From treatment

to the prevention
of malnutrition
 From treatment to the prevention of malnutrition

Severe Acute
Malnutrition
(SAM)

p 4-9 The lipid-based Ready-to-Use Foods for the treatment or prevention of Acute
Therapeutic Milks PlumpyNut CMV ReSoMal
F-75 and F-100 Malnutrition 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
Moderate Acute emergencies and situations of acute food shortage when energy, macro- and
Malnutrition micronutrients, and essential fatty acids requirements cannot be met by locally
(MAM) available/accessible foods, or when the state of the patient requires it.

p 10-13
PlumpySup PlumpyMum PlumpySoy PlumpyDoz

Chronic
Malnutrition The lipid-based Ready-to-Use Food supplements for home fortification belong to
the Enov range.
p 14-15 These products:
EnovMum EnovNutributter QBmix 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
Acute or chronic emergency context.
Diarrhoea

p 16-17

ZinCfant Plumpy and Enov products are usually distributed alongside with Immediate breastfeeding
communication campaign raising awareness about breastfeeding, good after birth, exclusively
practices in infant and young children feeding (IYCF), and other key health during the first 6 months
Enov, Plumpy, PlumpyNut, ZinCfant, EnovNutributter and QBmix are registered trademarks of Nutriset. messages (e.g. hand washing). and recommended for
at least 24 months
CMVTM, PlumpyDozTM, PlumpySoyTM, PlumpySupTM, PlumpyMumTM et EnovMumTM are Nutriset products trademarks. The breastfeeding logo is on all our products.
Some products are available in formula with peanuts, chickpeas, rices and lenses.

2 3
 Severe
Acute
Malnutrition

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, F-75 F-100
Nutriset developed the first therapeutic milk powders: F-75 and F-100.
These powders, mixed with water to become reconstituted milk, allowed Phase 1 milk as per the WHO protocol* Phase 2 milk as per the WHO protocol*
for the management of severely malnourished children (phase 1 and 2)* in
therapeutic feeding centers. Stabilization phase Nutritional rehabilitation of Severe Acute
Re-establishing the metabolism of children Malnutrition phase - Medical management
suffering from Severe Acute Malnutrition -
In 2010, responding to the requests of humanitarian organizations, Medical management From 6 months old
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 From 6 months old Milk powder to be reconstituted: 1 sachet for
bag of F-75 or F-100 now reconstitutes 600 ml of therapeutic milk. 500 ml of drinking water
Milk powder to be reconstituted: 1 sachet for
500 ml of drinking water
If fortified peanut pastes are now the primary products used in the fight 200 ml of reconstituted milk / kg of corporal
against Acute Malnutrition, therapeutic milk remains the recommended weight / day
130 ml of reconstituted milk / kg of corporal Or 200 kcal / kg of corporal weight / day
treatment in therapeutic feeding centers where children have medical weight / day
complications and/or little appetite. For this reason, Nutriset continues to Or 80-100 kcal / kg of corporal weight / day This product fits In-patient therapeutic care
strive every day to optimize all of its products to better meet the needs of program when the child is severely acute
the people they serve. This product fits In-patient therapeutic care malnourished and has a medical complication
program when the child is severely acute and / or little appetite.
malnourished and has a medical complication
* Reference document: Management of severe malnutrition: A manual for physicians and other senior health workers WHO and / or little appetite.
protocol, 1999.

4 5

Since the early 1990s, therapeutic milks have been used as a major solution
in the treatment of Severe Acute Malnutrition (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), PlumpyNut, 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 PlumpyNut 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
Malnutrition
PlumpyNut
RUTF Ready-to-Use Therapeutic Food
Nutritional rehabilitation of Severe Acute Malnutrition in ambulatory with
medical check up*
Same nutritional values as F-100
From 6 months old
Ready-to-Use Food
Available formulae: base peanuts, bases chickpeas or bases rices and
lenses
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 Malnutrition.
Studies conducted:
Collins S and Sadler K. 0utpatients care for severely malnourished children in emergency
relief programmes: a retrospective cohort study. Lancet. (2002); 360:1824-30.
Manary et al. Home based therapy for severe malnutrition with ready-to-use food. Arch Dis
Child. (2004); 89: 557-61.
Ciliberto MA. Home-based therapy for oedematous malnutrition with ready-to-use
therapeutic food. Acta Paediatr. (2006); 95:1012-5.
Briend A et al. Ready-to-Use therapeutic food for treatment of marasmus. Lancet. (1999);
353:1767-8.
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); 78:302-7.
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: 864-70.
 Severe
Acute
Malnutrition

Therapeutic C.M.V.
Mineral and Vitamin complex
ReSoMal
Mixed with skimmed milk powder, sugar, vegetal fat, cereal our and
water, CMV allows the reproduction of F-75 and F-100 Oral Rehydration Solution

From 6 months old Intended for the treatment of dehydration for severely acute
malnourished children
Powder product
From 6 months old
To use with Nutriset measuring scoops (follow use recommendation)*
Powder product to be reconstituted: 1 sachet for 2 L of drinking water
This product fits In-patient therapeutic care program.
5 to 15 ml / kg of corporal weight / hour

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 our 70 g 0g
Therapeutic CMV 6.4 g (1 Nutriset measuring scoop) 6.4 g (1 Nutriset measuring scoop)
Adjust to 2 litres Approx. 1.82 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

RUSF Ready-to-Use Supplementary Food
PlumpyNut was the first ready-to-use product to be used
in the treatment of Moderate Acute Malnutrition (MAM) and
Severe Acute Malnutrition (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 PlumpySup.
Nutrisets supplementary products differ from PlumpyNut in
their energy intake, their micro and macronutrient content,
and the essential fatty acids contained in each daily dose. Since
the development of PlumpySup, Nutriset has developed other
supplementary products, such as PlumpyDoz, PlumpySoy,
and PlumpyMum. 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
PlumpySup
RUSF Ready-to-Use Supplementary Food
LNS-LQ - Lipid-based Nutrient Supplement
Large Quantity
Nutritional rehabilitation of the Moderate Acute
Malnutrition
From 6 months old
Ready-to-Use Food
Available formulae: base peanuts or base
chickpeas
1 sachet / day
Or 75 kcal / kg of corporal weight / day until targeted weight
is reached
PlumpySup is a supplement to breastfeeding and usual diet
This product fits targeted or blanket 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):773-8.
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); 96:911-6.
Ackatia-Armah RS et al. Effect of selected dietary regimens
on recovery from moderate acute malnutrition in Malian
children. FASEB. (2012); 26:1031.10.
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);
143:215-20.
Moderate
Acute
Malnutrition
PlumpyDoz
RUSF Ready-to-Use Supplementary Food
LNS-MQ - Lipid-based Nutrient Supplement
Medium Quantity
Decrease the repercussion of Acute Malnutrition
during risky periods
Particularly fitted for children
from 6 to 36 months old
Ready-to-Use Food
3 teaspoon / 3 times / day
1 sachet / day
PlumpyDoz is a supplement to breastfeeding and usual diet
This product fits targeted supplement feeding
program.
Studies conducted:
Talley L et al. "Prevention of Acute Malnutrition 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:e442-50.
Grellety E et al. "Effect of mass supplementation with ready-
to-use supplementary food during an anticipated nutritional
emergency." PLoS One. (2012); 7:e44549.
Defourny I et al. "Large-Scale Distribution of Milk-Based
Fortified Spreads: Evidence for a New Approach in Regions with
High Burden of Acute Malnutrition." PLoS One. (2009); 4: e5455.
11
 Moderate
Acute
Malnutrition

PlumpySoy
RUSF Ready-to-Use Supplementary Food
LNS-LQ - Lipid-based Nutrient Supplement Large Quantity
Nutritional support to risky population
PlumpyMum
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 ftus and the infant

Particularly fitted vulnerable adults (e.g.: refugees, displaced persons, Pregnant and lactating women
HIV persons, etc.)
Ready-to-Use Food
Ready-to-Use Food
1 sachet / woman / day
PlumpyMum is a supplement to the usual diet
2 sachets / day
This product fits targeted supplement feeding program.
This product fits blanket 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).

12 13
 EnovMum Chronic
LNS-SQ Malnutrition
Lipid-based Nutrient Supplement
Small Quantity

Nutritional support for pregnant

and lactating women
Improve the development of
the ftus and the infant

Pregnant and lactating women

Ready-to-Use Food

1 sachet / day / woman

To mix with food after cooking
EnovMum is a supplement to the usual diet

This product fits

home fortification program.

Study conducted:
Adu-Afarwuah S. et al. "Acceptability of lipid-based

QB mix
nutrient supplements (LNS) among Ghanaian
infants and pregnant or lactating women." Maternal
& child nutrition. (2010); 4:e344-56.

LNS-SQ
Lipid-based Nutrient Supplement Small
Quantity
Condiment EnovNutributter
Today, all nutritional studies agree
Prevents nutritional lacks and helps to have LNS-SQ on the importance of preventing
a better protection against infections Lipid-based Nutrient Supplement
Small Quantity chronic malnutrition in the first
1,000 days of a childs life, from
Persons (from 5 years old) who have a daily
diet with only few diversification and who Prevent stunting conception to the second birthday*.
are at-risk of developing a deficiency in Improve the child growth, his motor An inappropriate nutritional
micronutrients essential for their health and cognitive development intake during this period may
have irreversible consequences
Paste condiment Children from 6 to 24 months old
on a childs physical and cognitive
Ready-to-Use Food
development.
1.5 g / person / day during two weeks
To mix with food after cooking
To effectively fight chronic
QB mix is a supplement to the usual diet 1 sachet / day / child malnutrition Nutriset created
To mix with food after cooking nutritional solutions aimed at
This product fits collective food program EnovNutributter is a supplement to supporting pregnant and lactating
(school, family meal, jail, etc.). breastfeeding and usual diet
women and the child growth over
This product fits the first 1,000 days of life.
home fortification program. * Black RE, Allen LH, Bhutta ZA, et al Maternal and child
Study conducted: undernutrition: global and regional exposures and health
consequences., Lancet (2008); 371: 24360.
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: 412-20.

14 15
 Acute
Diarrhoea

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 GMP1 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 ZinCfant
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 Monohydrate Zinc sulfate 20 mg
to three months. The following year, the product was integrated into the
WHOs Model List of Essential Medicines. (EML 15, section 17.5.2 ). 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
In 2012, ZinCfant is now the first 20mg zinc sulfate tablet with fast dispersion 3 months
to have been pre-qualified by WHO.
Child from 2 months old
1
Good Manufacturing Practice.
2
Clinical Management of Acute Diarrhoea, WHO and UNICEF Protocol, 2004. Tablets dispersible in drinking water or in the breast milk

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

16 17
 Process of product development

1 Identification

OF A NUTRITIONAL PROBLEM OF A TECHNOLOGICAL SOLUTION

Valuing local
Context analysis, Internal and external knowledge raw materials
nutritional capitalization: Scientific SES Anthro-
and population needs pological Feedback from the field users Implementation of a new
industrial process

Our Research and Development teams are

SPECIFICATIONS
daily working on the development of new
products matrix 2 INTERNAL PRODUCT DEVELOPMENT

Filled ready-to-eat breakfast cereals

These more fun products appeal to new populations while allowing us to Formulation Sourcing of raw material

diversify taste. Small series production (semi-industrial) Technical documents

Stability study Primary and secondary packaging

Sauces Product presentation to users

In order to better adapt our products to local food habits, Nutriset has
RESEARCH PRODUCT
developed sauces from commonly used spices. These products are intended
to be integrated with traditional dishes, targeting daily dietary nutritional
intake requirements bits.
3 PRODUCT FIELD STUDIES

Country-specific Plumpy and Enov products

While maintaining the same nutritional values, the Plumpy range of products MULTISECTORIAL PARTNERS (nutrition, good eating habits, marketing)
now incorporates different tastes. Transforming local raw materials to Acceptability
improve their nutritional qualities, Nutriset has developed formulas of
Efficacity
PlumpyNut and PlumpySup based, among others, on rice, lentils, and
Effectiveness / operational research
chickpeas.
CAPITALIZATION ON THE RESULTS OF THE STUDIES

4 PRODUCT LAUNCH

Product sales and marketing

Client communication

Industrialization or subcontracting

COMMERCIALIZATION

18 19
 Plumpy Plumpy Plumpy Plumpy Plumpy Enov Enov
CMV ReSoMal F-75 F-100 Qb Mix ZinCfant
Nut Sup Mum Soy Doz Mum Nutributter
TYPE OF MALNUTRITION

SAM

MAM

Chronic
Malnutrition

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

6-36
TARGET

months

From
2 months

Pregnant
& lactating
women
Design

Adults
Nutriset 2016 - All rights reserved

Nutriset - Hameau du Bois Ricard - CS 80035 - 76770 Malaunay

+33 (0)2 32 93 82 82 - +33 (0)2 32 93 82 89 - nutriset@nutriset.fr
@Nutriset_Fr - 337 986 798 RCS Rouen
www.nutriset.fr