Background: Stunting remains a significant global health issue, particularly in low- and middle-income countries (LMICs). Globally, around 22% of children under five are affected, with high rates persisting in South and Southeast Asia. This review examines government-led programs in high-performing LMICs (Nepal, Bangladesh, and Vietnam) to identify key strategies and opportunities for effective intervention. Methods: A literature search was conducted on PubMed using keywords and Medical Subject Heading terms, including “stunting”, “child undernutrition”, “malnutrition” and the names of the three specified countries. Articles were evaluated for relevance based on their focus on stunting prevalence, risk factors, and interventions in these countries, without restrictions on publication date or language. Results: Stunting prevalence among children under five has significantly declined in Nepal, Bangladesh, and Vietnam over the past two decades, reflecting the impact of sustained nutrition and health interventions. Nepal reduced stunting from 55.8% in 2000 to 26.7% in 2022, Bangladesh from 54.7% to 26.4%, and Vietnam from 41.5% to 19.3%. Successful strategies included multisectoral approaches integrating nutrition-specific and nutrition-sensitive interventions, enhanced policy frameworks, and strong governance. Despite progress, challenges remain, such as high wasting prevalence in Nepal and disparities among marginalized communities in Vietnam, emphasizing the need for targeted, context-specific interventions. Conclusions: Effective stunting reduction requires multisectoral strategies addressing underlying, intermediate, and immediate determinants. Insights from Nepal, Bangladesh, and Vietnam highlight the importance of sustained government commitment, robust policies, and coordinated interventions. Adapting these successful strategies to local contexts can support stunting prevention and management, promoting healthier and more resilient communities.

The treatment of uncomplicated severe acute malnutrition includes ready‐to‐use therapeutic foods (RUTFs). Novel RUTF recipes aim for inclusion of locally sourced nutrient‐dense food ingredients for sustainability in product availability. This study investigated the incorporation of rice bran into RUTF formulations to enhance the bioactive nutrient profile. Experimental RUTFs were developed containing 0%, 5%, 7.5%, and 10% rice bran, without a vitamin/mineral premix for targeted nutrient and non‐targeted metabolite analysis. Additionally, an investigation was conducted analyzing the nutrient density and food safety of small‐scale mill‐sourced rice bran varieties collected from Guatemala and Cambodia for comparison to a US‐commercial rice bran. Targeted nutrient composition analysis of the RUTFs revealed dietary fiber, vitamin E, and vitamin B1 generally increased with higher rice bran content, though it was not dose dependent. The non‐targeted metabolite analysis identified 883 biochemicals across the four experimental RUTFs. Significant metabolite fold changes were identified for a variety of lipids, amino acids, carbohydrates, vitamins, and xenobiotics in 5%, 7.5%, and 10% rice bran‐RUTFs compared to the 0%. Analysis of small‐scale mill‐sourced rice brans from Guatemala and Cambodia showed variation in vitamin composition, with vitamin B3 averaging 37.1 mg/100 g and vitamin E ranging from 3.2 to 6.0 mg/100 g. These varieties also demonstrated variable microbial levels and trace metal contents, warranting continuous monitoring and evaluation in global supply chains. These findings support the feasibility of incorporating rice bran into RUTFs for malnutrition treatment and the benefit of screening locally sourced rice bran to address regional nutrient‐dense food product development and specifically for malnutrition treatment.

Background: Ready-to-use therapeutic foods (RUTFs) have been developed to treat severe acute malnutrition (SAM) in children by promoting rapid weight gain, but the long-term effects have been overlooked. Incorporating prebiotic rice bran into RUTF can enhance balanced weight gain. We hypothesized that children receiving RUTF + rice bran would exhibit increased fat-free mass (FFM) and reduced body fat percentage and abdominal adiposity. Methods: A double-blinded randomized controlled trial (ClinicalTrials.gov:NCT05319717) involving 200 children with different degrees of acute malnutrition compared the effectiveness of RUTF with or without rice bran. Children received treatment for 8 weeks, with another 8 weeks of follow-up. Anthropometry, including skinfolds, was collected every 4 weeks. Results: Compliance was similar in both groups (~21%). Children aged 6 to 23 months receiving RUTF + rice bran gained more FFM than those receiving RUTF alone (p = 0.05 at week 8). Over the 8-week treatment, the fat mass index increased in children receiving RUTF (p = 0.02), but not in those receiving RUTF + rice bran (p = 0.48), although the increase in body fat percentage was similar (p = 0.23). The ratio of abdominal to peripheral skinfolds decreased in both groups during treatment but increased during follow-up, though the difference was not statistically significant. In children aged 24 to 59 months, no significant differences in body composition were observed. The fat-free mass index increased in both groups during treatment but declined afterwards, with significant changes noted in the RUTF + rice bran group. Conclusions: The addition of rice bran to RUTF affected body composition changes during treatment only in younger children, where more lean mass was gained and fat mass gain was limited. Differences in intestinal microbiome maturity might underlie this age difference.