The bacterial component of the human gut microbiota undergoes a definable program of postnatal development. Evidence is accumulating that this program is disrupted in children with severe acute malnutrition (SAM) and that their persistent gut microbiota immaturity, which is not durably repaired with current ready-to-use therapeutic food (RUTF) interventions, is causally related to disease pathogenesis. To further characterize gut microbial community development in healthy versus malnourished infants/children, we performed a time-series metagenomic study of DNA isolated from virus-like particles (VLPs) recovered from fecal samples collected during the first 30 mo of postnatal life from eight pairs of monoand dizygotic Malawian twins concordant for healthy growth and 12 twin pairs discordant for SAM. Both members of discordant pairs were sampled just before, during, and after treatment with a peanut-based RUTF. Using Random Forests and a dataset of 17,676 viral contigs assembled from shotgun sequencing reads of VLP DNAs, we identified viruses that distinguish different stages in the assembly of the gut microbiota in the concordant healthy twin pairs. This developmental program is impaired in both members of SAM discordant pairs and not repaired with RUTF. Phage plus members of the Anelloviridae and Circoviridae families of eukaryotic viruses discriminate discordant from concordant healthy pairs. These results disclose that apparently healthy cotwins in discordant pairs have viromes associated with, although not necessarily mediators, of SAM; as such, they provide a human model for delineating normal versus perturbed postnatal acquisition and retention of the gut microbiota's viral component in populations at risk for malnutrition.assembly of the human gut DNA virome | childhood malnutrition | age/disease-discriminatory phage and eukaryotic viruses | gnotobiotic mice | epidemiology M alnutrition (undernutrition) is a leading cause of child mortality worldwide (1). Severe acute malnutrition (SAM) can manifest itself as progressive wasting (marasmus) or as a more abrupt onset syndrome characterized by generalized edema, hepatic steatosis, skin rashes and ulcerations, and anorexia (kwashiorkor). The configuration of the bacterial component of the gut microbiota of healthy infants evolves to an adult-like configuration during the first 2-3 y of life (2, 3). Normal postnatal maturation of the gut microbial community is perturbed in SAM; children with SAM living in Malawi and in Bangladesh have gut microbiota with bacterial configurations that appear younger (more immature) than the microbiota of chronologically age-matched individuals with healthy growth phenotypes (3, 4). Moreover, this immaturity is only transiently improved with current ready-to-use therapeutic food (RUTF) interventions (3, 4). These children can be viewed as having a persistent developmental abnormality-one that affects a microbial "organ" whose key functions include the biosynthesis of vitamins and the biotransformation of dietary components into p...