title: A comprehensive linear programming tool to optimize formulations of ready-to-use therapeutic foods: an application to Ethiopia.
abstract: BACKGROUND
  Ready-to-use therapeutic food (RUTF) is the standard of care for children suffering from noncomplicated severe acute malnutrition (SAM).
  
  
  OBJECTIVE
  The objective was to develop a comprehensive linear programming (LP) tool to create novel RUTF formulations for Ethiopia.
  
  
  METHODS
  A systematic approach that surveyed international and national crop and animal food databases was used to create a global and local candidate ingredient database. The database included information about each ingredient regarding nutrient composition, ingredient category, regional availability, and food safety, processing, and price. An LP tool was then designed to compose novel RUTF formulations. For the example case of Ethiopia, the objective was to minimize the ingredient cost of RUTF; the decision variables were ingredient weights and the extent of use of locally available ingredients, and the constraints were nutritional and product-quality related.
  
  
  RESULTS
  Of the new RUTF formulations found by the LP tool for Ethiopia, 32 were predicted to be feasible for creating a paste, and these were prepared in the laboratory. Palatable final formulations contained a variety of ingredients, including fish, different dairy powders, and various seeds, grains, and legumes. Nearly all of the macronutrient values calculated by the LP tool differed by <10% from results produced by laboratory analyses, but the LP tool consistently underestimated total energy.
  
  
  CONCLUSIONS
  The LP tool can be used to develop new RUTF formulations that make more use of locally available ingredients. This tool has the potential to lead to production of a variety of low-cost RUTF formulations that meet international standards and thereby potentially allow more children to be treated for SAM.
authors.affiliation: From the Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (KNR, MIO, EDC, and MJM), and the Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (KPA and SAV).
authors.forename: Kelsey N
authors.initials: KN
authors.lastname: Ryan
authors.affiliation: From the Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (KNR, MIO, EDC, and MJM), and the Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (KPA and SAV).
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Adams
authors.affiliation: From the Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (KNR, MIO, EDC, and MJM), and the Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (KPA and SAV).
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Vosti
authors.affiliation: From the Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (KNR, MIO, EDC, and MJM), and the Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (KPA and SAV).
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Ordiz
authors.affiliation: From the Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (KNR, MIO, EDC, and MJM), and the Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (KPA and SAV).
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Cimo
authors.affiliation: From the Department of Pediatrics, Washington University School of Medicine, St. Louis, MO (KNR, MIO, EDC, and MJM), and the Department of Agricultural and Resource Economics, University of California, Davis, Davis, CA (KPA and SAV).
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D002648:Child; D002523:Edible Grain / Q000737:chemistry; D005002:Ethiopia; D007887:Fabaceae / Q000737:chemistry; D057140:Fast Foods / Q000592:standards*; D005240:Feasibility Studies; D005526:Food, Formulated / Q000592:standards*; D006801:Humans; D044342:Malnutrition / Q000178:diet therapy; D009821:Oils / Q000737:chemistry; D010865:Pilot Projects; D011382:Programming, Linear; D012639:Seeds / Q000737:chemistry
chemical_list: D009821:Oils
keywords: RUTF; formulation; linear programming; optimization; severe acute malnutrition