guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Annexes 174 Niacin Pantothenic acid Biotin n-6 fatty acids n-3 fatty acids 5 mg/100g minimum 3 mg/100g minimum 60 µg/100g minimum 3% to 10% of total energy 0.3 to 2.5% of total energy Reference document for F100 composition: Management of severe malnutrition - a manual for physicians and other senior health workers. WHO, Geneva, 1999. Available at: http://www.who.int/nutrition/publications/en/manage_severe_malnutrition_eng.pdf Note: iron has to be added to RUTF in contrast to F100. Safety: The food shall be free from objectionable matter; it shall not contain any substance originating from micro organism or any other poisonous or deleterious substances like antinutritional factors, heavy metals or pesticides in amounts that may represent a hazard to health of severely malnourished patients. • Aflatoxin level: 5 ppb maximum. • Micro-organism content: 10 000/g maximum • Coliform test: negative in 1 g • Clostridium perfringens: negative in 1 g • Yeast: maximum 10 in 1 g. • Moulds: maximum 50 in 1g. • Pathogenic Staphylococci: negative in 1 g. • Salmonella: negative in 125g • Listeria: negative in 25g The product should comply with the International Code of Hygienic Practice for Foods for Infants and Children of the Codex Alimentarius Standard CAC/RCP 21-1979. All added mineral and vitamins should be on the Advisory List of Mineral Salts and Vitamin compounds for Use in Foods for Infants and Children of the Codex Alimentarius Standard CAC/GL 10-1979 The added minerals should be water soluble and should not form insoluble components when mixed together. This mineral mix should have a positive nonmetabolizable base sufficient to eliminate the risk of metabolic acidosis or alkalosis. 215 Information on how to produce RUTF in countries is available at: http://www.who.int/child-adolescenthealth/New_Publications/NUTRITION/CBSM/tbp_4.pdf 215 The nonmetabolizable base can be approximated by the formula: estimated absorbed mmoles (sodium + potassium + calcium + magnesium) - (phosphorus+chloride). The mineral mix recommended for F100 by WHO is an example of mineral mix with suitable positive nonmetabolizable base.
ACF-In Guidelines for the integrated management of SAM Annexes 175
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