Therapeutic food

Therapeutic foods are foods designed for specific, usually nutritional, therapeutic purposes as a form of dietary supplement. The primary examples of therapeutic foods are used for emergency feeding of malnourished children or to supplement the diets of persons with special nutritional requirements, such as the elderly.

Therapeutic foods are usually made of a mixture of protein, carbohydrate, lipid and vitamins and minerals. Therapeutic foods are usually produced by grinding all ingredients together and mixing the ingredients together. “The mixing process allows for the protein and carbohydrate components of the food to be embedded in the lipid matrix. The size of the particles within the mixture has to be less than 200 µm ., in order for the mixture to maintain its consistency. Using this method, the therapeutic food is produced and packaged without using water, which would eliminate the issue of spoilage of the food. Some therapeutic foods require the addition of water before administering, while others can be consumed as is. Therapeutic foods are designed and manufactured to ensure that the foods are ready to eat straight from the packaging. Those foods resist bacterial contamination and require no cooking.

The World Health Organization's standards for the treatment of malnutrition in children specify the use of two formulas during initial treatment, F-75 and F-100. These formulas contain a mixture of powdered milk, sugar, and other ingredients designed to provide an easily absorbed mix of carbohydrates and essential micronutrients. They are generally provided as powdered mixes which are reconstituted with water. The WHO recommends the use of these formulas, with the gradual introduction of other foods, until the child approaches a normal weight.

The standard treatment of childhood malnutrition is administered in 2 phases. Phase one usually deals with children who are severely malnourished and very ill as a result. The therapy used in this phase is F-75, a milk-based liquid food containing modest amounts of energy and protein (75 kcal/100 mL and 0.9 g protein/100 mL) and the administration of parenteral antibiotics. When an improvement in the child’s appetite and clinical condition is observed, the child is then entered into phase two of the treatment. This phase uses F-100 for feeding the child. F-100 is a “specially formulated, high-energy, high-protein (100 kcal/100 mL, 2.9 g protein/100 mL) milk-based liquid food”. The child is in phase two until he/she is no longer wasted [weight-for-height z score (WHZ) 2]. Phase two starts while the child is at the hospital but is usually completed after the child goes home. The parent is then responsible for feeding the child a flour supplement made of cereal and legumes as a replacement for the milk-based foods used in phase one and phase two.

READY-TO-USE THERAPEUTIC FOOD

A subset of therapeutic foods, ready-to-use therapeutic foods (RUTFs), are energy-dense, micronutrient-enriched pastes that have a nutritional profile similar to the traditional F-100 milk based diet used in inpatient therapeutic feeding programs and are often made of peanuts, oil, sugar and milk powder.

RUTFs are a “homogeneous mixture of lipid-rich and water-soluble foods”. The lipids used in formulating RUTFs are in a viscous liquid form. The other ingredients are in small particles and are mixed through the lipid. The other ingredients are protein, carbohydrate, vitamins and minerals. The mixture needs to be homogeneous in order for it to be effectively consumed, and to do this, a specific mixing process needs to be implemented. The fat/lipid component of the RUTF is heated and stirred first. The heat should be maintained in order for the lipid to remain in the most optimum form for mixing in the other ingredients. The protein, carbohydrate and vitamins and minerals are in a powdered format and are then slowly and gradually added to the lipid, while the lipid is being vigorously stirred. After all the ingredients are added to the liquid lipid and vigorous stirring is maintained, the mixture is then stirred with more speed and for several minutes. If the powdered ingredients have a particle size that is larger than 200 µm, the mixture would start to separate. So, the particle size of the powdered ingredients need to be maintained at less than 200 µm, for the mixture to not readily separate.

The most common RUTFs are made of four ingredients: sugar, dried skimmed milk, oil and vitamin and mineral supplement (CMV). Other qualities that RUTFs should have include that their texture is soft or crushable and taste is acceptable and suitable for children of young ages. RUTFs should also be ready to eat without the need for them to be cooked. A very important characteristic is that the RUTFs have a long shelf-life and that they are micro-organism contamination resistant, without the need for expensive packaging. Since the ingredients need to be suspended in liquid, the liquid used in producing RUTFs needs to be fat/lipid. 50% of the protein forming RUTFs should come from dairy products. 

Short Introduction to HACCP

Hazard Analysis Critical Control Point or HACCP (English, pronounced /ˈhæsʌp/) is a systematic preventive approach to food safety and pharmaceutical safety that addresses physical, chemical, and biological hazards as a means of prevention rather than finished product inspection. HACCP is used in the food industry to identify potential food safety hazards, so that key actions can be taken to reduce or eliminate the risk of the hazards being realized. The system is used at all stages of food production and preparation processes including packaging, distribution, etc. The Food and Drug Administration (FDA) and the United States Department of Agriculture (USDA) say that their mandatory HACCPprograms for juice and meat are an effective approach to food safety and protecting public health. Meat HACCP systems are regulated by the USDA, while seafood and juice are regulated by the FDA. The use of HACCP is currently voluntary in other food industries.

A forerunner to HACCP was developed in the form of production process monitoring during World War II because traditional "end of the pipe" testing was not an efficient way to ferret out artillery shells that would not explode. HACCP itself was conceived in the 1960s when the US National Aeronautics and Space Administration (NASA) asked Pillsbury to design and manufacture the first foods for space flights. Since then, HACCPhas been recognized internationally as a logical tool for adapting traditional inspection methods to a modern, science-based, food safety system. Based on risk-assessment,HACCP plans allow both industry and government to allocate their resources efficiently in establishing and auditing safe food production practices. In 1994, the organization of International HACCP Alliance was established initially for the US meat and poultry industries to assist them with implementing HACCP and now its membership has been spread over other professional/industrial areas.
Hence, HACCP has been increasingly applied to industries other than food, such as cosmetics and pharmaceuticals. This method, which in effect seeks to plan out unsafe practices, differs from traditional "produce and test" quality control methods which are less successful and inappropriate for highly perishable foods. In the US, HACCP compliance is regulated by 21 CFR part 120 and 123. Similarly, FAO/WHO published a guideline for all governments to handle the issue in small and less developed food businesses.

Principle of HACCP

Principle 1: Conduct a hazard analysis. – Plans determine the food safety hazards and identify the preventive measures the plan can apply to control these hazards. A food safety hazard is any biological, chemical, or physical property that may cause a food to be unsafe for human consumption.

Principle 2: Identify critical control points. – A Critical Control Point (CCP) is a point, step, or procedure in a food manufacturing process at which control can be applied and, as a result, a food safety hazard can be prevented, eliminated, or reduced to an acceptable level.

Principle 3: Establish critical limits for each critical control point. – A critical limit is the maximum or minimum value to which a physical, biological, or chemical hazard must be controlled at a critical control point to prevent, eliminate, or reduce to an acceptable level.

Principle 4: Establish critical control point monitoring requirements. – Monitoring activities are necessary to ensure that the process is under control at each critical control point. In the United States, the FSIS is requiring that each monitoring procedure and its frequency be listed in the HACCP plan.

Principle 5: Establish corrective actions. – These are actions to be taken when monitoring indicates a deviation from an established critical limit. The final rule requires a plant's HACCP plan to identify the corrective actions to be taken if a critical limit is not met. Corrective actions are intended to ensure that no product injurious to health or otherwise adulterated as a result of the deviation enters commerce.

Principle 6: Establish procedures for ensuring the HACCP system is working as intended.– Validation ensures that the plants do what they were designed to do; that is, they are successful in ensuring the production of a safe product. Plants will be required to validate their own HACCP plans. FSIS will not approve HACCP plans in advance, but will review them for conformance with the final rule.

Verification ensures the HACCP plan is adequate, that is, working as intended. Verification procedures may include such activities as review of HACCP plans, CCP records, critical limits and microbial sampling and analysis. FSIS is requiring that the HACCP plan include verification tasks to be performed by plant personnel. Verification tasks would also be performed by FSIS inspectors. Both FSIS and industry will undertake microbial testing as one of several verification activities.

Verification also includes 'validation' – the process of finding evidence for the accuracy of the HACCP system (e.g. scientific evidence for critical limitations).

Principle 7: Establish record keeping procedures. – The HACCP regulation requires that all plants maintain certain documents, including its hazard analysis and written HACCP plan, and records documenting the monitoring of critical control points, critical limits, verification activities, and the handling of processing deviations.