RUSF & LNS-MQ Harmonized Specifications. Copenhagen, 1 July 2015 Saskia de Pee

RUSF & LNS-MQ Harmonized Specifications Copenhagen, 1 July 2015 Saskia de Pee

RUSF & LNS-MQ Harmonisation Objectives Improve sourcing of products and programming among agencies and suppliers, through harmonisation of product specifications and packaging Increase flexibility to respond to supply chain issues (emergencies) Support local production through Using the same premix for RUSF and LNS-MQ Having one premix for different raw materials, e.g. peanut vs chickpea vs rice/lentil recipes Defining the premix

RUSF & LNS-MQ: Nutrient content aims Same nutrient density for RUSF & LNS-MQ (nutrient/1000 kcal or nutrients/100 g) Comply with nutrient targets of 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 targets into consideration as well Nutrients without max in RUTF & RUSF and no UL, aim to meet highest minimum target (LNS-MQ / RUTF / RUSF)

RUSF & LNS-MQ: Same composition 100g sachet in line with WHO MAM-food targets 50 g to provide a good contribution to daily requirement of essential nutrients At or above RNI for normal healthy individuals 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 MAM food; max = RUTF ; note the use of iodized salt in diet also provides iodine Selenium: min & max from RUTF Potassium: No RNI, just DRI, 64% for 7-12 mo, 15% for 1-3 y, wide range & taste impact

RUSF & LNS-MQ: Different use = Different, harmonized, packaging 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

Cost and transition period Packaging size and dairy protein are driving cost, depending on supplier: RUSF cost is expected to increase by 0 to 200$/MT LNS MQ cost is expected to decrease by 0 to 400$/MT, including the extra cost of the 50 g sachets (which is expected to be 0 to 100$/MT compared to RUSF) 4 months transition period To give suppliers time to Update formula and packaging Consume existing stock of premix and packaging material To give programme time to Liaise with counterparts Inform staff at all levels of programs

Harmonized RUSF & LNS-MQ, almost extendable to RUTF Note: WHO min & max in joint statement for RUTF and technical note for MAM foods are targets for nutrient intake from these foods, they are not min and max for product specs WHO MAM foods technical note fatty acid specs, extendable to RUTF: Omega 3: 0.3-1.8 g/100 g Omega 6: 2.6-6.1 g/100 g Vitamin A, set below min for RUSF, as concurrent vitamin A intake was not taken into account when WHO set requirement for MAM foods, and RUTF target is lower Protein content min higher for RUTF than for RUSF (25 vs 20 g/1000 kcal) RUTF: 20% milk powder (50% protein from dairy source) RUSF: 10% milk powder (33% protein from dairy) Higher milk content provides more K, Ca, P RUTF has requirement for non-metabolisable base, for which content of Na, K, Ca, Mg, Cl, P need to be taken into account. This determines sources and amounts for Ca, P, K For RUSF/LNS-MQ, 900 (800-1400) mg K/100 g, with 50% K from potassium chloride and 50% from potassium citrate. This should be ok for taste impact in combination with 10% milk powder. For RUTF, min target 1100 mg K/100 g, most current formulations have 100% from KCl, which is ok with 20% milk powder

Nutrient content targets - 1 WHO target: Variation related to: Intake by consumer Recipe variation Variation raw material nutrient content Premix nutrient contribution ±10% Moment of consumption: T0 vs close to BBD (losses over time) Label: Expected minimum intake (except for Vit A and potassium as lowest is far from expected average) Min: Lowest level, at BBD, incl min from raw material, premix 10%, expected losses over time Max: Highest level, at T0, incl max from raw material, premix + 10%

Nutrient content targets - 2 Label: Expected minimum intake (except for Vit A and potassium as lowest is far from expected average) T0 min: Lowest level at T0: min from raw material, premix 10% T0 max: Highest level at T0: max from raw material, premix + 10% RUSF: Different recipes, variation due to raw material and premix ± 10% RUTF: One recipe, variation due to premix ±10% RUTF & RUSF WHO intake targets LNS-MQ: 1 DRI/50 g, max=ul

Pantothenic Acid (Vit B5) mg Calcium d-pantothenate 4.9 Pyridoxine (Vit B6) mg Pyridoxine hydrochloride 2.2 Biotin (Vit Set B7) premix mcg Biotin (1%- trituration) vitamins 65 Folic acid (Vit B9) mcg Folic acid food grade 300 3! Cobalamine (Vit B12) mcg Vitamin B12 (0.1 sd) 2.9 Ascorbate (Vit C) mg Ascorbic acid fine powder 90 Table Cholecalciferiol 1: Premix contribution (Vit D) and mcg premix Dry Vitamin nutrient D3 sources (sd) (approximate incorporation 18 rate: 3.4%) Dl-α tocopherol acetate (Vit Dry Vitamin E acetate mg 20 E) (50% dl-α tocopherol acetate)) Nutrient Phytomenadione (Vit K) mcg Dry Recommended Vitamin K (5%) nutrient sources added 27 per Nutrients Unit Di-Calcium (/alternative Phosphate options) anhydrous Calcium (Ca) mg 100g 413 4 LNS / tricalcium phosphate +/-10% Copper Retinol (Vit A) 1 Dry Vitamin sulphate A Palmitate anhydrous / copper Copper (Cu) mcg mg 1.2 gluconate 1050 2 / Dry Vitamin A Acetate Iodine (I) mcg Potassium Thiamine mononitrate iodide (10% trituration) 110 Thiamin (Vit B1) mg 2.5 1.5 / Thiamine mg from hydrochloride NaFeEDTA + 7.5 mg, Riboflavin (Vit B2) which Riboflavin can be from Ferrous sulphate Iron (Fe) mg 102.6 monohydrate, dried / ferrous sulphate / Niacin (Vit B3) mg Niacinamide 16 ferrous fumarate, encapsulated or not Pantothenic Acid (Vit B5) mg Magnesium Calcium d-pantothenate sulphate monohydrate 4.9 Pyridoxine Magnesium (Vit (Mg) B6) mg Pyridoxine hydrochloride 100 / magnesium citrate or gluconate 2.2 Biotin Manganese (Vit B7) (Mn) mcg mg Manganese Biotin (1% sulphate trituration) monohydrate 1.065 Folic acid (Vit B9) mcg Di-Calcium Folic acid food Phosphate grade anhydrous 300 3 Phosphorus (P) mg 319 5 Cobalamine (Vit B12) mcg / Vitamin tricalcium B12 phosphate (0.1 sd) 2.9 Ascorbate (Vit C) 350 Ascorbic mg potassium acid fine chloride Potassium (K) mg powder 350 90 + 500 mg tri potassium citrate Cholecalciferiol (Vit D) mcg Dry Vitamin D3 (sd) 18 Sodium selenite Dl-α tocopherol Selenium acetate (Se) (Vit mcg Dry Vitamin E acetate 15 mg / sodium selenate 20 Zinc E) (Zn) mg Zinc (50% sulphate dl-α tocopherol acetate)) 11 Phytomenadione (Vit K) mcg Dry Vitamin K (5%) 27!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Di-Calcium Phosphate anhydrous 1 Beadlet or spray dried form can be used assuming there is no carryover of antioxidants not approved in Codex. 2 This is the recommended amount if there are no process losses. If process losses have been demonstrated by a study, appropriate over dosage should be applied to ensure that analytical targets are reached 3 This is equivalent to 500 mcg Dietary Folates Equivalent 4 This is equivalent to a total of 1.4% Di-calcium phosphate: In final product Ca/P ratio should be 1-1.5, where 30% of P from plant sources and 100% from animal sources can be included in the estimate

Di-Calcium Phosphate anhydrous Calcium (Ca) mg 413 4 / tricalcium phosphate Set premix Copper - minerals sulphate anhydrous / copper Copper (Cu) mg 1.2 gluconate Iodine (I) mcg Potassium iodide (10% trituration) 110 2.5 mg from NaFeEDTA + 7.5 mg, Di-Calcium Phosphate anhydrous Calcium (Ca) mg which can be from Ferrous sulphate Iron (Fe) mg 413 4 / tricalcium phosphate 10 monohydrate, dried / ferrous sulphate / Copper sulphate anhydrous / copper Copper (Cu) mg ferrous fumarate, encapsulated or not 1.2 gluconate Magnesium sulphate monohydrate Magnesium Iodine (I) (Mg) mcg mg Potassium iodide (10% trituration) 110 100 / magnesium citrate or gluconate 2.5 mg from NaFeEDTA + 7.5 mg, Manganese (Mn) mg which Manganese can be from sulphate Ferrous sulphate monohydrate 1.0 Iron (Fe) mg 10 monohydrate, Di-Calcium dried Phosphate / ferrous sulphate anhydrous Phosphorus (P) mg / 319 5 ferrous / tricalcium fumarate, phosphate encapsulated or not Magnesium 350 mg sulphate potassium monohydrate chloride Magnesium Potassium (Mg) (K) mg mg 100 350 / magnesium + 500 mg citrate tri potassium or gluconate citrate Manganese (Mn) mg Manganese Sodium sulphate selenite monohydrate 1.0 Selenium (Se) mcg 15 Di-Calcium / sodium Phosphate selenate anhydrous Phosphorus (P) mg 319 5 Zinc (Zn) mg / tricalcium Zinc sulphate phosphate 11 350 mg potassium chloride Potassium (K) mg 350!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! + 500 mg tri potassium citrate 1 Beadlet Sodium selenite Selenium or spray (Se) dried form can be mcg used assuming there is no carryover of antioxidants not approved 15 in Codex. 2 This is the recommended amount if there / sodium are no process selenate losses. If process losses have been demonstrated by a study, appropriate Zinc (Zn) over dosage should mg be applied Zinc sulphate to ensure that analytical targets are reached 11 3 This is equivalent to 500 mcg Dietary Folates Equivalent!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 4 This is equivalent to a total of 1.4% Di-calcium phosphate: In final product Ca/P ratio should be 1-1.5, where 1 30% Beadlet of P or from spray plant dried sources form can and be used 100% assuming from animal there is sources no carryover can be of included antioxidants in the not estimate approved in Codex. 2 5 This This is is the equivalent recommended to a amount total of if 1.4% there Di-calcium are no process phosphate: losses. If process In final losses product have Ca/P been ratio demonstrated should be by 1-1.5, a where 30% of P from plant sources and 100% from animal sources can be included in the estimate study, appropriate over dosage should be applied to ensure that analytical targets are reached

Can harmonization include LNS-SQ as well? Note that ilins formulation is different from current Nutributter formulation Target 1 RNI of essential nutrients, comparable to LNS-MQ, but less kcal/d Dose harmonized premix 2-2.5 times (50 vs 20 g)? Taste issues with KCl Split premix into small amount MN and macro-minerals (Ca, P, K), so that K can be dosed separately? May also be good for RUTF Different inclusion of ingredients? DSM: 4.8 g/20 g (LNS-MQ: 5/50 g) N-6 EFA: 4.46 g vs 0.54 g (ilins vs LNS-MQ) N-3 EFA: 0.58g vs 0.06g (ilins vs LNS-MQ) Conclusion: Requires R&D for product specification + acceptability testing

Next Steps WFP to issue the new specs for RUSF and LNS-MQ, followed by interim period where both old and new specs are valid Interagency review of steps required for extending harmonized specs to RUTF R&D required to determine whether and how harmonization can be extended to LNS-SQ as well