are based in part on measurements of the state of development of the gut microbial community.Although that envisioned approach for evaluating MDCFs brings a microbial and 'multi-omics' perspective to human-nutrition research, it presents a variety of challenges for organizations such as the WHO and UNICEF that formulate recommendations for treating malnourished children. These challenges include balancing a desire to aggregate children over broad age ranges (e.g., from 6 months to 24 or even 36 months) on the basis of their anthropometric scores with the inevitably more stratified view of human biology that is revealed when co-development of the microbiome and host is considered; how this balancing act is negotiated could have substantial therapeutic and policy implications 11 . A list of other considerations for MDCF development that are related to science and technology, social and cultural considerations, and policy and governance is provided (Table 1).Research and development in this area needs to be incentivized in ways that ensure equitable and widespread distribution of the fruits of such efforts. A promising system developed by Nutriset, the largest manufacturer of ready-to-use foods for malnourished children globally, relies on a franchise model that provides local stakeholders the intellectual property, tools and expertise to produce its therapeutic foods 5 . Such a model leverages patent protection to create financial incentives for local manufacturers by effectively making intellectual property inaccessible to large manufacturing companies in high-income countries that could potentially monopolize production. Although focusing on local production may sacrifice short-term economies of scale for sustainability, a campaign to develop and deploy MDCFs must include long-term strategies for developing nations to achieve nutritional autonomy 12 .Looking ahead, it is important to determine whether microbiome-directed therapeutic foods can be developed for women of childbearing age to maximize their nutritional health, minimize low birth weight in their offspring and help break the vicious cycle of intergenerational malnutrition. Additionally, can knowledge gained from identifying foods that repair the microbiome of children with malnutrition also be used to identify a temporal sequence of complementary foods that prevent failed microbial community development and thus promote healthy growth? These questions lie at the base of a new kind of food pyramid that considers the gut microbiome as part of nutrition itself.