The Global Diet Quality Score (GDQS)-Meal and GDQS-Menu Metrics: How to Measure Meal and Menu Quality in Institutional Feeding Programs.

To achieve equitable, environmentally sustainable, and nutritious food systems, transformational change is needed. One potential path to such change is through institutional feeding programs, such as schools feeding. Despite the wide reach of institutional feeding programs there has not until recently been a simple yet rigorous metric that can measure, track, and evaluate the nutritional quality of the meals and menus. This lack of standardized measurement is particularly noticeable in low- and middle-income countries, with the implication that the relative contribution of institutional feeding programs towards reducing malnutrition or how to invest to maximize impact remains largely unknown. The Global Diet Quality Score (GDQS)-Meal and GDQS-Menu metrics were designed to fill this gap and to enable consistent and accurate tracking of the nutritional quality of meals and menus around the world. Derived from the existing Global Diet Quality Score (GDQS) metric, the GDQS-Meal and GDQS-Menu metrics assign a point total for the overall nutritional quality of a meal or menu based on its performance of four sub-metrics: 1) Healthy GDQS-Meal (or Menu), 2) Unhealthy GDQS-Meal (or Menu), 3) Fortification and Biofortification, and 4) Food Group Diversity. The metrics were designed to be low-burden and easy-to-use while maintaining scientific rigor for individuals of all ages in schools and across other institutional feeding programs such as prisons and workplace cafeterias. Results from the GDQS-Meal and GDQS-Menu metrics can be used for identification of simple substitutions for healthier meal and menu options, enforcement of meal quality standards, benchmarking, educational purposes, and advocacy efforts to encourage institutional feeding programs to invest in healthier meal and menu options.