icddr,b’s MDCF-2: Fighting child malnutrition, one sachet at a time
In neighborhoods where hunger speaks loudly, MDCF-2, the small sachet of fortified paste developed by icddr,b, became a beacon of hope. Recently, it was named one of TIME’s Best Inventions of 2025 in the social impact category
When Mahfuza was born, she weighed much less than a healthy infant should. Her mother, Salma, only 26 and already raising two children, lived with her family of five in a single cramped room. Between feeding the others and keeping the home running, she barely had the strength to understand how to care for a fragile newborn who demanded extra care.
"For the first six months, Mahfuza survived on breast milk like any other infant. I tried to give her rice and lentil food, but gaining weight remained a challenge as she refused to eat much," said Salma.
Around her baby's first birthday, Salma learned about MDCF-2 (Microbiota-Directed Complementary Food), a gut-restoring food developed by icddr,b for malnourished children. Their Mirpur branch is just a five-minute walk from her home. News of the new trial spread quickly, as field officers reached out to Salma to ask if she would like her child to participate.
Keep updated, follow The Business Standard's Google news channel
She began feeding Mahfuza the food twice a day. Within just two weeks, she noticed a remarkable change: her tiny daughter was filling out, growing stronger, and finally developing the way a child should. These changes gave Salma hope that her daughter might have a healthy future after all.
This is not uncommon in Bangladesh. In slums and rural villages alike, poverty denies expectant mothers of proper nutrition, and their children bear the consequences from the very moment they enter the world.
Lucky, 33, and mother of three, knows this all too well. Her daughter Ayesha refused solid food and grew weaker by the day. Desperate, Lucky brought her to icddr,b's Mirpur branch, where she learned that Ayesha was severely malnourished.
"The people from icddr,b told us they had developed a new product for malnourished children and asked if we would try it," she said.
"As my other children had also received nutritional food from them before and benefited from it, I agreed."
Ayesha began eating MDCF-2, the same nutrient-rich paste. Soon, she was no longer the child who pushed food away — she now chases a ball across their narrow lane, strong enough to run and play.
In both cases, the improvement continued even after the three-month trial ended. Their children now eat regular food and are growing naturally.
In neighborhoods where hunger speaks loudly, the small sachet of fortified paste became a beacon of hope—so much so that MDCF-2 was named one of TIME's Best Inventions of 2025 in the social impact category.
How the study unfolded
The development of MDCF-2 did not happen overnight. Behind the miracles in Mirpur's slums lie years of scientific work. It all started with a simple question: Why do so many children remain malnourished in a world that produces ample food?
Dr Tahmeed Ahmed, executive director of icddr,b and Jeffrey Gordon of Washington University in St Louis, along with a team of around 15 scientists, formulated a therapeutic food—Microbiota-Directed Complementary Food No. 2 (MDCF-2) — designed to promote the growth of specific intestinal bacteria that break down food into molecules linked to bone growth and brain development. The Gates Foundation supported this research.
Around 2009, at a conference, Dr Tahmeed and Professor Jeffrey Gordon happened to sit together at breakfast. Dr Tahmeed focused on child nutrition and the microbiome, while Gordon studied obesity — in many ways, the opposite end of the problem. What began as a casual discussion over a meal grew into years of collaboration.
"We talk about food security and equity, but we need to work hard to make that reality. The search for better solutions has to continue," said Dr Tahmeed.
Globally, severe stunting and wasting still threaten millions of children. Traditional nutritional supplements help some, but many continue to fall behind. Researchers wanted to know what was missing.
Their answer came from the gut. The human intestine holds an astonishing ecosystem — around 100 trillion microorganisms, including nearly a thousand types of bacteria, yeasts and parasites. This microbiome shapes metabolism, immunity, and even gene expression.
In malnourished children, the balance of bacteria is disrupted: the growth-promoting microbes are too few; the harmful ones take over.
So how do we increase the good, growth-promoting bacteria?
"One way is to give them beneficial bacteria. But another way is to feed them the right foods," explained Dr Tahmeed.
Our goal was to find a more advanced treatment backed by the World Health Organisation, made entirely from Bangladeshi ingredients. Not every child can afford hospital treatment — they need a food-based solution with which they can recover.
To find those foods, scientists studied what healthy children living in Dhaka's slums already ate.
"Through nutritional anthropology, we observed and measured. What were they eating? It took us nearly a year to identify and collect those ingredients," added the scientist.
They identified twelve common ingredients: banana, chickpeas, egg, milk powder, peanuts, potato, red lentils, rice, spinach, sweet pumpkin, tilapia and whole wheat flour. Each ingredient was analysed for its ability to support beneficial gut bacteria.
Dr Ishita Mostofa, associate scientist at icddr,b's nutrition and clinical services division, shared how the field research of this product was conducted.
"We profiled the food commonly eaten by children in the slums of Mirpur and prepared different combinations. We tested these on mice first. Fish had to be removed because it didn't blend well with the other ingredients. After analysing blood samples, protein profiles and microbiota from stool, MDCF-2 proved to be the strongest candidate," explained Dr Mostofa.
From those studies, researchers created food prototypes using local, affordable, and culturally acceptable ingredients.
"The ingredients were ground into very fine particles, almost powder-like. Only peanuts contained oil, so we added oil, sugar and micronutrients. The mixture had a shelf life of just one day, so our team prepared it fresh every morning in a clean, field-based kitchen," she continued.
Organoleptic tests — taste, smell and texture — showed that children are willing to eat them. They ran trials in Dhaka and Kurigram for three months with 124 children.
In the first month, mothers came to the field office twice a day — in the morning and late afternoon — to receive each dose. In the second month, the first dose was given under observation, while the second was given to the mothers to take home in a container. In the final month, field workers delivered both doses to each household.
"Each child received 25 grams twice a day, on top of their regular meals, covering around 30% of their nutritional needs," Dr Ishita added.
In this study, two products were tested: the commonly used ready-to-use supplementary food (RUSF) and a new microbiota-directed formulation, MDCF-2, in two groups among the 124 children.
MDCF-2 was made of a simple list of ingredients — chickpea, soybean, peanut, green banana, soybean oil, sugar and micronutrients — it was designed not just to feed a child, but to repair the gut.
Children given MDCF-2 gained more weight than those who received RUSF, despite MDCF-2 having fewer calories. During follow-up, they were significantly less stunted, their gut microbiota was more mature, and their bodies showed higher markers for bone growth, immune development and brain function.
In other words, the food was not only filling stomachs but was also helping children grow.
WLZ (weight-for-length z-score), a key indicator of child growth, rose with the increase of beneficial bacteria in the gut. The science was clear: the right food could change the biology of a child's future.
"For a long time, Bangladesh did very little for malnourished children. We relied on traditional approaches: a child would be breastfed, and after six months, given home-cooked food. But not every household can afford nutritious traditional meals. Over the years, malnutrition and stunting increased, and that is where traditional methods stopped working. We needed an intervention," shared Dr Tahmeed.
Children have tiny stomachs. They need energy-dense food in small amounts, something their bodies can process.
For many children born into poverty, a sachet of MDCF-2 could mean the difference between just surviving and actually living healthily.
And the work is not stopping there. Researchers are already looking ahead — developing a glycan powder that could be sprinkled on rice, planning nutritious snacks for children, and even fortifying local products like RUTF (Ready-to-Use Therapeutic Food) 'Sharnali', which has been designed to treat children who are severely acutely malnourished (SAM), making them more effective.
After the first trial was completed, further studies of the mixture began, and MDCF-2 is now being patented for commercialisation.
"Our goal was to find a more advanced treatment backed by the World Health Organisation, made entirely from Bangladeshi ingredients. Not every child can afford hospital treatment — they need a food-based solution with which they can recover," concluded Dr Tahmeed.
