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What is the origin of the name “Project Peanut Butter?”

In 2002, when RUTFs were recognized as life-changing, Dr. Manary and his family returned to America from Africa determined to raise money to continue a program. There was no specific name for the project at first, except "the-RUTF-research-program". A woman at the Manary's church and Dr. Manary's great-aunt began to refer to the program as the "Peanut Butter Project", describing the basic ingredient in the food. This evolved into Project Peanut Butter, and the organization took the name officially 2004, when it was legally established as a nonprofit.

Why do some starving children look bloated?

Many children who are starving appear "bloated" due to a fluid shift in their bodies (a healthy person's bodily fluid does not shift in this way). The medical term for this condition is "edema". The exact science behind edema is not well understood and appears to be complex, but edema is a sign of severe acute malnutrition. It is associated with famines, particularly in African nations.

Why don’t families practice birth control if their children are starving?

Family size in the countries with high rates of malnutrition is typically high. At one point in many societies, the number of children in a family was equated with wealth or even degree of supernatural blessings. Although this is not as much a factor in these countries today, parents still rely on a large family to help with work and to keep the family from starvation. With high infant and under-five morality rates, parents are less likely to limit the number of children they have. Research shows that birth rates in societies drop AFTER childhood survival rates improve. By improving the child survival rate, Project Peanut Butter strives to increase the likelihood that parents will have smaller families.

Won’t these children become malnourished again after completing therapy with RUTF?

It is true that once recovered from severe malnutrition, many children do continue to live in extreme poverty, but only rarely do they again succumb to malnutrition. PPB research shows that less than ten percent of severely malnourished kids will relapse. Why? Once restored to health with RUTF, a child has built up a nutritional reserve. Even when faced again with a hungry period or an infection, a child who has recovered earlier with the use of RUTF typically has enough strength and nutrition to fight through additional periods of food shortage.

Where else in the world is RUTF produced, and who else produces it?

RUTF is produced in many countries around the world, in both developed nations and locally. For-profit companies and nonprofit organizations alike manufacture the food. Many international aid organizations, including UNICEF, Clinton Health Access Initiative (CHAI), and Doctors Without Borders (MSF), purchase RUTF from suppliers and use it in their local programs.

Does RUTF go by any other names?

Ready-to-Use Therapeutic Food (RUTF) is a generic name for a product that has a specific nutritional makeup proven to bring malnourished children back from the edge of starvation. It may go by any number of “brand” names, depending on what company produces it. Many people have heard of “Plumpy’nut,” which is produced by a major France-based RUTF manufacturer called Nutriset. Project Peanut Butter’s product is known locally as “Chiponde” in Malawi and “Dutasi” in Sierra Leone. All of these foods are classified as RUTF, though their exact formulas may differ slightly.

Why don’t we hear about malnutrition on the news if it is such a huge problem?

Malnutrition is a silent epidemic, typically affecting the poorest people in the world. Even though malnutrition is a major cause of death among children worldwide, it is a chronic condition of the poor and therefore does not attract much attention from those of us safe from its grasp.

Where does PPB get its funding?

PPB receives a large portion of funding from grants and private foundations. We also rely heavily on individual donations from our supporters.

How does PPB decide which countries to work in?

The Manary’s chose Malawi for the first field trials because it was a country where they had previously lived and worked. Dr. Manary had familiarity with the medical system of the country and was an adjunct professor at the Malawi College of Medicine. It was a natural progression to spread PPB's work on the same continent, but in general, PPB looks for certain things in a country before deciding to set up RUTF production there. These things may include the local availability of RUTF ingredients in the quantities PPB requires, the presence of high quality suppliers and processors of raw materials, a favorable business climate that facilitates legal establishment, the availability of industrial level utilities and trained personnel, the presence of internationally accredited laboratories for product testing, political stability and safety, support from local and international aid organizations, and, of course, a genuine need for a local producer of RUTF. It is PPB’s hope that other nonprofits and governments will attack malnutrition using RUTF in the many other countries where it is needed.

Does PPB encounter many children with peanut allergies?

No. RUTF has been used to treat millions of malnourished children around the world, and the reported cases of peanut allergy have been very few. Many citizens of developed countries are surprised to hear this, since peanut allergies are increasingly prevalent in some parts of the world. There are a few theories for why we don’t see many peanut allergies among malnourished children. An allergic reaction is basically a person’s immune system overreacting to foreign matter that it perceives as potentially harmful. The immune system of a malnourished child is very active already because the child is very sick, so it typically would not even recognize peanuts as a threat or expend the extra energy to tackle such a thing. We must also consider the environment in which typical malnourished children grow up; it is more than likely not nearly as sanitary as that of children who grow up developed nations. Kids in African nations are frequently exposed to a variety of pathogens and “foreign material” at a young age, as they spend more time outdoors and eat whatever is available. Their immune systems are thus conditioned to fight more dangerous pathogens and would not recognize peanuts as an allergen.

Does PPB only treat severely malnourished children?

Since the majority of cases of severe acute malnutrition are found in children ages 6 months to 5 years, this is the major focus of PPB’s work. However, Dr. Manary and other investigators are constantly conducting research to better understand how to treat malnutrition in other groups of people. These groups include moderately malnourished children, malnourished adults, pregnant women, and adults living with HIV/AIDS and Tuberculosis. Project Peanut Butter does treat moderately malnourished children in addition to severely malnourished children at our mobile clinics.



If you have an additional question about Project Peanut Butter that has not been answered above, please don't hesitate to send your question to Thank you.



This is a list of scientific publications and abstractions related to Project Peanut Butter.

  • Manary MJ, Ndekha MJ, Ashorn P, Maleta K, Briend A: Home-based therapy for severe malnutrition with Ready-to-use food. Arch Dis Childhood 2004; 89-557-561.

  • Sandige H, Ndekha MJ, Briend A, Ashorn P, Manary MJ: Locally produced and imported ready-to-use-food in the home-based treatment of malnourished Malawian children. J Pediatr Gastro Nutr 2004; 39:141-146.

  • Maleta K Kuittinen J, Duggan MB, Briend A, Manary MJ, Wales J, Kulmala T, Ashorn P: Supplementary feeding of underweight, stunted Malawian children with ready-to-use food. Jpediatr Gastro Nutr 2004; 38:152-158.

  • Manary MJ, Ndekha M, brined A, Ashorn P: Home-based Therapy using ready-to-use food is of benefit to malnourished, HIV infected Malawian children. Act Paediatr 2005; 94:222-225.

  • Ciliberto MA, Sandige H, Ndehka MJ, Ashorn P, Briend A, Ciliberto HM, Manary MJ. A comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. Am J Clin Nutr 2005; 81(4):864-870.

  • Patel MP, Sandige HL, Ndekha MJ, Briend A, Ashorn P, Manary MJ. Supplemental Feeding with ready-to-Use therapeutic food in Malawian children at risk of malnutrition. J Health Pop and Nutr 2005.

  • Other Scientific Publications about Malnutrition Darmaun D Manary MJ, Matthews DE: A method for measuring both glutamine and glutamine levels with stable isotope enrichments. Anal Biochem 1985; 147:92-102.

  • Brewster DR, Manary MJ, Menzies IS, Henry RL, O'Loughlin EV: Comparison of milk and maize based diets in kwashiorkor. Arch Dis Child 1997; 76:242-248.

  • Brewster Dr Manary MJ, Menzies IS, O'Loughlin EV, Henry RL: Intestinal permeability in kwashiorkor. Arch Dis Child 1997; 76:236-241.

  • Manary MJ, Brewster DR, Broadhead RL, Crowley JR, Field CR, Yarasheski KE: Protein metabolism in children with edematous malnutrition and acute lower respiratory infection. AM J Clin Nutr 1997; 65:1005-1010.

  • Brewster DR, Manary MJ, Graham SM: Case Management of Kwashiorkor: An intervention project at 7 nutrition rehabilitation centers in Malawi. Eur J Clin Nutr 1997; 51:139-147.

  • Manary MJ, Brewster DR: Potassium Supplementation in Kwashiorkor. J Pediatr Gastroenterol Nutr 1997; 24:194-201.

  • Manary MJ, Brewster DR, Broadhead RL, Graham SM, Hart CA, Crowley JR, Field CR, Tarasheski KE: whole-body protein kinetics in children with kwashiorkor and infection: A comparison of egg white and milk as dietary sources of protein. Am J Clin Nutr 19997; 66:643-648.

  • Manary MJ, Broadhead RL, Yarasheski K: whole-body protein kinetics in marasmus and kwashiorkor during acute infection. Am J Clin Nutr 1998; 67:1205-1209.

  • Brewster DR, Manary MJ, Menzies IS, Henry RL, O'Loughlin EV: Comparison of milk and maize based diets in kwashiorkor. Malawi Medical Journal 1998; 11:2-5.

  • Manary MJ, Brewster DR: Potassium supplementation in kwashiorkor. Malawi Medical Journal 1998; 11:6-10.

  • Brewster DR, Manary MJ, Graham SM: Case management of kwashiorkor: An intervention project at 7-nutrition rehabilitation centers in Malawi. Malawi Medical Journal 1998; 11:15-20.

  • Manary MJ, Hart CA Whyte MP: Severe hypophosphatemia in children with kwashiorkor is associated with increased mortality. J Pediatr 1998; 133:789-791.

  • Manary MJ, Yarasheski KE, Hart CA, Broadhead RL: Plasma urea appearance rate is lower when children with kwashiorkor and infection are fed egg white tryptophan rather than milk protein. J Nutr 2000; 130:183-188.

  • Manary MJ, Brewster DR: Intensive nursing care of kwashiorkor in Malawi. Acta Paediatr 2000; 18(2):203-207.

  • Manary Mj, Leeuwenburgh C, Heinecke JW: Increased oxidative stress in kwashiorkor. J Pediatr 2000; 137(3):421-424.

  • Manary MJ, Hotz C, krebs NF, Gibson RS, Westcott JE, Arnold T, Broadhead RL, Hambidge KM: Dietary phytate reduction improves zinc absorption in Malawian children recovering from tuberculosis but not in well children. J Nutr, 2000; 130:2959-2964.

  • Manary MJ, MacPherson GD, McArdle F, Jackson MJ, Hunt CA: Selenium status, kwashiorkor and congestive heart failure. Acta Paediatr 2001; 90:950-952.

  • Manary MJ, Hotz C, Krebs NF, Gibson RS, Westcott JE, Broadhead RL, hambidge KM: Zinc homeostatis in Malwian children on a high phytate maize-based diet. Am J Clin Nutr 2002; 75:1057-1061.

  • Manary MJ, Krebs NF, Gibson RS, broadhead RL, Hambidge KM: Community-based dietary phytate reduction and its effect on iron status in Malawian children. Annals Trop Paediatr 2002; 22:133-136.

  • Manary MJ, Yarasheski KE, Broad RL: Urea production and leucine oxidation in malnourished children with and without acute infection. Metabolism 2002; 51(11):1418-1422.

  • Manary MJ, Yarasheski KE, Berger R, Broadhead RL: CO2 production during acute infection in malnourished Malawian children. Eur J Clin Nutr 2004; 58:116-120.

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