WHO guideline development group meeting – Efficacy, safety, and effectiveness of ready-to-use therapeutic foods (RUTF) with reduced milk-protein content

07 November 2019 (10:00 – 12:00 CET and 16:00 – 18:00 CET) via WebEx

The World Health Organization (WHO) is committed to driving public health impact in every country ensuring healthy lives and promoting well-being for all at all ages. Through its unique normative function in health, WHO aims to provide global, evidence-informed recommendations on the efficacy, safety, and effectiveness of ready-to-use therapeutic foods (RUTF) with less than 50% of proteins coming from milk products compared to the ‘standard’ RUTF for treating uncomplicated severe acute malnutrition in children aged 6 months or older.

Currently, WHO recommends that children with uncomplicated severe acute malnutrition (undernutrition) and appetite be treated with RUTF in the community. The RUTF have a nutritional composition based on the F-100 therapeutic milk used in hospital settings. Thus, the current RUTF composition specifies that at least half of the proteins contained in RUTF should come from milk products.

Innovative RUTF formulations with reduced milk protein, or no milk protein have been evaluated in different study settings. One of the aims of these new RUTF formulations is to reduce the production costs by replacing milk (the most expensive ingredient) with other sources of protein. Reducing the cost of RUTF may help in reducing costs of procurement of goods used in the management of acute malnutrition, and help increase coverage, currently estimated to be at 25%.

WHO has started the process to review the efficacy, effectiveness, and safety of the new RUTF formulations (containing alternative sources of protein (non-dairy) or less than 50% of proteins coming from milk) for treating infants and children aged 6 months or older with uncomplicated severe acute malnutrition and appetite. The WHO normative process includes retrieval, assessment and summary of evidence on values and preferences (i.e. cultural, religious), inter/intra-household sharing, acceptability, adherence, equity, feasibility, accessibility, sustainability and cost-effectiveness in different settings.

For this purpose, WHO is establishing a WHO guideline development group – RUTF to advise and support this normative work. The guideline development group is a multidisciplinary group of experts encompassing a range of technical and programmatic skills as well as diverse perspectives, aiming at having geographical representation and gender balance. The WHO guideline development group – RUTF will support WHO’s 13th programme of work on various areas and will advise WHO on the following:

• Providing input into the scope of the guidelines and assisting the steering group in developing the key questions in PICO format;
• Choosing and ranking priority outcomes that will guide the evidence reviews and focus the recommendations;
• Examining the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles or other assessments of the quality of the evidence used to inform the recommendations and provide input;
• Interpreting the evidence, with explicit consideration of the overall balance of benefits and harms;
• Formulating recommendations and determining their strength taking into account benefits, harms, values and preferences, feasibility, equity, ethics, acceptability, resource requirements and other factors, as appropriate;
• Defining implications for further research and gaps;
• Discussing implementation and evaluation considerations of the guideline.