MOZAMBIQUE, Africa — The baby gives the silver pouch a squeeze and a thick, brown goo gushes out over his chubby fingers. His eyes are wide as he mashes the food between his gums, but as soon as he swallows, he gives a "gah" of glee and kicks his legs against his wooden high chair. Next to him, another of the 60 or so African orphans he shares a cinder block home with, licks her fingers.
It's yummy. That's one thing that Plumpy'Nut, a paste made of peanut butter, oil, sugar and vitamins, has going for it. A staple in many orphanages in the developing world, Plumpy'Nut has also been hailed by organizations like the World Food Programme and the UN Standing Committee on Nutrition as a sort of miracle in the fight against child hunger. During the 2005 food crisis in Niger, 90 percent of the 60,000 children treated with the ready-to-use therapeutic food recovered from severe malnutrition. Now, as the international aid community rushes to help those suffering from the effects of famine in Somalia, foods like Plumpy'Nut, developed by scientists to pack an extra punch of vitamins and minerals, are on the front line.
These ready-to-use therapeutic foods, which don't require any extra ingredients or preparation, are the newest innovation in the quest to bring the benefits of vitamins to the developing world. Their easy-to-open silver packages have made addressing world hunger a tangible, tasteable thing for would-be advocates and inspired the launch of a growing number of new nonprofits devoted to financing, producing and distributing the peanut butter product. Their success in treating malnourished children over the past five years has turned a magnifying glass on the nutritional content of international food aid across the board.
"The development of new products we really have the tools now to respond better," said Rene McGuffin, senior spokesman for the World Food Programme. "We fortify wherever we can. Whether it's oil, salt, or cereal, when you're dealing with something like the crisis in Africa getting those vitamins and nutrients in there is of the utmost importance."
Miracle peanut butter
Plumpy'Nut, which was developed by a French pediatrician, is patented — a fact that has raised eyebrows in the humanitarian aid community. But, since its widespread introduction, plenty of knock-offs have popped up anyway. Some nonprofit organizations have even struck up partnerships with peanut farmers in developing countries and put the locals to work blending the formula.
"The development of Plumpy'Nut has been a huge, almost unprecedented way to get people excited about aid," said Steve Hansch, a Georgetown University nutritionist who sits on the board of the World Hunger Education service. Just three packets a day of ready-to-use therapeutic foods for six weeks will bring a starving child from the brink of death to chubby, happy, normal nutritive health. Specifically designed for children, the paste not only saves lives, but provides the needed nutrients for healthy brain growth.
Mark Moore, founder and CEO of MANA Nutrition, got involved in the ready-to-use therapeutic food business after hearing about the product's success during a Capitol Hill information meeting on hunger in Africa. Elizabeth Stoltz, a New York City college student, founded a nonprofit dedicated to raising money for the little packets of peanut butter after reading about it in an issue of CosmoGirl. R.I. Navyn Salem, founder of the Rhode Island-based Plumpy'Nut manufacturer Edesia Global Nutrition Solutions, fell in love with ready-to-use therapeutic foods during an episode of "60 Minutes" during which Anderson Cooper compared the development of the paste to the discovery of penicillin.
"People love a silver bullet," Hansche said — or what appears to be a silver bullet.
The peanut butter paste is also inspiring because it makes the discussion of world hunger "tangible," he said.
During a recent discussion of humanitarian food aid at Georgetown University, where Hansch teaches, a student brought up ready-to-use therapeutic foods. Hansche happened to have a packet in his pocket. He pulled it out and served it up. UNICEF made international headlines this week by giving Britain's Prince William a taste of the peanut butter paste. At fund raisers for hunger initiatives, nonprofits routinely pass around packets for tasting.
"You can't beat a lesson like that," he said. "When you talk about measles immunizations you can't say, quick give me a shot so I can experience it."
Upping the standards
When it comes to addressing global hunger, though, ready-to-use therapeutic foods are just part of the solution. While Plumpy'Nut has been shown to help children teetering so close to death they would have otherwise required hospitalization, it isn't a long-term nutrition solution, said Chessa Lutter, senior advisor of food and nutrition for the Pan American Health Organization. Malnutrition comes in many forms, ranging from a vitamin deficiency to starvation. International aid organizations use a wide portfolio of products, many of which are fortified with vitamins and minerals, to address the various stages of hunger.
More than two billion people worldwide suffer from vitamin and mineral deficiencies, according to the World Health Organization — a condition that manifests itself in many ways, ranging from fatigue to stunted growth to blindness. By pumping an extra dosage of vitamins into foods like salt, bread and milk, the United States has successfully eliminated vitamin-deficiency-caused diseases like goiter, rickets, beriberi and pellagra. When it comes to foreign aid, though, the United States and other rich countries have been criticized for dumping surplus stocks of low-quality food on poor nations.
Medecins Sans Fontieres (Doctors Without Borders), one of the most vocal critics of U.S. food aid, has used the success of ready-to-use therapeutic products as ammunition to lobby for better fortified food products across the board. This year, inspired by the efficiency of ready-to-use therapeutic foods, the World Health Organization announced plans to tighten up the nutritional standards for all food aid for young children. The new guidelines will recommend increasing vitamin and mineral content, changing blending techniques and improving shelf life.
"It is a delicate issue that has a lot of implications for development agencies," said Dr. Francesco Branca, director of the World Health Organizations Department of Nutrition and Health Development. "Next year there will be a completely new generation of food available for emergencies and also for the longer term situations where food aid is necessary."
Historically, grain has made up the bulk of food aid. While grain provides lifesaving calories, without vegetables and fruits, people develop vitamin and mineral deficiencies, according to the World Hunger Education Service. To fill in the gaps, scientists developed fortified cereals to be used in humanitarian aid, like corn soy blend and wheat soy blend.
Compared to vitamin-packed foods like Plumpy'Nut, Medicins Sans Frontieres has called the soy blends "sub-standard."
Hansche dismissed this an "extreme" point of view, but, as a global nutritionist, he was candid about the shortcomings of food fortification in international aid.
"Is what we are doing adequate?" he said. "Absolutely not."
There are a number of barriers standing in the way of developing a Plumpy'Nut-style solution to other forms of malnutrition.
First off: cost.
"Food aid is still dominated by corn soy blend and wheat soy blend because they are cheap, but they aren't equivalent nutritionally to ready-to-use therapeutic foods," Lutter said. Fortified grains cost between three and five times as much as whole grains. Ready-to-use therapeutic foods, like Plumpy'Nut, cost even more.
But the trouble with soy blends is deeper than just cost. Just because vitamins are present in a food doesn't mean the body can access it, said Michael Dunn, an associate professor of food science at Brigham Young University. For example, in many developing countries, the government recommends boiling water before using it, Dunn said. People add the corn soy blend to the cold water then boil it for forty five minutes. Most vitamins survived the boiling, but, by the end, only 10 percent of the vitamin C remained.
"If we are going to continue to use these products, something needs to be done about vitamin C," Dunn said.
Dunn and his colleague at BYU, Paul Johnston, have both been involved in developing fortified foods for use in developing countries. Dunn helped millers in South America come up with a system of adding vitamins to mass-produced tortillas. Johnston designed a "super cookie" to treat malnourished children in Bolivia.
But while these fortified super foods do boost metabolisms and correct deficiencies, their effects last only as long as the international aid community is shipping them in, Dunn said. Because of the logistical challenges of establishing routine food fortification in developing country's, there's a general consensus — even among those who make their living developing fortified foods — that the answer to hunger in developing countries lies, not in scientifically altered super foods, but in education.
"These kinds of foods are helpful for the short term," said James Hansen, a nutrition advisor to the welfare department for The Church of Jesus Christ of Latter-day Saints and a retired pediatrician. "It will get them through until they can be on their feet better and sustain a life or two in the process. But foods like Plumpy'Nut aren't a long-term solution. It's just not sustainable."
Even so, Hansen said — and Johnston and Hansch agreed — the hype surrounding Plumpy'Nut has been a positive thing for international food aid. It might not be a miracle cure to malnutrition, but it has done a miraculous thing for the food fortification industry.
"Plumpy'Nut has the attention of the world," he said.