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Plumpy’Nut. Revolutionary Humanitarian Aid or Cash Cow?

E. Mark Windle
Image of red and white coloured sachets of Plump'Nut, a nutritional product used in humanitarian crises.

Image licence attribution: Russell Watkins/DFID. Creative Commons BY 2.0

E. Mark Windle    2 June 2026

A tragic though often-used opener for any discussion on global nutritional health is the fact that malnutrition underpins nearly half of all causes of deaths in children under the age of five. Over the past 50 years, the world has seen around a dozen famines in Africa and Asia, whether caused by conflict, natural disaster or drought. In these events, somewhere between 6 to 8.5 million people are estimated to have died from malnutrition or its complications. The true number is higher still, when it is considered that these acute crises superimpose on a chronic backdrop of food insecurity.

Given these daunting statistics and the need for aid delivery at scale, a longstanding relationship has existed between the humanitarian and commercial sectors. Nutritional supplementation is big business. In 2025 alone, UNICEF procured 278 million US dollars-worth of nutrition supplies from the food manufacturing and pharmaceutical industries. Prior to the 1990s, aid organisations struggled to keep up with the demand to feed malnourished populations in many areas. Community kitchens and food distribution hubs were an important means of support for those physically able to attend. Indeed, these remain an essential part of nutritional care. But as the situation in Gaza has demonstrated, chronic conflict creates isolation and difficulties in reaching the very young children, pregnant women, the elderly, and the injured or disabled. These groups become those most at risk of severe malnutrition.

So, enter Plumpy’Nut. This convenient supplement with the cute name and French origins has proven to be a lifesaver in regions of humanitarian crises. From its humble beginnings to becoming the United Nation’s go-to for the treatment of severe malnutrition, the Plumpy’Nut rise to success has been impressive. But the tale is also one tainted by ethical debate, legal wrangles, misuse in the field and political interference in supply.

Origins

In the late 1940s, the Rouen District Dairy Cooperative launched the Nova brand to promote its line of yogurts and cheeses throughout Normandy and Brittany. The well-coordinated enterprise was pretty much an overnight success. Within a few years, Mamie Nova was launched: a new product range of luxury yogurts and desserts with a series of iconic advertising campaigns that turned the brand into a household name.1

Working for Mamie Nova was Michel Lescanne, a young agricultural and food processing engineer whose dreams really lay elsewhere in the food manufacturing industry. Lescanne had long wanted to apply his expertise to ways of alleviating childhood malnutrition. In 1986, he set out to do just that by establishing his own company, Nutriset, so that he could focus on developing commercially viable food aid.

The concept had arrived at a crucial time for global relief efforts. UNICEF’s work to support children in crises had begun in Europe and the US following World War II and expanded significantly during the Vietnam War and the Nigerian Civil War. By the 1970s, aid organisations were operating various programmes that were improving the nutritional health in over 100 nations. However, this often involved food acquisition from local producers or limited international sources, as the overseas supply chain and logistics were in their infancy. By the time Lescanne arrived on the scene, decades of conflict and crises had led to chronic food shortages. Malnutrition rates were high, and the landscape of international aid needed to evolve.

F-100

UNICEF’s Child Survival and Development Revolution outlined the urgent need for implementation of GOBI: an umbrella acronym for combined growth and development monitoring, oral rehydration therapy, the promotion of breast feeding and immunisation. Alongside other infant nutrition public measures, the rollout of GOBI was associated with improved vaccination uptake and less gastrointestinal disease. Infant mortality was also reduced. 2, 3  Nutritional care was another major UNICEF focus. Surveys concentrated on collecting data about food security and the efficacy of ration provisions in refugee camps. Organisations were also starting to consider how the most severely malnourished could be optimally fed.

The use of supplementation in humanitarian settings wasn’t new. Basic milk, oil and sugar mixes had been used in camps in Gaza, Asia and elsewhere since at least the 1950s, with nutritional refinements made over subsequent years. Lescanne partnered with researchers and organisations that were already working on milk-based therapeutic products to create a product that could be a source of complete nutrition. Professor Mike Golden was one, widely regarded as a key player in the development of a prototype high protein-high energy oral supplement, first tested by Golden and coworkers in Jamaica in the late 1980s. With the support of Action Contre la Faim (ACF; Action Against Hunger), Nutriset started commercial production of F-100 in 1993. 4 Containing 100kcal and 2.9g protein/100ml, F-100 is still made today for use in the main recovery / rehabilitation phase from malnutrition. A derivative product known as F-75 is also available as a ‘starter’ supplement, containing 75kcal and 0.9g protein/100ml on reconstitution.

F-100 and F-75 were an early game changer. Positive effects were demonstrated on weight gain, physiological markers of muscle mass increased, and mortality rate of severely malnourished children was reduced. Over following decades, safety and clinical benefits have been re-evaluated and reconfirmed. 5-7  Both products are now regularly used by the World Health Organisation and UNICEF.

Plumpy’Nut development

F-100 is a dried powdered product. It requires reconstitution with cooled, boiled water and was initially indicated only for administration under supervision and in clinical settings such as feeding centres. In North Uganda, it was observed that mothers were reluctant to bring their children to humanitarian or medical hubs, because of the high risk of kidnapping by the Lord’s Resistance Army. 8 A ready-to-use therapeutic food (RUTF) was needed that was nutritionally rich and required no preparation, reconstitution or refrigeration, and so could be kept and taken at home if required.

The ACF Scientific Committee considered various options. André Briend, a paediatrician, coworker of Golden and AFC committee member, was aware of the popularity of the hazelnut spread product Nutella. The possibility of using a peanut butter base was suggested as a core ingredient of RUTF to optimise palatability. Briend made the decision to resign from the ACF to join forces with Nutriset on product development. Plumpy’Nut was officially released onto the market in 1996.

Presented as a nutrient dense paste in a plastic wrapper, ingredients include peanut butter, sugar, vegetable oil and skimmed milk powder. The product is enriched with Vitamins A, C, D, E and K, a range of B vitamins, Calcium, Iron, Zinc, Copper, Iodine, and Magnesium. 9 Each 92-gram sachet provides 500 kilocalories. UNICEF guidelines for use are for three sachets to be taken daily for 6-8 weeks. 10

The primary indication for use is in the treatment of severe malnutrition in children aged 6 months and over, though it can also be used in adults with severe acute malnutrition, or to treat moderate acute malnutrition in accordance with national protocol. Plumpy’Nut is not intended to be made freely available within communities. When consumed as a home-based therapy, usage should be overseen where possible by community health workers.

The first evaluations were promising. In a study of malnourished Senegalese children aged 6-36 months, weight gain was faster with the (solid texture) Nutriset-produced RUTF than with F-100 therapeutic milk. 11 In a Bangladesh MSF nutrition programme for pregnant and lactating women, 85% of subjects perceived some therapeutic benefit from the paste version. 12

Product development continued to enhance composition, acceptability and stability. RUTF products were now revolutionising the humanitarian sector, with studies alluding to dramatic reductions in malnutrition-related morbidity and mortality. By the mid-2000s, UNICEF entered a mass-scale procurement agreement with Nutriset. UNICEF is now the biggest purchaser of global RUTF.

Patent and monopoly challenges

For the first 10 years of manufacture, and riding on the early field results of mitigated progression of malnutrition, the product was lauded as a revolutionary tool within the humanitarian sector. Its status was reinforced during the 2005-2006 Niger food crisis, when chronic poverty, drought and damage by locust infestation resulted in 3.3 million people facing increased food insecurity. The acute malnutrition rate reached 13.4 percent. Plumpy’Nut was distributed with the aim of reaching 40,000 malnourished children.

Recovery rates for those treated were once again impressive, at around 90%. 13 However Nutriset had a major supply challenge. Some NGOs felt that manufacture and delivery was not happening quickly enough and there was too much reliance on international logistics. Of the product provided by Nutriset to its primary clients (UNICEF and Médecins Sans Frontières), 30% of the Niger supply was made locally in one factory. The remainder had to be shipped in from factories abroad.14

With limited manufacturing capacity and import delays, Nutriset recognised that collaborating with local partners for Plumpy’Nut manufacture made sense. By patenting Plumpy’Nut and entering into contracts with local factories, Michel Lescanne indicated that Nutriset were playing their part in sustaining local industries and contributing to local economies. 13 Profits continued: over a 4-year period to 2009, sales increased by 36 million euros. 14 There were also general nods of approval now from humanitarian groups, especially with RUTF products, including Plumpy’Nut, being rubber-stamped by WHO and UNICEF.

Meanwhile, other manufacturers (conscious of market opportunities created by supply gaps) viewed Nutriset’s patents and its working relationship with the UN as a monopoly. UNICEF was buying Plumpy’Nut as most of its world stock of RUTF. Andre Briend was known to have professional links with the WHO and UNICEF at various points in time, though he did wave any personal right to financial benefits from the development of Plumpy’Nut.

Concerns were expressed that patent registrations were preventing manufacturers from creating and producing similar RUTF products and so were holding the health of hundreds of thousands of malnourished children to ransom. Two US companies, Breedlove Food and the Mama Cares Foundation, filed lawsuits in Washington DC for nullification of the US patent. Claims were that Plumpy’Nut was not a unique product; the concept and development of fortified oil-based energy dense supplements was already established in the industry; and Nutriset were preventing other companies from producing similar products that could be manufactured at a fraction of the cost. 15 The lawsuits collapsed after US courts deemed that the patent was valid.

No magic bullet

A RUTF packet that requires no preparation and minimal storage requirements offers convenience for the parent of a malnourished child and makes warehouse storage, transfer and distribution less problematic. While comments were not specifically aimed at Plumpy’Nut, there were worries that the inherent advantages of RUTF and media hype about nutrient properties were tempting overuse in the field. 16 Plumpy’Nut was only indicated for the treatment of malnutrition. In practice, it was frequently being used for malnutrition prevention. Public health efforts to promote breastfeeding (and the conferred immunological and bonding benefits) were being undermined.

At the other extreme, product acceptability varied between groups and populations. Palatability and general tolerance may seem minor issues but heavily influence a child’s compliance with nutrition therapy. In one study of 149 care givers in an urban slum region of Bangladesh, only four out of ten felt that Plumpy’Nut was readily accepted. Nearly half of children required significant encouragement with consumption. 17

Cost

UNICEF acknowledges that RUTF use in malnutrition treatment programmes requires significant financial outlay. 18  In 2017, an eight-week course of treatment with Plumpy’Nut was around 40-60 US dollars depending on the location of manufacture. 19 However, nearly ten years later, the cost of treatment is about the same. 20 This may partly reflect increased production capacity and advances in technological efficiency. Market competition may be another factor, with the expiration of patents in the US in 2017 and in the UK and European Union in the following year.

Despite cost stability, the use of Plumpy’Nut in chronically poor African and Asian countries remains heavily dependent on international aid funding sources. RUTF manufacturers have also reported huge increases in milk powder, grain and vegetable oil costs—almost double as a result of the war on Ukraine and global drought conditions affecting crop yields. 21

US foreign aid cuts

Originally established in the early 1960s by President John F. Kennedy, the United States Agency for International Development (USAID) is the financial conduit for US foreign aid. Programmes are given the green light after review by US Congress and involve contractual allocations of financial support to agencies working on the ground in health, education and social welfare.

In January 2025, just days after the Trump administration established the controversial Department of Government Efficiency (DOGE) and with Elon Musk in prominent position, USAID was targeted for closure. Trump’s claims were that the organisation was corrupt, run by “radical left lunatics” and required scrapping. In less than one month, the USAID workforce was decimated to 2% of its original size. Knock-on effects included the immediate cessation of major clinical trials for diseases associated with high mortality, and the prevention of medical aid and food supply to numerous global regions with high levels of food insecurity. By spring, USAID was able to re-engage in some specific collaborations with the UN World Food Programme. However, with foreign aid payouts largely halted, other agencies had to downsize operations drastically. 22

Nutriset’s concern lay in the ability of Edesia Nutrition, the contracted US manufacturer of Plumpy’Nut, to continue production and supply. Implications of the cuts were huge—Edesia Nutrition typically made enough Plumpy’Nut to support five million children in over two dozen countries each year. Edesia and another peanut-paste supplement producer had to cease manufacturing and shipping for the first half of 2025, as several foreign aid contracts were placed on pause or cancelled completely. Stock lay idle in the company warehouses for months. In August production was allowed to partially resume, but only after Edesia Nutrition had accumulated a deficit of 22 million US dollars in cancelled or unshipped orders. 23

RUTF in Gaza

Gaza’s history of food insecurity stretches back to the early 1900s, as a result of occupations by the Ottoman, Britain and (most notably) Israel. Famine was officially confirmed in Gaza for first time in August 2025. Even at the time of writing, an estimated 100,000 children and 37,000 breastfeeding and pregnant women in Gaza require treatment for acute malnutrition.

Plumpy’Nut regularly features in NGO donation campaigns in the media and charity storytelling, though most groups have a range of RUTF products at their disposal. Multiple RUTF options and suppliers provide flexibility—a key requirement in conflict zones, and political decisions that affect supply chains. That said, in many cases Plumpy’Nut is a preferred choice (for financial, contractual or logistical reasons) and has been used in Gaza by UNICEF, MSF and the World Food Programme almost since its invention. Edesia Nutrition also works with smaller partners inside Gaza including Multifaith Alliance to deliver Plumpy’Nut to local communities.

Unique challenges exist in delivering aid to Gaza. Ever since the early days of Israeli occupation, control of Gaza’s borders has been strangulating. With the escalation in conflict since October 2023, border closure frequency has increased dramatically. In 2025 when Gaza was already teetering on the edge of famine, Israeli forces put in place a complete land blockade for 12-weeks.

Even when aid trucks are allowed to enter, restrictions are placed on specific items. Israeli authorities have previously classified peanut butter as a ‘luxury’ item, preventing the entry of derived products into Gaza. 24 As Jamil and coworkers noted, the effectiveness of RUTFs including Plumpy’Nut has been hampered by politics, supply chain issues, blockades and the widespread displacement of care givers. 25

When intervention with RUTF in Gaza is been possible, outcomes have been positive. In one of the first major assessments since October 2023, a study was conducted as an evaluation of 1,415 moderate and severely malnourished children being treated with Plumpy’Nut at Patients’ Friends Benevolent Society Hospital, which was the only functioning paediatric facility in Gaza City at the time. Significant improvements in body weight and markers of lean body mass were found, particularly in those treated for more than four weeks. 26

All’s well that ends well?

Are there parallels between the Plumpy’Nut story and the infamous pharma scandals of the 1990s, when restrictive patents and corporate profiteering of HIV antiretroviral drugs led to millions of deaths in Africa? With regard to patents, Nutriset have stated they actually offer commercial protection to contracted producers in poor countries and in doing so, support businesses and local economies. Over time, many disputes over intellectual property protection and price setting have been resolved. In part, this occurred passively. As Plumpy’Nut patents in various countries reached their natural expiration dates, the market was opened up. Nutriset remains the largest RUTF manufacturer, though it is responsible for less than half of world production these days. 27

Then there is the PlumpyField initiative. This franchise programme involves extensive collaboration with government bodies, humanitarian agencies and local businesses. Nutriset maintains overall control, though the PlumpyField networking does represent a major shift towards local manufacture. It has undoubtedly optimised manufacture and distribution—and lessened cost—in emergency situations. MSF and Nutriset are friends again. In many instances Nutriset allows NGOs and local companies to produce the paste without paying licence fees, as long as quality standards are adhered to. This approach certainly isn’t harming business—Nutriset’s turnover was in excess of 160 million euros in 2022.

Lescannes’ original vision remains. Steadfast commitment to treating malnutrition and improving the health and survival of the world’s most vulnerable individuals is at the heart of everything Nutriset does. It may not be a not-for-profit operation, but the company is run as a social and solidarity enterprise. As a signatory of the UN Global Compact, Nutriset has committed to conduct its business in a way that preserves human rights and international labour standards. Profits to shareholders are limited and a substantial amount of Nutriset income is reinvested into R&D to fight malnutrition.

The incidence of global malnutrition is not static. Constant political unrest and new escalations in conflict see to that. Peaks and troughs in food insecurity affect the demand for aid and the ability for humanitarian and commercial sectors to respond appropriately. Political variables—not least Trump administration changes on foreign policy and aid funding—are equally hard to predict or influence. But Nutriset has a system in place and for the most part it seems to be working.

For now at least, Nutriset’s future in the management of malnutrition seems secure.

References

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