What’s on the menu? A review of school meal quality across twenty-nine countries

OBJECTIVE: The double burden of malnutrition (DBM) - the coexistence of undernutrition and overweight/obesity - poses a critical global health challenge, particularly for children and adolescents. School meal programmes offer an opportunity to address the DBM by providing nutritious meals that support growth, development and lifelong health. However, limited school meal quality data hinders effective programme design. This study evaluates global school meal quality through nutrient composition analyses and the Global Diet Quality Score (GDQS)-Meal and -Menu metrics. DESIGN: Data were collected from the Global Child Nutrition Foundation's 2024 Global Survey of School Meal Programs, grey literature and in-country stakeholders. Nutritional content was compared to age-specific Nutrient Reference Values, including Harmonized Average Requirements. The nutritional quality of meals and menus was assessed using GDQS metrics based on twenty-five food groups. SETTING: Twenty-nine countries across diverse geographic and socio-economic contexts. PARTICIPANTS: Not applicable. RESULTS: Most menus met or exceeded 30 % of recommended daily nutrient values. Lunches had the highest nutrient contributions, followed by snacks and breakfasts. GDQS-Meal and -Menu scores revealed variability across age groups, meal types and countries. Overall, 57 % of menus achieved high nutritional quality, 37 % medium and 6 % low. Few menus lost points for unhealthy components. Diverse, balanced menus with healthy food groups scored higher, though fortification also proved nutritionally valuable. CONCLUSIONS: While most menus contribute significantly to daily nutrient needs, variability across countries, age groups and meal types highlights opportunities for context-specific improvements through diversification and fortification. Learning from high-performing peer programmes can help identify feasible improvements.