Global evidence on nutritious meal programs: A PRISMA-compliant systematic review of health outcomes and pharmacoeconomic implications
Keywords:
cost-effectiveness, health outcomes, nutrition intervention, pharmacoeconomic evaluation, public health policAbstract
Background: Nutritious meal programs (NMPs) have been widely implemented as public health strategies to address malnutrition, enhance learning outcomes, and strengthen economic well-being. Although numerous studies have evaluated their nutritional and educational effects, global evidence integrating both health and pharmacoeconomic outcomes remains limited. This study aimed to systematically review global findings on the health and economic efficiency of NMPs published between 2020 and 2025. Methods: This review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020) guidelines using a narrative synthesis approach. A comprehensive search was conducted across PubMed, PMC, Scopus, and grey literature from international organizations. Eligible studies included interventional or quasi-experimental designs that reported quantitative health and economic indicators. Data were analyzed descriptively and categorized into three domains: study characteristics, health outcomes, and pharmacoeconomic implications. Findings: Overall, NMPs demonstrated meaningful improvements in health indicators such as nutritional status, cognitive performance, and school attendance, which collectively contribute to long-term productivity and quality of life. From an economic perspective, most studies reported favorable cost-efficiency and positive social value, with cost–benefit ratios remaining within acceptable economic thresholds. Cross-study comparisons indicated that programs emphasizing balanced or fortified meals tended to yield the most significant health and economic advantages, reflecting strong synergy between clinical and fiscal outcomes. Conclusion: NMPs are effective and cost-efficient interventions that generate mutually reinforcing health and economic benefits. Novelty/Originality of this article: This review provides a comprehensive synthesis of global evidence on the health outcomes and pharmacoeconomic implications of NMPs, offering a valuable foundation for evidence-based nutrition and public health policy development across diverse national contexts.
References
Alderman, H., & Bundy, D. (2022). School feeding during the COVID-19 pandemic: Lessons learned and future directions. World Bank. https://doi.org/10.1596/36627
Bhutta, Z. A., Salam, R. A., & Das, J. K. (2023). Global nutrition and health: Progress and challenges. The Lancet Global Health, 11(4), e450–e468. https://doi.org/10.1016/S2214-109X(22)00547-9
Cohen, J. F., & Rees, R. (2021). Universal school meals and associations with student outcomes: A systematic review. Nutrients, 13(3), 911. https://doi.org/10.3390/nu13030911
Fanzo, J., Davis, C., & McLaren, R. (2021). Global food systems, diet, and health. Annual Review of Public Health, 42, 1–21. https://doi.org/10.1146/annurev-publhealth-090419-102340
Fanzo, J., Hunter, D., Borelli, T., & Mattei, F. (2021). Diversifying food and diets: Using agricultural biodiversity to improve nutrition and health. Routledge. https://doi.org/10.4324/9781003113266
Food and Agriculture Organization. (2023). The state of food security and nutrition in the world 2023. Food and Agriculture Organization. https://doi.org/10.4060/cc3017en
Global Child Nutrition Foundation. (2021). School meal programs around the world: Report 2021. https://survey.gcnf.org/wp-content/uploads/2021/03/GCNF_School-Meal-Programs-Around-the-World_Report_2021_Final.pdf
Global Nutrition Report. (2022). Stronger commitments for greater action. https://globalnutritionreport.org/reports/2022-global-nutrition-report/
Global Panel on Agriculture and Food Systems for Nutrition. (2021). The cost of malnutrition: Why policy action is urgent. GLOPAN. https://www.glopan.org/sites/default/files/pictures/CostOfMalnutrition.pdf
Global Partnership for Education. (2021). School feeding and learning outcomes: Evidence brief. https://www.globalpartnership.org/
Gupta, A., Patel, M., & Chatterjee, S. (2023). Nutrition, chronic disease prevention, and health economics: A global perspective. Public Health Nutrition, 26(5), 989–1001. https://doi.org/10.1017/S1368980022002211
Horton, S., & Steckel, R. (2021). Malnutrition: Global economic and health consequences. Health Affairs, 40(11), 1764–1772. https://doi.org/10.1377/hlthaff.2021.00492
Iannotti, L., & Ickes, S. (2022). Evidence for policies and practices to address global nutrition challenges. Annual Review of Public Health, 43, 1–20. https://doi.org/10.1146/annurev-publhealth-060922-041451
Jiang, Z., Liu, M., & Zhang, Y. (2024). School nutritious lunch program improves hemoglobin, BMI, and cognitive outcomes among children in China: A randomized controlled trial. Nutrients, 16(5), 1254. https://doi.org/10.3390/nu16051254
Kawabata, M., Tanaka, Y., & Suzuki, K. (2022). Balanced bento consumption and mental well-being among Japanese university students: A cohort analysis. Journal of Nutritional Science, 11, e67. https://doi.org/10.1017/jns.2022.67
Li, M., Chen, X., & Zhao, W. (2023). Impact of subsidized university meals on metabolic health and productivity among young adults in China: A cohort study. Asia Pacific Journal of Clinical Nutrition, 32(4), 845–854. https://doi.org/10.6133/apjcn.2023.32.4.13
López, A., Rodríguez, P., & Salazar, M. (2020). Micronutrient-rich breakfast program and its effects on hemoglobin and school absenteeism in Mexico. Salud Pública de México, 62(6), 704–711. https://doi.org/10.21149/12034
Masset, E. (2021). A review of the evidence on the impact of school feeding on education outcomes. International Journal of Educational Development, 81, 102365. https://doi.org/10.1016/j.ijedudev.2020.102365
Mohapatra, S., Gupta, A., & Reddy, R. (2023). Cost-effectiveness of the fortified mid-day meal scheme in improving nutritional outcomes among Indian schoolchildren: A cluster-randomized trial. SAGE Open Medicine, 11, 1–8. https://doi.org/10.1177/20503121231172253
Okafor, C., Adesina, T., & Umeh, O. (2021). Effects of community-based fortified school meals on anemia and cognition among Nigerian primary students. African Health Sciences, 21(3), 1012–1020. https://doi.org/10.4314/ahs.v21i3.1012
Osei-Kwasi, H. A., Nicolaou, M., & Powell, K. (2020). Systematic review of dietary patterns and chronic disease outcomes in LMICs. Public Health Nutrition, 23(1), 24–37. https://doi.org/10.1017/S1368980019003032
Popkin, B. M., Corvalan, C., & Grummer-Strawn, L. M. (2020). Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet, 395(10217), 65–74. https://doi.org/10.1016/S0140-6736(19)32497-3
Shekar, M., & Popkin, B. (2020). Obesity: Health and economic consequences of an impending global challenge. World Bank Group. https://doi.org/10.1596/978-1-4648-1491-8
Shetty, P. (2022). Malnutrition: The global challenge. British Medical Bulletin, 141(1), 5–16. https://doi.org/10.1093/bmb/ldac009
Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., & Moodie, M. L. (2020). The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. The Lancet, 393(10173), 791–846. https://doi.org/10.1016/S0140-6736(18)32822-8
Titi-Lartey, O. A., & Bhutta, Z. A. (2023). Recognition and management of marasmus and kwashiorkor. In Nutrition in clinical practice (pp. 1–10). Springer.
Urban Institute. (2023). Meals-to-you evaluation report: Outcomes of a national pandemic nutrition program. https://www.urban.org/research/publication/meals-to-you-evaluation
Wang, D., & Zhang, X. (2021). Impacts of school feeding on educational and health outcomes in LMICs: A systematic review. Journal of Global Health, 11, 04003. https://doi.org/10.7189/jogh.11.04003
Wang, L., Johnson, K., & Ramirez, D. (2022). Universal free school meals and student attendance in low-income districts in the United States: A quasi-experimental study. American Journal of Public Health, 112(9), 1558–1568. https://doi.org/10.2105/AJPH.2022.307057
World Health Organization. (2023). Strengthening nutrition action through food systems transformation. World Health Organization. https://www.who.int/publications/i/item/9789240076004
WHO. (2024). Policy brief: Investment in nutritious meal programs and global health returns. World Health Organization. https://www.who.int/publications/nutritious-meals-2024
World Bank. (2021). An investment framework for nutrition. https://openknowledge.worldbank.org/handle/10986/26069
World Food Programme. (2022). State of school feeding worldwide 2022. https://www.wfp.org/publications/state-school-feeding-worldwide-2022
Downloads
Published
How to Cite
Issue
Section
Citation Check
License
Copyright (c) 2026 Arung: Community Health Insight
This work is licensed under a Creative Commons Attribution 4.0 International License.
