Evaluating amino acid fortification in low-dairy ready-to-use therapeutic food formulations: Insights from a meta-analysis re-evaluation

Severe wasting is treated with ready-to-use therapeutic food (RUTF), wherein the protein content primarily comes from milk and peanuts. As these ingredients are the main drivers of RUTF's cost, global initiatives seek alternatives using locally available, sustainable ingredients to reduce cost and increase coverage. To compensate for reduced/removed dairy protein, current practice is to add amino acids to meet Codex protein quality requirements. In this meta-analysis re-evaluation, we compared RUTF formulations with <50% dairy protein, with or without amino acid fortification, against standard milk-peanut RUTF for the outcome of weight gain. Growth outcomes were similar between fortified and unfortified RUTFs when compared to standard RUTF. These findings suggest that elevating protein quality scores by adding amino acids may be insufficient to ensure clinical efficacy in novel RUTF formulations. Additionally, the findings suggest that Protein Digestibility Corrected Amino Acid Score (PDCAAS) compliance alone may not guarantee clinical efficacy. Future formulation efforts should address digestibility, antinutritional factors, and increasing total protein content to achieve effective, sustainable novel RUTF formulations.