Nutraceutical Interventions in Stunting: Advances, Challenges, and Prospects.

Childhood stunting remains a major global health challenge, reflecting the cumulative effects of inadequate nutrition, recurrent infection, and chronic intestinal dysfunction during early life. Beyond conventional micronutrient supplementation, nutraceutical interventions have emerged as complementary strategies to address the complex biological pathways underlying impaired linear growth. This review synthesizes current evidence on nutraceutical approaches to stunting, including improvements in macronutrient quality, bioactive food components, and microbiome-targeted strategies such as probiotics, prebiotics, synbiotics, postbiotics, and microbiota-directed foods. Evidence from clinical and preclinical studies indicates that nutraceutical effects on growth are generally modest and heterogeneous, with more consistent effects on weight gain than on height-for-age (HAZ). Variability in efficacy is strongly influenced by baseline nutritional status, environmental enteric dysfunction (EED), infection burden, dietary quality, and water, sanitation, and hygiene (WASH) conditions. Mechanistically, nutraceuticals may act through modulation of gut barrier integrity, inflammatory tone, microbial metabolism, and endocrine signaling pathways, particularly those involving the growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis. Recent microbiota-directed food trials provide proof-of-concept that targeted correction of microbiome immaturity and gut dysfunction can support linear growth. Looking forward, advances in nutrigenomics, microbiome science, and epigenetics support a shift toward precision nutrition strategies that tailor interventions to biological responsiveness and context. Systems biology approaches integrating multi-omics data, network pharmacology, and interpretable artificial intelligence are expected to refine mechanistic understanding and guide intervention design. Effective translation will require rigorous trial designs, regulatory clarity, and integration of nutraceuticals within broader stunting reduction frameworks in low- and middle-income countries.