Grass carp (Ctenopharyngodon idellus) is one of the most important aquaculture fish in China. This study tried to explore the effects of dietary alcoholic extract of lotus leaf (AELL) addition on the growth performance and health status of grass carp by feeding juvenile fish (average weight: 34 ± 1 g) with four different experimental diets: control, AELL7, AELL14 and AELL21 for 8 weeks. At the end of the growth trial, the highest values of final body weight (FBW), weight gain rate (WGR), specific growth rate (SGR) and feed intake (FI) all occurred in group AELL14 (P < 0.05). Compared to control, the crude lipid content of whole-body and the serum malondialdehyde (MDA) in the three experimental groups decreased, while the serum superoxide dismutase (SOD), glutathione peroxidase (GSH) and total antioxidant capacity (T-AOC) values almost all increased in the three experimental groups. The highest serum immunoglobulin M (IgM) concentration occurred in AELL14 group (P < 0.05). In AELL14 and AELL21 groups, both the serum complement 3 (C3) concentration and lysozyme (LYS) activity were significantly higher, whereas the final cumulative mortality in challenge test was significantly lower, when compared to those in control group (P < 0.05). The AELL exerted dose-dependent beneficial effects on grass carp health through up-regulating related gene expressions and enzyme activity. In conclusion, the optimal dietary AELL level is 0.14% for juvenile grass carp. •Lotus leaf extract can improve growth performance and health status of grass carp.•Lotus leaf extract exhibited dose-dependent beneficial effects on grass carp.•Optimal lotus leaf extract inclusion level in the grass carp diet is 0.14%.