Table 1 inclusion/ exclusion criteria of the study participants

Inclusion

 Parent(s) willing to sign consent form; the informed consent document will explicitly request permission to use the collected fecal samples for future studies, including but not limited to culturing component bacterial strains

 Child age 12–18 months and no longer exclusively breast fed

 WLZ (<−2 to −3) without bilateral pedal edema at the time of randomization

 Parent(s) willing to bring the child to the feeding center twice daily for the first 4 weeks of nutritional therapy, once daily for the second 4 weeks, and provide feeding once daily at home for the second 4 weeks, and twice daily at home for the final 4 weeks

Exclusion

 Medical conditions: Children with tuberculosis (diagnosis based on WHO 2014 guidelines which have been incorporated in the national TB control guidelines of Bangladesh). The guidelines depend upon the following five diagnostic principles (three out of five should be positive):

  -Specific symptoms of TB

  -Specific signs of TB

  -Chest X-ray

  -Mantoux test

  -History of contact

 Any congenital/acquired disorder affecting growth, i.e., known case of trisomy-21 or cerebral palsy; children on an exclusion diet for the treatment of persistent diarrhoea; having known history of soy, peanut or milk protein allergy

 Severe anemia (< 8 mg/dl)

 Antibiotic use within the last 15 days for Primary MAM participants

 Receiving concurrent treatment for another condition

 Failure to obtain informed written consent from parents/guardians