Hi Njau The ration of RUTF aims to provide the child with all of their nutritional needs for RECOVERY from SAM. Thanks

Energy requirements for catch up growth can be roughly estimated with the assumption that maintenance requirements are 80-100 kcal/kg and the cost of growth is about 5 kcal /g. 200 kcal/day is more than twice the energy intake recommended for a well nourished child. It corresponds to the requirement for a catch up growth of around 20 g/kg/day (100 + 5 x 20), a weight gain never achieved in OTP. This recommendation goes back to the old days when the recovery phase took place in hospital, where feeds were supervised and weight gains often much higher than in OTPs. Now in community settings, weight gain are lower, typically 5 g/kg/day on average and children presumably never eat that much RUTF. A lower recommendation, around 150 kcal/kg/day to take into account children with a weight gain higher than average and some wastage, would be more appropriate.