Despite improvements in crop production and poverty levels, the WHO estimates that 24% of children are stunted globally, totaling 171 million children. Stunting is a form of chronic malnutrition when children fall below their height-for-age median, leading to cognitive impairment and lifelong economic loss. Nutritional supplementation has failed to improve the prevalence of stunting, prompting alternative explanations that include environmental enteric dysfunction (EED), an inflammatory intestinal abnormality, and mycotoxin exposures. Both of these associated factors are climate-dependent.

A systematic review of primary research was conducted in PubMed and WHO databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 191 studies were identified; 27 met the inclusion criteria, and 23 articles were selected and related to stunting, EED, and mycotoxins. Recently published clinical trials were unsuccessful at resolving EED with immunosuppressant, antiparasitic, or dietary therapies.

A stunting factor known to co-occur with EED is mycotoxin exposure from contaminated grains and groundnuts, although the pathway linking mycotoxin exposure to stunting is unclear. Current studies have evaluated influences of reducing exposure and removing mycotoxins from affected foods, although the results have been unclear. Research in EED and mycotoxicity is underway but remains elusive in mitigating childhood stunting. Climate change and environmental factors will further exacerbate both factors by increasing the difficulty of proper sanitation establishment and shortening the time food can be safely stored in humidity.

Efforts at reducing stunting, particularly among developing countries, need to focus on improved sanitation and mycotoxin eradication in the context of changing climates.