Main
weight gain, wasting, undernutrition
WASTING, UNDERNUTRITION
The global health challenge of childhood undernutrition is considerable; in 2020, an estimated 149 million children under the age of 5 years had stunted growth (low height for age) while 45 million exhibited wasting (low WLZ)Studies of healthy members of birth cohorts living in several countries have identified shared features of gut microbial community assembly—a process that is largely completed by the end of the second postnatal yearWe used gnotobiotic mouse and piglet models to design MDCF formulations for repairing the microbial communities of children with MAM. MAM is defined as having a WLZ score that is 2–3 s.d. below the median of a multinational cohort of age-matched healthy children. In a 3-month randomized controlled feeding study of 12–18-month-old Bangladeshi children with MAM, we demonstrated that a lead formulation (MDCF-2) produced a significant improvement in the rate of weight gain (Here we reconstruct the genomes of bacteria present in the gut communities of the participants in the completed trial, identify metabolic pathways that are differentially expressed in response to MDCF-2 in MAGs that are positively associated with WLZ and determine how their differential expression relates to the processing of components of MDCF-2 and ponderal growth responses. The results highlight the marked strain specificity of microbiome responses and point to two 