Global evidence on nutritious meal programs: A PRISMA-compliant systematic review of health outcomes and pharmacoeconomic implications

Abstract

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: 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.