Understanding Stunting: Impact, Causes, and Strategy to Accelerate Stunting Reduction-A Narrative Review

Abstract

Stunting is a major global health concern, particularly in low- and middle-income countries, due to its persistently high prevalence. It often originates from chronic malnutrition during the critical first 1000 days of life. Maternal and child nutrition are critical determinants of a child's growth and development. This article aimed to explore the impact, causes, and evidence-based strategies to accelerate the reduction of stunting incidence worldwide. This review was undertaken with sources from PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE from October 2024 to January 2025. This review was undertaken with sources from PubMed, Scopus, Google Scholar, Science Direct, and MEDLINE from October 2024 to January 2025 using the keyword "Stunting", "Causes of stunting", "Stunting Impact", "Stunting Intervention", and "Stunting Prevention". The findings highlight the multifactorial causes of stunting, including maternal malnutrition, inadequate breastfeeding and complementary feeding, poor sanitation, and socioeconomic factors. Stunting is associated with impaired linear growth, cognitive deficits, gut dysbiosis, endocrine disruption, anemia, and increased risk of chronic diseases later in life. Addressing stunting demands multisectoral strategies focusing on maternal and child nutrition, infection prevention, improved WASH (Water, Sanitation, and Hygiene) practices, and socioeconomic support. The evidence presented may guide policy development and targeted interventions to prevent stunting and its long-term effects.

Keywords: children; dysbiosis; growth failure; stunting; undernutrition.

Figure 1

Stunting Syndrome: This figure explains how stunting syndrome is identified as a continuous cycle. Several factors that influence the intergenerational stunting syndrome cycle include genetic factors, nutritional deficiencies in mothers and children throughout life, inadequate breastfeeding, improper complementary feeding, infectious diseases and inflammation, and social factors such as lack of resources across generations and poverty. Various pathological alterations due to impaired linear growth in early life are associated with heightened morbidity and mortality rates, decreased physical ability, poor brain development, diminished economic prospects, and an increased risk of metabolic disorders in adulthood. HAZ—Height-for-Age Score (Created in BioRender, https://www.biorender.com/, accessed on 18 April 2025).

Figure 2

Explanation of the role of nutrition and endocrine regulation in stimulating growth. IGF-1—insulin-like growth factor 1; IGF-2—insulin-like growth factor 2; GH—growth hormone; GHRH—Growth Hormone Releasing Hormone; MC3R—Melanoconine-3 Receptor; T3—triiodothyronine; Ca²⁺—calcium; Zn²⁺—zinc; Mg²⁺—magnesium; Cu—copper (Created in BioRender, https://www.biorender.com/, accessed on 3 December 2024).

Figure 3

Mechanism of how fasting, nutrient deficiency, and protein deficiency affect growth hormones (GH, IGF-1, FGF21). IGF-1—insulin-like growth factor 1; GH—growth hormone; ↑—increase; ↓—decrease (Created in BioRender, https://www.biorender.com/, accessed on 23 December 2024).

Figure 4

The role of amino acids in the mTORC pathway in inducing impaired cognition. mTORC—mammalian target of rapamycin; mTORC1—mammalian target of rapamycin complex 1; mTORC2—mammalian target of rapamycin complex 2; GDP—guanosine diphosphate; GTP—guanosine triphosphate; Rag—regulator proteins, Rag A/B is small rags, Rag C/D is large rags, while Rag A/B forms a heterodimer with product of Rafg C/D (Created in BioRender, https://www.biorender.com/, accessed on 23 December 2024).

Figure 5

Pathophysiology EED induced impaired nutritional status (Created in BioRender, https://www.biorender.com/, accessed on 24 December 2024).

Figure 6

Mechanism of thyroid hormone synthesis. TSH—thyroid-stimulating hormone; TRH—thyrotropin-releasing hormone; T4—thyroxine; T3—triiodothyronine (Created in BioRender, https://www.biorender.com/, accessed on 30 December 2024).

Figure 7

Endocrine dysregulation during starvation and undernutrition. IGF-1—insulin-like growth factor 1; GH—growth hormone; GhRH—growth hormone-releasing hormone; TSH—thyroid-stimulating hormone; TRH—thyrotropin-releasing hormone; ACTH—adrenocorticotropic hormone; T4—thyroxine; T3—triiodothyronine; ↑—increase; ↓—decrease (Created in BioRender, https://www.biorender.com/, accessed on 18 January 2025).

Figure 8

Multisectoral strategies for reducing stunting prevalence. (Created on Microsoft Word, https://www.microsoft.com/en-us/microsoft-365/word, accessed on 30 December 2024).

Figure 9

Scheme for treating gut dysbiosis in addressing stunting (Created in BioRender, https://www.biorender.com/, accessed on 24 December 2024).