How do you save millions of children wasting from malnutrition in areas with little food, no fridges and no hospitals?
The answer is a kind of “miracle” peanut butter, inspired by Nutella and enriched with skim milk powder, vegetable oil, sugar and an elixir of vitamins and minerals capable of restoring life and colour to kids on the brink of death.
The Plumpy’Nut peanut paste was invented 30 years ago by a French paediatrician who saw children perishing in Africa’s arid Sahel strip, often because the therapeutic milk used in hospitals spoiled easily.
Now almost 9 million children a year are treated for severe malnutrition with Plumpy’Nut, the world’s first Ready-to-Use Therapeutic Food (RUTF) which can be sucked straight from the packet like cookie dough.
Nine out of 10 children with severe malnutrition recover using the paste, according to UNICEF, although production has taken a massive hit as key donor countries such as the US slash aid.
Nutritionist Alison Fleet, from Sydney’s northern beaches, has led the technical side of UNICEF’s efforts to ramp production to a billion packets a year. She helped expand from a single French supplier to more than 20 in the nations where the paste is needed most, from Madagascar to Afghanistan.
The World Health Organisation’s endorsed RUTFs – so nutritionally powerful some consider them more medicine than food – in 2007.
“That’s a pivotal moment in the treatment of severe acute malnutrition across the globe because, before, children and their families would have to travel for miles to a big hospital to get treatment, and a lot of them died,” Fleet said.
But the Plumpy’Nut packets, sealed and stripped of moisture so bacteria can’t grow, can be delivered straight to poverty-stricken communities and have a shelf life of two years.
Every bit of each 92-gram, 500-calorie packet is optimised: 30.3 grams of fat from the peanuts and oil, 12.8 grams of protein from the nuts and the amino acid-rich milk powder, and 25 per cent sugar to provide a quick energy boost and mask the iron, zinc, potassium, folate and B-vitamins with sweetness.
Each packet, according to an NPR analysis, confers the calories of two McDonald’s hamburger patties, the protein of half a chicken breast, the calcium of three cups of milk, the vitamin C of an orange, the iron of a bunch of spinach and the folic acid of nine asparagus spears. Children eat about two packs per day.
The product’s inventor, child nutritionist Andre Briel, had tried to make therapeutic foods from bars, biscuits, pancakes and doughnuts, but all were too fragile or destroyed critical vitamins when cooked.
He finally landed on a peanut paste, inspired by the oily hazelnut-chocolate spread Nutella, as a medium that could quickly supply the myriad building blocks needed to drive the healthy growth of bones, muscle and brains.
Adam Liaw, cook and food writer, has seen the paste at work in Burundi, a mountainous and landlocked African nation where every scrap of dirt is used to coax food from the ground, but it’s still not enough.
Most children grow up stunted by malnutrition. Liaw met a woman distressed because her husband was no longer around and she had six children to feed. The children were eating Plumpy’Nut straight from the packet.
“It was clear to me this little packet was literally the difference between life and death,” Liaw, a UNICEF ambassador, said.
For other children, it’s the difference between being so listless they can’t stand up and having the energy to chase a soccer ball.
“When you actually see it in action, it becomes more of an emotional thing than a scientific thing,” Liaw said.
The invention of Plumpy’Nut was controversial at first. Mark Manary, an early researcher testing the paste in Malawi, was accused of “killing children” by a peer who thought the intervention too simple to work.
But a 2004 paper by Manary showed 95 per cent of children recovered with the paste.
“It didn’t get scaled for a long time,” Fleet said. “That’s what happens in public health because governments are very conservative. You have to generate a lot of clinical evidence.”
Now alternative RUTFs finessed for local palates are in the works, Fleet said, including chickpea and mung bean pastes for use in Asia. The program, however, has suffered a drop in funding.
“We had several big donors just reduce their support for these programs because of the Ukraine war and instability, so they put money into defence instead of humanitarian programs,” Fleet said.
Last year, about 120,000 sachets of the paste were left to gather dust in a warehouse in Rhode Island after their shipment to Sudan was cancelled amid the Trump administration’s gutting of USAID.
Suppliers are capable of producing 290,000 tonnes of the paste, but only about a third of that amount was delivered in 2025.
UNICEF is aiming for long-term, secure funding for the program, so the product can get to more of the 12.2 million children suffering from severe wasting.
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Angus Dalton is the science reporter for The Sydney Morning Herald.Connect via X or email.
