Milk-and-Dairy-Products-in-Human-Nutrition-FAO

Chapter 7 – Milk and dairy programmes affecting nutrition 291
peanuts, oil, sugar and micronutrient fortificants. In the following section, the
evidence-base on the use of milk powder in blended foods is presented. In the programmes
covered here, milk powder is added to other foods to enhance their nutritional
value, rather than nutrients being added to milk to enrich its nutritional value
(as was the case with fortified-milk programmes discussed in the previous section).
7.6.1 Latin America and the Caribbean
The Vaso de Leche Programme in Peru has been distributing milk, milk powder
and cereals since the 1980s. A large-scale World Bank-funded evaluation, ranked at
the plausibility level of inference, found that this large social transfer programme
has delivered milk products to poor households with undernourished children but
did not observe an association between public expenditures for this programme and
anthropometric outcomes in demographic and health survey data from 1996 and
2000 (Stifel and Alderman, 2006). Milk powder is often included in commercially
produced complementary foods in other parts of Latin America (Lutter et al., 2008;
Young Child Nutrition Working Group, 2009). Participatory recipe trials conducted
in Haiti using USAID food aid products found that adding milk to corn–soy
blend (CSB) increased both the energy and vitamin A content (Ruel et al., 2004).
This study, designated observational/formative, was not designed to demonstrate
any effects on nutrition in young children.
7.6.2 Africa
The peanut-butter-based RUTF and RUSF products were first introduced by the
company Nutriset, of Malaunay, France, as Plumpy’nut ® . Plumpy’nut ® is a mixture
of peanut butter, milk powder, soybean oil, sugar and micronutrients. The paste is
energy-dense (500 kcals per packet), resistant to bacterial contamination, easy to
store, with a long shelf-life, and does not require cooking before feeding. There is
a growing body of evidence of its effectiveness in community-based management
of acute malnutrition, and some efforts are currently underway to investigate the
effectiveness of similar products with different macro- and micronutrient compositions
for preventing undernutrition. However, such interventions should generally
be confined to countries with chronic emergencies or in crisis. Nutributter ® , also
produced by Nutriset and others, has been examined for efficacy in promoting
growth, development and preventing micronutrient deficiencies (Adu-Afarwuah et
al., 2007). While dry, skimmed milk powder is currently a standard ingredient of
these products, research is underway to test alternative products that do not include
milk or have a reduced milk content, because of the high cost of milk powder.
The added nutritional value of the milk powder in the RUTF and RUSF has
been examined to a limited extent. One randomized, controlled study in Malawi,
ranked as probability level, compared three types of blended foods for improving
recovery from moderate wasting (weight-for-height Z-score [WHZ] of greater
than or equal to −3 but less than or equal to −2) (Matilsky et al., 2009). In the
first group, milk powder was added to a peanut paste that contained oil and sugar
(25 percent milk, 26 percent peanut, 49 percent oil and sugar). The second group
replaced the milk powder with soy powder (26 percent soy, 27 percent peanut,
47 percent oil and sugar). The third group was given CSB (80 percent corn, 20
percent soy). Important differences were found between the two food supplement