A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: an application to Ethiopia

An Optimization Tool to Formulate Diets within a Supplementary Nutrition Program for Children

Background

In large supplementary feeding programs for children, it is challenging to create and sustain contextual, acceptable, nutritionally complete, and diverse supplemental foods. For example, the Indian Supplementary Nutrition Program (SNP) supplements the dietary intake of children, pregnant and lactating women, and severely acutely malnourished (SAM) children by offering dry take home rations (THRs) or hot cooked meals (HCMs) across India, but an optimization tool is necessary to create local contextual recipes for acceptable and nutritionally adequate products.

Objectives

This study aimed to create a linear programming (LP) model to optimize diverse food provisions for a SNP to meet its program guidelines, using locally available foods, within budgetary allocations.

Methods

A LP algorithm with appropriate constraints was used to generate an optimal THR based on raw foods, or an optimal weekly HCM menu comprised of a lunch meal with mid-morning snacks, based on user choices of foods and recipes. The database of foods used was created by a prospective survey conducted across all states of India for this purpose, such that the recipe and food optimization was diverse and specific to the guidelines for each beneficiary group.

Results

An interactive web-based app, which can optimize feeding programs at any population level, was developed for use by program implementers and is hosted at https://www.datatools.sjri.res.in/SNP/. In the Indian example analyzed here, the recommended optimized diets met the guidelines for diversified and nutritionally complete SNP provision but at a cost that was almost 25% higher than the present Indian budget allocation.

Conclusions

The optimization model developed demonstrates that contextual SNP diets can be created to meet macronutrient and most essential micronutrient needs of large-scale feeding programs, but appropriate diversification entails additional costs.

A Review of Pet Food Recalls from 2003 Through 2022

This is a review of U.S. Food and Drug Administration (FDA) recalls of products that are for dogs and cats which took place from 2003 through 2022. It includes recalls for pet foods (food, treats, and chews), ingredients, supplements (vitamins and minerals), and drugs. There were 3,691 recalls during this period: 51% were Class I, 35% were Class II, and 14% were Class III. Food items and ingredients accounted for the majority or 68%, drugs for 27%, and supplements (vitamins and minerals) accounted for 5% of these recalls. Recalls that could be associated with dogs only accounted for 42%, with cats only 18%, and with multiple species 40%. The primary reasons for the recalls were biological contamination at 35%, chemical contamination at 32%, and cGMP violations at 8%. Almost 25% of the total recalls in the past 20 years were due to a melamine incident in 2007/2008 (73% of those were Class I). Salmonella recalls for the 20 years accounted for 23% of the total recalls (94 % of those were Class I). Although the recalls for vitamins and minerals accounted for only 5.6% percent of the total, 70% of those were Class I and 30% Class II. Pet food is a complex part of the processed food industry, and the processing of pet food is subject to at least 40 different federal regulations. To avoid recalls and be successful, pet food manufacturers need a robust food safety culture to meet all of these requirements to produce a safe product. In contrast, the melamine contamination (an adulteration event) in 2007/2008 which resulted in animal deaths and recalls is a prime example of the need for an effective and robust supplier approval program in order to avoid fraudulent suppliers in the future.

Acceptability of alternative ready-to-use therapeutic foods in acute malnutrition management-a systematic review

"Commercial" Ready-To-Use Therapeutic Foods (RUTFs) are used in acute malnutrition management, but they are not always appropriate being expensive and unfamiliar. Much research has tried to develop alternative RUTF formulations and this work systematically reviewed eight articles discussing the approaches used to assess the children's sensory satisfaction, families' acceptance, and the cultural appropriateness of 13 alternative RUTFs. Different approaches were used by the authors and much research to standardise methodologies and findings is urgent to ensure that food products are culturally appropriate, acceptable and appreciated, with the final aim of completing the development process of alternative RUTFs. This work proposed some indications to follow in alternative RUTF acceptability evaluation processing. Moreover, community engagement and education resulted key aspects in alternative RUTF acceptance. An innovative, multi-disciplinary, multi-stakeholder approach could develop alternative "fit-for-the-purpose" RUTFs to help food-insecure communities acquire sufficient, safe, nutritious food in long-term Community Management of Acute Malnutrition.

Dietary Sources and Nutrient Adequacy Potential of Local Foods among Children (6-23 Months) in Urban Slums of West Oromia (Ethiopia)

Background

Identifying the combination of local foods that optimize nutrient intake is challenging. This study addressed how local foods could be rationally combined to provide basic nutritional needs, while limiting the use of commercial foods among children in Ethiopia.

Methods

A cross-sectional survey was carried out to estimate dietary intakes of 396 children (6-23 months of age) using 24-hour recall and WDR. Anthropometrics (weight and height) of the children was taken to calibrate energy and protein requirements to body sizes during ProPAN analysis. Model parameters were defined using dietary and market-survey data. ProPAN (2.0), SAS (9.2), and NutriSurvey for Windows were used for data analysis.

Results

Age-specific optimal combinations of local foods that achieve nutrient adequacy set by the WHO/FAO (≥70% RDA) for 9 nutrients were successfully generated. Overall, the percentage of children consuming ≥ EAR for most nutrients obtained from median servings was 54.3%, 89.9%, 61.8%, 12.9%, 85.6%, 79.7%, and 34.2% for energy, protein, iron, zinc, vitamin A, vitamin C, and calcium, respectively. The percentage of RDA was 46.3% for zinc, 56.7% for vitamin A, 24.3% for vitamin C, and 40% for calcium among infants (6-11 months), whereas the respective percentage of RDA was 78.1% for zinc, 100% for vitamin A, 43.3% for vitamin C, and 50% for calcium in older children (12-23 months of age). However, careful combination of local foods, slightly complimented by commercial foods, has shown substantial improvement in nutrient adequacy, ensuring ≥99% RDA for all target nutrients.

Conclusions

Careful combinations of local foods have the potential to achieve optimum dietary intakes of essential nutrients. However, minimal consideration of commercial foods has been inevitable, especially for infants aged 6-11 months.

A comprehensive approach to design molded culinary products using cottage cheese for school meals

Abstract Among the main challenges regarding the food industry, it could be noted that it is necessary to make food products with the required quality and affordable cost. Computing modeling methods solved such tasks by optimizing food recipes based on specific product criteria. However, the problem of optimizing school meals still needs to be addressed. Cottage cheese and culinary products are valuable sources of protein and calcium. They are particularly in demand for schoolchildren’s nutrition. This research aimed to develop molded culinary products with cottage cheese (cheese pancakes) based on the criteria convolution method using the Harrington-Mecher desirability function, i.e., a generalized desirability function in order to meet the physiological needs of school-aged children. The components used were cottage cheese, two additives from Jerusalem artichoke: (M1: «Jerusalem artichoke, pumpkin, pear» or M2: Jerusalem artichoke, quince, mountain ash), egg, and dry components (barley flakes or oat flour). Components were combined at specific ratios; the masses obtained were subject to structural-mechanical and sensory analysis. To determine the optimal equation of the dependence of the critical shear stress (yield stress) regarding the quantitative recipe composition, regression analysis was conducted, followed by Multi-criteria optimization based on Harrington’s desirability function. Two cheese pancake recipes were proposed, as they showed optimum quality characteristics of the final product: Recipe 1 (%): Cottage cheese 74.0, plant additives 14.0, oat flour 7.7, eggs 4.3; Recipe 2 (%): Cottage cheese 69.0, plant additives 17.0, flakes barley 10.0, eggs 4.0. The proposed approach was effective in optimizing various molded culinary products and represents a methodological basis for finding new innovative technological solutions in the food industry and public catering.

The role of food science and technology in humanitarian response

Background

In humanitarian contexts, ensuring access to safe, nutritious, good quality and culturally appropriate food in the right quantity at the right time and place during an emergency or a protracted crisis is an enormous challenge, which is likely to increase given uncertainties such as climate change, global political and economic instability and emerging pandemics like COVID-19. Several international organizations and non-government organizations have well established systems to respond to food security emergencies. However, the role of food science and technology in humanitarian response is not well understood and is seldom considered in humanitarian circles.

Scope and approach

The role of food science and technology in humanitarian response and the importance of addressing the requirements of the local consumers within the local food systems are discussed.

Key findings and conclusions

Humanitarian food aid policies focus on immediate and short-term assistance to save lives. The implementation of emergency programs and projects tends to induce dependency on aid, rather than strengthening local food systems and ensuring resilience. Transformative change must embrace innovation across the whole food system with an increased emphasis on food science and technology that addresses local food security, generates employment and contributes to the local economy. There needs to be a move beyond rehabilitating and increasing agricultural production to addressing the whole food system with a view to link humanitarian assistance and longer-term support to sustainable livelihoods and resilience.

Development of a Natural Product Rich in Bioavailable Omega-3 DHA from Locally Available Ingredients for Prevention of Nutrition Related Mental Illnesses

Objectives: Poor mental health remains a serious public concern worldwide. The most vulnerable individuals are children and adolescents in developing countries. Nutritional deficiency of long-chain omega-3 fatty acids, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have long been recognized as a major contributing factor for mental health illnesses. Provision of ready-to-use natural product rich in preformed Omega-3 DHA and EPA could address this problem. However, most commonly used products are expensive and contain less or no preformed Omega-3 DHA and EPA, making them less suitable for prevention of mental illnesses in resource-poor countries. The main objective of this study was to develop a natural product rich in preformed Omega-3 DHA and EPA from locally available ingredients.Methods: Linear programing (LP) was used to formulate a natural product rich in preformed Omega-3 DHA and other essential nutrients using locally available ingredients other than fish and dairy products. Laboratory analysis was then performed to validate the nutritional value of the LP-formulation using standard analytical methods. The relative difference between the LP tool calculated values, and the laboratory-analyzed values were calculated. Sensory testing was also done to evaluate consumer acceptance of the final product.Results: Optimal formulation contained about 220 mg of preformed Omega-3 DHA + EPA, enough to meet the RDI for children aged 2-10 years. The LP analysis further showed that the cost of the developed product is USD 0.15/100 g, which is 50% lower than that of Plumpy'nut. Laboratory analysis revealed similar results as that of LP at P = 0.05.Conclusions: These findings indicate that ready-to-use natural food rich in preformed DHA and EPA can be developed from locally available ingredients.

Formulation and processing of gruels made from local ingredients, thin enough to flow by gravity in enteral tube feeding

Designing enteral foods from local ingredients for tube feeding of low-income people who cannot eat orally is needed. Two processing methods, involving the addition of amylase or malt, were used to thin a blenderized tube feeding formula based on sorghum, sesame and soybean seeds. Two composite flours, either with higher carbohydrate (F1D) or higher lipid (F2D) contents were formulated to obtain an enteral food aimed at adults. To thin the formula enough for it to flow inside the feeding tube, increasing concentrations of amylase (0.27-2.17 g/100 g DM) were added to gruels F1D (F1DE) and F2D (F2DE) prepared at 25% DM. Sorghum malt was also added to F1D (F1DM) as an alternative source of amylase. But F1DE and F1DM flow times in a 50 cm feeding tube (10 Fr) remained much longer (up to 14 s) than that of the commercial enteral food (4 s). The F1DE and F1DM osmolalities (485 and 599 mOsmol/Kg water, respectively) were higher compared to that of F1D but remained within the range specified for adult enteral food. F1D, F1DE and F1DM gruels showed pseudoplastic behavior. Their loss ratio (tan δ ), elastic (G') and loss (G'') moduli were similar, but apparent viscosity, flow time in the feeding tube and consistency index (k) showed that F1DE was thinner than F1DM. Adding an incubation step before cooking of F1DM suspension allowed further thinning of the gruel, showing it is possible to formulate an enteral food using local ingredients that flows by gravity in the feeding tube.

Alternative Ready-To-Use Therapeutic Food Yields Less Recovery Than the Standard for Treating Acute Malnutrition in Children From Ghana

In Ghana, an alternative ready-to-use food (RUTF) formulation that met all specifications was not as good as standard RUTF in affecting recovery from acute malnutrition among children aged 6 to 59 months.

Background:

Only 20% of children with severe acute malnutrition (SAM) have access to ready-to-use therapeutic food (RUTF), and RUTF cost limits its accessibility.

Methods:

This randomized, double-blind controlled study involved a clinical equivalence trial comparing the effectiveness of an alternative RUTF with standard RUTF in the home-based treatment of uncomplicated SAM and moderate malnutrition in Ghanaian children aged 6 to 59 months. The primary outcome was recovery, equivalence was defined as being within 5 percentage points of the control group, and an intention-to-treat analysis was used. Alternative RUTF was composed of whey protein, soybeans, peanuts, sorghum, milk, sugar, and vegetable oil. Standard RUTF included peanuts, milk, sugar, and vegetable oil. The cost of alternative RUTF ingredients was 14% less than standard RUTF. Untargeted metabolomics was used to characterize the bioactive metabolites in the RUTFs.

Results:

Of the 1,270 children treated for SAM or moderate malnutrition, 554 of 628 (88%) receiving alternative RUTF recovered (95% confidence interval [CI]=85% to 90%) and 516 of 642 (80%) receiving standard RUTF recovered (95% CI=77% to 83%). The difference in recovery was 7.7% (95% CI=3.7% to 11.7%). Among the 401 children with SAM, the recovery rate was 130 of 199 (65%) with alternative RUTF and 156 of 202 (77%) with standard RUTF (P=.01). The default rate in SAM was 60 of 199 (30%) for alternative RUTF and 41 of 202 (20%) for standard RUTF (P=.04). Children enrolled with SAM who received alternative RUTF had less daily weight gain than those fed standard RUTF (2.4 ± 2.4 g/kg vs. 2.9 ± 2.6 g/kg, respectively; P<.05). Among children with moderate wasting, recovery rates were lower for alternative RUTF, 386 of 443 (87%), than standard RUTF, 397 of 426 (93%) (P=.003). More isoflavone metabolites were found in alternative RUTF than in the standard.

Conclusion:

The lower-cost alternative RUTF was less effective than standard RUTF in the treatment of severe and moderate malnutrition in Ghana.

Ready-to-Use Supplemental Food for Nutritional Supplementation in Cystic Fibrosis

Undernutrition is common in cystic fibrosis (CF) and is correlated with long-term outcomes, yet current nutritional interventions have not demonstrated consistent improvements in energy intake, and subsequently, growth. Development of novel nutritional interventions to increase energy intake is essential to improve clinical outcomes of individuals with CF. Ready-to-use supplemental food (RUSF) is a modifiable, inexpensive, palatable, safe, and nutrient-dense food for treatment or prevention of acute malnutrition in developing countries. Utilizing a linear-programming tool we identified 6 RUSF formulations with sufficient nutrient density (495 kcal/100 g), protein, and fat for children with CF. Palatability was established by a taste-trial and affirmed by a 2-wk tolerability assessment that demonstrated consistent consumption and tolerance of the RUSF. Although preliminary, this study demonstrates the potential for developing RUSF as a nutritional supplement for increasing energy intake in children with CF.

Useful Tools for Food Aid: Linear Programming and Protein Quality Tools

The development of a superior treatment option for severe acute malnutrition (SAM) which allowed for home-based therapy put in place constraints that are crucial for ensuring the feasibility and nutritional integrity of the treatment. Soon after the initial success of ready-to-use therapeutic food (RUTF), there were attempts to modify the formulation for cost and other areas of acceptability. While alternative formulations have been taken on in clinical trials, they have been inferior to the standard RUTF recipe. Linear programming (LP) technology, however, has streamlined the formulation process allowing the user to account for the crucial constraints required to maintain the feasibility and nutritional integrity of standard RUTF. With the aid of an LP tool and other functional tools for assessing nutrient quality, nutrition researchers can use innovative approaches in food development that could potentially revolutionize food aid products.

A Review of the Use of Linear Programming to Optimize Diets, Nutritiously, Economically and Environmentally

The "Diet Problem" (the search of a low-cost diet that would meet the nutritional needs of a US Army soldier) is characterized by a long history, whereas most solutions for comparable diet problems were developed in 2000 or later, during which computers with large calculation capacities became widely available and linear programming (LP) tools were developed. Based on the selected literature (52 papers), LP can be applied to a variety of diet problems, from food aid, national food programmes, and dietary guidelines to individual issues. This review describes the developments in the search for constraints. After nutritional constraints, costs constraints, acceptability constraints and ecological constraints were introduced. The 12 studies that apply ecological constraints were analyzed and compared in detail. Most studies have used nutritional constraints and cost constraints in the analysis of dietary problems and solutions, but such research begin showing weaknesses under situations featuring a small number of food items and/or nutritional constraints. Introducing acceptability constraints is recommended, but no study has provided the ultimate solution to calculating acceptability. Future possibilities lie in finding LP solutions for diets by combining nutritional, costs, ecological and acceptability constraints. LP is an important tool for environmental optimization and shows considerable potential as an instrument for finding solutions to a variety of very complex diet problems.

Innovative optimization of ready to use food for treatment of acute malnutrition

Treatment of acute malnutrition typically requires the provision of ready-to-use food (RUF). Common RUF is effective but expensive, being manufactured from costly ingredients, and shipped worldwide from few global suppliers. I developed a linear programming tool to create RUF optimized for low cost using locally grown crops while maintaining necessary nutritional goals and other constraints. My tool utilizes a database of the nutritional value, price, and water efficiency of suitable ingredients and allows adjustment of constraints, including nutrients, flavour, and crop water efficiency. It is designed to (a) address nutrient requirements conforming to current standards and practice; (b) optimize RUF formulae for low cost using a wide range of ingredients for nutritional value and acceptability improvement; (c) ensure protein quality through protein digestibility corrected amino acid score; and (d) adjust RUF formulae according to locally grown crop selection, local prices, and crop water footprint. The tool creates formulae free of expensive dairy ingredients, ensuring desired protein digestibility corrected amino acid score by automatically balancing proteins with complementary quantities of essential amino acids. Using publicly available data with an application to Nigeria, my tool created RUF formulae suitable for local production using local crops to meet all nutrient requirements at a fraction of the ingredient cost and water footprint of current formulae, demonstrating the tool's effectiveness. Optimization of RUF for low cost using locally grown crops will facilitate local production and reduce ingredient as well as transport costs, so more patients can receive lifesaving treatment.

Cost of the Diet: a method and software to calculate the lowest cost of meeting recommended intakes of energy and nutrients from local foods

BACKGROUND

When food is available, the main obstacle to access is usually economic: people may not be able to afford a nutritious diet, even if they know what foods to eat. The Cost of the Diet method and software was developed to apply linear programming to better understand the extent to which poverty may affect people's ability to meet their nutritional specifications. This paper describes the principles of the method; the mathematics underlying the linear programming; the parameters and assumptions on which the calculations are based; and then illustrates the output of the software using examples taken from assessments.

RESULTS

The software contains five databases: the energy and nutrient content of foods; the energy and nutrient specifications of individuals; predefined groups of individuals in typical households; the portion sizes of foods; and currency conversion factors. Data are collected during a market survey to calculate the average cost of foods per 100 g while focus group discussions are used to assess local dietary habits and preferences. These data are presented to a linear programming solver within the software which selects the least expensive combination of local foods for four standard diets that meet specifications for: energy only; energy and macronutrients; energy, macronutrients and micronutrients; and energy, macronutrients and micronutrients but with constraints on the amounts per meal that are consistent with typical dietary habits. Most parameters in the software can be modified by users to examine the potential impact of a wide range of theoretical interventions. The output summarises for each diet the costs, quantity and proportion of energy and nutrient specifications provided by all the foods selected for a given individual or household by day, week, season and year. When the cost is expressed as a percentage of income, the affordability of the diet can be estimated.

CONCLUSIONS

The Cost of the Diet method and software could be used to inform programme design and behaviour change communication in the fields of nutrition, food security, livelihoods and social protection as well as to influence policies and advocacy debates on the financial cost of meeting energy and nutrient specifications.

Optimizing Ready-to-Use Therapeutic Foods for Protein Quality, Cost, and Acceptability

This article describes current research on the development of alternative ready-to-use therapeutic foods (RUTFs) in the treatment of severe acute malnutrition. An innovative and versatile linear programming tool has been developed to facilitate the creation of therapeutic formulas that are determined acceptable on multiple levels: costs, ingredient acceptability, availability and stability, nutrient requirements, and personal preferences. The formulas are analyzed for ease of production by Washington University team members and for organoleptic properties acceptability to target populations. In the future, RUTF products that are cost-effective, acceptable, sustainable, and widely available will become a reality.

Acceptability of locally produced ready-to-use therapeutic foods in Ethiopia, Ghana, Pakistan and India

Successful treatment of severe acute malnutrition has been achieved with ready-to-use therapeutic food (RUTF), but only 15% of children with severe acute malnutrition receive RUTF. The objective of this study was to determine whether new formulations of RUTF produced using locally available ingredients were acceptable to young children in Ethiopia, Ghana, Pakistan and India. The local RUTFs were formulated using a linear programming tool that allows for inclusion of only local ingredients and minimizes cost. The study consisted of 4 two-arm, crossover, site-randomized food acceptability trials to test the acceptability of an alternative RUTF formula compared with the standard peanut-based RUTF containing powdered milk. Fifty children with moderate wasting in each country were enrolled in the 2-week study. Acceptability was measured by overall consumption, likeability and adverse effects reported by caregivers. Two of the four RUTFs did not include peanut, and all four used alternative dairy proteins rather than milk. The ingredient cost of all of the RUTFs was about 60% of standard RUTF. In Ethiopia, Ghana and India, the local RUTF was tolerated well without increased reports of rash, diarrhoea or vomiting. Children consumed similar amounts of local RUTF and standard RUTF and preferred them similarly as well. In Pakistan, local RUTF was consumed in similar quantities, but mothers perceived that children did not enjoy it as much as standard RUTF. Our results support the further investigation of these local RUTFs in Ethiopia, Ghana and India in equivalency trials and suggest that local RUTFs may be of lower cost.

An Economic Optimization Model for Improving the Efficiency of Vitamin A Interventions: An Application to Young Children in Cameroon

BACKGROUND

Vitamin A (VA) intervention programs in developing countries do not generally consider spatial differences in needs or in intervention costs. New data from Cameroon reveal nonuniform spatial distributions of VA deficiency among young children and of costs of some of the programs designed to address them.

METHODS

We develop a spatially explicit, intertemporal economic optimization tool that makes use of subnational dietary intake data and VA intervention program costs to identify more efficient sets of interventions to improve VA nutrition among young children aged 6 to 59 months in Cameroon.

RESULTS

The model suggests substantial changes in the composition and geographic foci of VA intervention programs vis-à-vis a business-as-usual scenario. National VA-fortified edible oil and bouillon cube programs are cost-effective, even when start-up costs are considered. High-dosage VA supplementation delivered via Child Health Days is most cost-effective in the North macro-region, where needs are greatest and the cost per child effectively covered is lowest. Overall, the VA intervention programs suggested by the optimization model are approximately 44% less expensive, with no change in the total number of children effectively covered nationwide.

CONCLUSIONS

The VA intervention programs should consider spatial and temporal differences in needs and in the expected benefits and costs of alternative VA interventions. Doing so will require spatially disaggregated strategies and the data and political will to support them, longer planning time horizons than are currently used in most developing countries, and long-term funding commitments.

Effect of emulsifier and viscosity on oil separation in ready-to-use therapeutic food

Oil separation is a common food quality problem in ready-to-use therapeutic food (RUTF), the shelf-stable, peanut-based food used to treat severe acute malnutrition in home settings. Our objective was to evaluate the effect on oil separation of three emulsifiers at different concentrations in RUTF. We also assessed two viscosity measurements. A scale-up experiment was carried out during full-scale RUTF production in Malawi. Results indicate that viscosity is inversely correlated with oil separation, and that the Bostwick consistometer is a simple, useful tool to predict viscosity. Oil separation in RUTF may be mitigated by use of an emulsifier, which increases the viscosity of the product. The emulsifier that reduced oil separation to the greatest extent was a mixture of high and low monoacylglycerol (MAG) emulsifiers. Proper raw material quality control to achieve consistent ingredient fat level and fat type, and production temperature and shearing control should be a focus in RUTF manufacturing.