The efficacy and effectiveness of ready-to-use therapeutic food (RUTF) for the treatment of wasting have been previously documented,1,2 and its use as part of community-based treatment of severe acute malnutrition in children is now recommended.3
The article by Isanaka and colleagues4 in this issue of JAMA provides evidence that RUTF distributed for a 3-month period was efficacious in preventing wasting and severe wasting in children aged 6 to 60 months. In this cluster randomized controlled trial of 12 villages in Niger, all families with children aged 6 to 60 months with weight-for-height 80% or more of the National Center for Health Statistics reference standard received 92 g (providing 500 kcal) of RUTF daily for 3 months. The distribution of RUTF during the period of the year with documented food shortages improved weight maintenance among children and reduced wasting by 36% and severe wasting by 58%. This well-designed and implemented study extends current knowledge of RUTF from therapeutic use to the prevention of wasting in a population-based sample. However, whether untargeted distribution of RUTF would be a cost-effective, sustainable intervention compared with other approaches to prevent malnutrition remains to be determined.
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