered trademarks of Nutriset. CMV TM, Plumpy Doz TM, Plumpy Soy TM, Plumpy Sup TM, Plumpy Mum TM and Enov Mum TM are Nutriset products trademarks. 2

3 The lipid-based Ready-to-Use Foods for the treatment or prevention of Acute belong to the Plumpy range. These products: aim to fill the energy, macro- and micronutrient, and essential fatty acids gap of targeted beneficiaries. are designed for the treatment or prevention of acute malnutrition or for use in emergencies and situations of acute food shortage when energy, macro- and micronutrients, and essential fatty acids requirements cannot be met by locally available/accessible foods, or when the state of the patient requires it. The lipid-based Ready-to-Use Food supplements for home fortification belong to the Enov range. These products: aim to fill micronutrients gaps, particularly those important for promoting proper growth and immunity in children. are mainly used for home fortification programmes aiming at improving the nutrition and health status of the target group in a non-emergency/development or chronic emergency context. These nutrition programmes usually include a Behavioral Change Communication (BCC) component promoting key health and nutrition messages. Plumpy and Enov products are usually distributed alongside with communication campaign raising awareness about breastfeeding, good practices in infant and young children feeding (IYCF), and other key health messages (e.g. hand washing). The breastfeeding logo is on all our products. Breastfeeding is recommended until at least 24 months and exclusive the first 6 months. 3

4 Therapeutic milks Food aid to developing countries began in Europe and the United States in the aftermath of the Second World War. For well over 30 years, agricultural surpluses were shipped to these countries to bolster food supplies. Even though food stocks were increased, the low nutritional value of these grains did not meet the actual nutritional needs of the populations. In the early 1990s, nutritionists determined the specific needs and requirements of malnourished people living in developing countries and then engaged in research activities to define the most appropriate nutritional solutions. Based on the nutritionists recommendations, Nutriset developed the first therapeutic milk powders: F-75 and F-100. These powders, mixed with water to become reconstituted milk, allowed for the management of severely malnourished children (phase 1 and 2) * in therapeutic feeding centers. In 2010, responding to the requests of humanitarian organizations, Nutriset revised the packaging of the milk powders to optimize their use in therapeutic feeding centers and to avoid as much waste as possible. Each bag of F-75 or F-100 now reconstitutes 600 ml of therapeutic milk. If fortified peanut pastes are now the primary products used in the fight against Acute, therapeutic milk remains the recommended treatment in therapeutic feeding centers where children have medical complications and/or little appetite. For this reason, Nutriset continues to strive every day to optimize all of its products to better meet the needs of the people they serve. * Reference document: Management of severe malnutrition: A manual for physicians and other senior health workers WHO protocol,

5 Severe Acute F-75 Phase 1 milk as per the WHO protocol* Stabilization phase Re-establishing the metabolism of children suffering from Severe Acute - Medical management From 6 months old Milk powder to be reconstituted: 1 sachet for 500 ml of drinking water 130 ml of reconstituted milk / kg of corporal weight / day Or kcal / kg of corporal weight / day This product fits In-patient therapeutic care program when the child is severely acute malnourished and has a medical complication and / or little appetite. F-100 Phase 2 milk as per the WHO protocol* Nutritional rehabilitation of Severe Acute phase - Medical management From 6 months old Milk powder to be reconstituted: 1 sachet for 500 ml of drinking water 200 ml of reconstituted milk / kg of corporal weight / day Or 200 kcal / kg of corporal weight / day This product fits In-patient therapeutic care program when the child is severely acute malnourished and has a medical complication and / or little appetite. 5

6 Since the early 1990s, therapeutic milks have been used as a major solution in the treatment of Severe Acute (SAM). These products are still the benchmark for the treatment of children with medical complications and therefore should remain in therapeutic feeding centers. In 1996, Nutriset responded to a major constraint commonly met in the field, which was the inevitable inconvenience of preparing therapeutic milks in hot climates with limited access to clean water sources. Therefore, the first Ready-to-Use Therapeutic Food (RUTF), Plumpy Nut, was created as a more convenient nutritional solution; it did not require preparation, was easier to monitor, and provided more decentralized coverage. It could also easily be handled by children and their mothers, thus allowing an ambulatory management. In 2007, WHO and UNICEF issued a joint statement endorsing RUTF as the recommended product in the treatment of SAM *. Once a severely acute malnourished child is identified and referred to a health center for medical examination, he can return home with his mother with a weekly ration of his treatment. The mother regularly returns to the health center with her child for health and growth monitoring and to receive additional supplies of Plumpy Nut to complete the nutritional rehabilitation. This ease of treatment helped to significantly increase the follow up rate until nutritional rehabilitation is complete. * Joint statement on the community-based management of severe acute malnutrition, Unicef, WFP and MSF. 6

7 Severe Acute Plumpy Nut RUTF Ready-to-Use Therapeutic Food Nutritional rehabilitation of Severe Acute in ambulatory with medical check up * Same nutritional values as F-100 From 6 month old Ready-to-Use Food 200 kcal / kg of corporal weight / day until the targeted weight / height ratio is reached Or 2 sachets / days for children weighting between 5 and 6.9 kg; 3 sachets / days for children weighting between 7 and 9.9 kg; 4 sachets / days for children weighting more than 10 kg, during 6 to 8 weeks The national care protocol is the reference if it exists This product fits the CMAM program of Severe Acute. Studies conducted: Collins S and Sadler K. 0utpatients care for severely malnourished children in emergency relief programmes: a retrospective cohort study. Lancet. (2002); 360: Manary et al. Home based therapy for severe malnutrition with ready-to-use food. Arch Dis Child. (2004); 89: Ciliberto MA. Home-based therapy for oedematous malnutrition with ready-to-use therapeutic food. Acta Paediatr. (2006); 95: Briend A et al. Ready-to-Use therapeutic food for treatment of marasmus. Lancet. (1999); 353: Diop el HI. Comparison of the efficacy of solid ready-to-use and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomised trial. Am J Clin Nutr. (2003); 78: Ciliberto et al. A comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. Am J Clin Nutr (2005); 81:

8 Therapeutic CMV Mineral and Vitamin complex Mixed with skimmed milk powder, sugar, vegetal fat, cereal flour and water, CMV allows the reproduction of F-75 and F-100 From 6 months old Powder product To use with Nutriset measuring scoops (follow use recommendation)* This product fits In-patient therapeutic care program. * Table for the reconstitution of CMV Preparation for 2 litres Therapeutic Milk F-75 Therapeutic Milk F-100 Dry skimmed milk 50 g 160 g Sugar 140 g 100 g Vegetable oil 54 g 120 g Cereal flour 70 g 0 g Therapeutic CMV 6.4 g (1 Nutriset measuring scoop) 6.4 g (1 Nutriset measuring scoop) Adjust to 2 litres Approx litres of drinking water Approx. 1.7 litres of drinking water Energy value obtained 1,500 Kcal / 2 litres 2,000 Kcal / 2 litres 8

9 Severe Acute ReSoMal Oral Rehydration Solution Intended for the treatment of dehydration for severely acute malnourished children From 6 months old Powder product to be reconstituted: 1 sachet for 2 L of drinking water 5 to 15 ml / kg of corporal weight / hour This product fits In-patient therapeutic care program. 9

10 RUSF Ready-to-Use Supplementary Food Plumpy Nut was the first ready-to-use product to be used in the treatment of Moderate Acute (MAM) and Severe Acute (SAM). Even while today, the product is included in the recommended protocol for the ambulatory treatment of SAM, Nutriset has since developed supplementary solutions to more cost-effectively treat and prevent MAM, such as Plumpy Sup. Nutriset s supplementary products differ from Plumpy Nut in their energy intake, their micro and macronutrient content, and the essential fatty acids contained in each daily dose. Since the development of Plumpy Sup, Nutriset has developed other supplementary products, such as Plumpy Doz, Plumpy Soy, and Plumpy Mum. This diversification allows an increasingly targeted response to the specific needs of certain populations (e.g., pregnant and lactating women, people living with HIV/ AIDS virus, etc.); certain situations (lean periods, people displacement, etc.); and certain geographic areas (e.g. adapting products to available raw materials, cultural and linguistic adjustment of our packaging, etc.). 10

11 Moderate Acute Plumpy Sup RUSF Ready-to-Use Supplementary Food LNS LQ - Lipid-based Nutrient Supplement Large Quantity Nutritional rehabilitation of the Moderate Acute From 6 months old Ready-to-Use Food 75 kcal / kg of corporal weight / day until targeted weight is reached Plumpy Sup is a supplement to breastfeeding and usual diet This product fits targeted or blanket supplement feeding program. Plumpy Doz RUSF Ready-to-Use Supplementary Food LNS MQ - Lipid-based Nutrient Supplement Medium Quantity Decrease the repercussion of Acute during risky periods Particularly fitted for children from 6 to 36 months old Ready-to-Use Food 3 teaspoon / 3 times / day Plumpy Doz is a supplement to breastfeeding and usual diet This product fits targeted supplement feeding program. Studies conducted: Matilsky D K et al. "Supplementary feeding with milk / peanut and soy / peanut fortified spreads results in higher recovery rates than feeding with corn/soy blend in moderately malnourished Malawian children." JN. (2009); 139(4): Karakochuk C et al. Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial. Am J Clin Nutr. (2012); 96: Ackatia-Armah RS et al. Effect of selected dietary regimens on recovery from moderate acute malnutrition in Malian children. FASEB. (2012); 26: Chang CY et al. Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery. J Nutr. (2013); 143: Studies conducted: Talley L et al. "Prevention of Acute During the Lean Season: Comparison of a Lipid-Based Nutrient Supplement and an Improved Dry Ration, South Darfur, Sudan." A quasi-experimental Study. J Nutr Disorders Ther (2012); 2:3. Isanaka S et al. "Reducing wasting in young children with preventive supplementation: a cohort study in Niger." Pediatrics. (2010); 126:e Grellety E et al. "Effect of mass supplementation with readyto-use supplementary food during an anticipated nutritional emergency." PLoS One. (2012); 7:e Defourny I et al. "Large-Scale Distribution of Milk-Based Fortified Spreads: Evidence for a New Approach in Regions with High Burden of Acute." PLoS One. (2009); 4: e

12 Plumpy Soy RUSF Ready-to-Use Supplementary Food LNS LQ - Lipid-based Nutrient Supplement Large Quantity Nutritional support to risky population Particularly fitted vulnerable adults (e.g.: refugees, displaced persons, HIV persons, etc.) Ready-to-Use Food 2 sachets / day This product fits blanket supplement feeding program. 12

13 Moderate Acute Plumpy Mum RUSF Ready-to-Use Supplementary Food LNS LQ - Lipid-based Nutrient Supplement Large Quantity Treatment of pregnant and lactating women with a suboptimal nutritional status Improve the development of the fœtus and the infant Pregnant and lactating women Ready-to-Use Food 1 sachet / woman / day Plumpy Mum is a supplement to the usual diet This product fits targeted supplement feeding program. Study conducted: Huybregts, L. et al. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso AJCN (2009). 13

14 Enov Mum LNS Small Quantity Lipid-based nutrient Supplement Nutritional support for pregnant and lactating women Improve the development of the fœtus and the infant Pregnant and lactating women Ready-to-Use Food 1 sachet / day / woman To mix with food after cooking Enov Mum is a supplement to the usual diet This product fits home fortification program. QB mix LNS Small Quantity Lipid-based nutrient Supplement Condiment Prevents nutritional lacks and helps to have a better protection against infections Persons (from 5 years old) who have a daily diet with only few diversification and who are at-risk of developing a deficiency in micronutrients essential for their health Paste condiment 1.5g / person / day during two weeks To mix with food after cooking QBmix is a supplement to the usual diet This product fits collective food program (school, family meal, jail, etc.). Study conducted: Adu-Afarwuah S. et al. "Acceptability of lipid-based nutrient supplements (LNS) among Ghanaian infants and pregnant or lactating women." Maternal & child nutrition. (2010); 4:e Enov Nutributter LNS Small Quantity Lipid-based nutrient Supplement Prevent stunting Improve the child growth, his motor and cognitive development Children from 6 to 24 month old Ready-to-Use Food 1 sachet / day / child To mix with food after cooking Enov Nutributter is a supplement to breastfeeding and usual diet This product fits home fortification program. Study conducted: Adu-Afarwuah S. et al. "Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development." AJCN (2007); 86:

15 Chronic Today, all nutritional studies agree on the importance of preventing chronic malnutrition in the first 1,000 days of a child s life, from conception to the second birthday*. An inappropriate nutritional intake during this period may have irreversible consequences on a child s physical and cognitive development. To effectively fight chronic malnutrition Nutriset created nutritional solutions aimed at supporting pregnant and lactating women and the child growth over the first 1,000 days of life. * Black RE, Allen LH, Bhutta ZA, et al Maternal and child undernutrition: global and regional exposures and health consequences., Lancet (2008); 371:

16 Chronic Today, all nutritional studies agree on the importance of preventing chronic malnutrition in the first 1,000 days of a child s life, from conception to the second birthday*. An inappropriate nutritional intake during this period may have irreversible consequences on a child s physical and cognitive development. To effectively fight chronic malnutrition Nutriset created nutritional solutions aimed at supporting pregnant and lactating women and the child growth over the first 1,000 days of life. * Black RE, Allen LH, Bhutta ZA, et al Maternal and child undernutrition: global and regional exposures and health consequences., Lancet (2008); 371:

17 Development of ZinCfant In 1998, after the World Health Organization (WHO) conducted several studies on the nutritional impact of zinc, the rapidly dispersing tablet emerged as the most suitable product, thus meeting the requirements of use and price. Nutriset was then asked to develop these tablets according to the specifications defined by WHO. The product was jointly developed by Nutriset and its partner, LP Rodael (French GMP 1 certified) and was a success, because it managed to hide the strong metallic taste of zinc, thereby reducing emetic effect of zinc sulfate. In July 2001 after various stability studies, Nutriset provided WHO with zinc tablets, iron, and placebo for studies in Nepal, India, and Zanzibar. In May 20014, UNICEF and WHO issued a joint recommendation for the clinical treatment of acute diarrhoea that promote the use of zinc in comination with Oral Rehydration Salts (ORS) 2. The combined use of these two products can reduce the volume and frequency of diarrhoea in children under the age of 5 years old and prevent new episodes for a period of up to three months. The following year, the product was integrated into the WHO s Model List of Essential Medicines. (EML 15, section ). In 2012, ZinCfant is now the first 20mg zinc sulfate tablet with fast dispersion to have been pre-qualified by WHO. 1 Good Manufacturing Practice. 2 Clinical Management of Acute Diarrhoea, WHO and UNICEF Protocol,

18 Acute Diarrhoea ZinCfant Monohydrate Zinc sulfate 20mg Recommended for the treatment of Acute Diarrhoea in association with ORS Decrease the gravity and the time of the diarrhoeal incident, regenerate the zinc reserve in the organism and avoid new incidents of diarrhoea in the coming 3 months Child from 2 months old Tablets dispersible in drinking water or in the breast milk ½ tablet / day during 10 to 14 days for children from 2 to 5 months old 1 table / day during 10 to 14 days for children from 6 months to 5 years old Is used in association with standard ORS 17

19 Our Research and Development teams are daily working on the development of new products matrix Filled ready-to-eat breakfast cereals These more fun products appeal to new populations while allowing us to diversify taste. Sauces In order to better adapt our products to local food habits, Nutriset has developed sauces from commonly used spices. These products are intended to be integrated with traditional dishes, targeting daily dietary nutritional intake requirements bits. Country-specific Plumpy and Enov products While maintaining the same nutritional values, the Plumpy range of products now incorporates different tastes. Transforming local raw materials to improve their nutritional qualities, Nutriset has developed formulas of Plumpy Nut and Plumpy Sup based, among others, on rice, lentils, and chickpeas. 18

20 Process of product development 1 IDENTIFICATION OF A NUTRITIONAL PROBLEM OF A TECHNOLOGICAL SOLUTION Context analysis, nutritional and population needs Internal and external knowledge capitalization: Scientific SES Anthropological Feedback from the field users Valuing local raw materials Implementation of a new industrial process SPECIFICATIONS 2 INTERNAL PRODUCT DEVELOPMENT Formulation Small series production (semi-industrial) Stability study Sourcing of raw material Technical documents Primary and secondary packaging Product presentation to users RESEARCH PRODUCT 3 PRODUCT FIELD STUDIES MULTISECTORIAL PARTNERS (nutrition, good eating habits, marketing ) Acceptability Efficacity Effectiveness / operational research CAPITALIZATION ON THE RESULTS OF THE STUDIES 4 PRODUCT LAUNCH Product sales and marketing Client communication Industrialization or subcontracting COMMERCIALIZATION 19

21 CMV ReSoMal F-75 F-100 Plumpy Nut Plumpy Sup Plumpy Doz Plumpy Soy Plumpy Mum Enov Mum Enov Nutributter Qb Mix ZinCfant TYPE OF MALNUTRITION SAM MAM Chronic Acute Diarrhoea Powder RUTF NATURE OF THE PRODUCT RUSF LNS Large Quantity RUSF LNS Medium Quantity RUSF LNS Small Quantity Condiment Tablets From 6 months 6-24 months TARGET 6-36 months From 2 months Pregnant & lactating women Adults Nutriset - Hameau du Bois Ricard - CS Malaunay +33 (0) (0) nutriset@nutriset.fr RCS Rouen Nutriset All rights reserved Design