Oct. 1, 2006 — -- It seems underwhelming in its plastic silver package, but Plumpy'nut, the peanut-based therapeutic food paste, is more than enough for hundreds of thousands of malnourished children.
Plumpy'nut, generically known as ready to use therapeutic food, or RUTF, is the invention of André Briend, a French pediatric nutritionist currently working with the World Health Organization.
For years, powdered milk laden with vitamins had been a solution to malnutrition. But preparing the milk required hygienic environments and refrigeration, which usually necessitated inpatient treatment, and was costly and time consuming.
Teaming with Michael Golden, an Irish nutritionist, Briend, who then worked for Action Against Hunger, sought to create a take-home, spoil-proof, preparation-free food to treat malnutrition.. In 1999, Plumpy'nut, a thick, edible, pastelike substance containing peanuts, vegetable oil, milk powder, vitamins and minerals, was created.
Each packet -- roughly the size of a cereal bar -- contains 500 calories of perfectly proportioned proteins, fats and carbohydrates. Two packets a day for two weeks are enough to nourish and rehabilitate a starving child.
Though the product was created almost seven years ago, it became widely used only in 2005 when the relief group Doctors Without Borders introduced it in Africa.
"It went a bit slowly," said Milton Tectonidis, a Doctors Without Borders special nutritionist. "They first came up with the product as an alternative to milk, tested it on inpatients, ran a number of trials ... and found the results were excellent."
By 2003, the group started giving Plumpy'nut to outpatients, said Tectonidis. "We worked with other NGOs [nongovernmental organizations] to test it out. In each case, it treated 1,000 or 2,000 patients, and we took inspiration from them. When we came out with it in 2005, we treated 60,000 in four months."
Since then, several hundred thousand malnourished children have been rehabilitated with Plumpy'nut, which is handed out in weeklong supplies -- a total of 14 packets -- to the mothers of starving children.
Perhaps more important than the number of children who've been helped by the peanut paste are the resources it has freed up in a resource-scarce environment.
"If you calculate the cost with all the staff and the water and the electric and the hygienic processing and construction," said Tectonidis, "it comes out as much more to treat inpatient than out-patient."
Instead, precious medical attention and relief resources can be devoted to the critically ill or those wounded in war.
While widespread distribution of a peanut-based product like Plumpy'nut could pose a danger to allergy-prone children in the United States, that is not a concern on the African continent.
"Food allergy seems far less common in poor countries than in rich countries," said Briend. "This well-known observation has been explained by different factors, but apparently, crowding and repeated exposure to infections seem to play a role."
The dearth of allergies and asthma in developing nations, and the rapid growth of these ailments in industrialized countries (registered peanut allergies in the United States doubled from 1997-2002), is largely attributed to the hygiene hypothesis, a topic addressed in an April 2002 article in Science magazine called "Allergy, Parasites and the Hygiene Hypothesis."
"The lack of intense infections in industrialized countries, owing to improved hygiene, vaccination and use of antibiotics, may alter the immune system such that it responds inappropriately to innocuous substances," explained the article.
"After several years of using this product," said Briend, "and feeding several hundreds of thousands of severely malnourished patients with it, I never heard of a place where it was a real issue."
Recently, another product was developed. EZ Paste, generically known as BP-100, is similar to Plumpy'nut but does not contain peanuts. It does not have a commercial manufacturer.
As of 2006, only one company, the French-based Nutriset, was manufacturing Plumpy'nut and its individual ingredients for self-assembly.
"There should be hundreds of them," said Tectonidis, making products like Plumpy'nut.
But until American companies "get on it and become competitive," he said, major manufacturing of the revolutionary food will remain minimal.
Plumpy'nut costs roughly 25 cents per packet to manufacture, making a two-week supply (the amount usually needed to make a significant difference in malnutrition) costs roughly $7.
But by using peanut and milk surpluses in countries like the United States, where farmers are often paid to destroy their surplus crops, Tectonidis hopes to be able to buy the ingredients for RUTF wholesale, which would cut manufacturing costs in half.
"There could be a program where they get the raw materials for free and distribute it to the people all over the world," he said. "As long as they agree to sell the product without charging for the raw materials, we could get the product down to 10 or 12 cents a package."
The United Nations World Food Program could help such a collaboration, which Tectonidis said is urgently needed. "Young children in poor countries are dropping like flies due to acute malnutrition," he said.