From Policy to School Plate: Assessing the Translation of Aquatic Food Recommendations into School Meal Systems in Low- and Middle-Income Countries

School meals can improve child nutrition and support local food systems. This study examined the inclusion of aquatic foods in dietary guidance and school food policies in low- and middle-income countries (LMICs), and how this guidance was reflected in school menus, recipes and meals reportedly served. We systematically searched grey literature for national food-based dietary guidelines (FBDGs), school food guidance, menus and recipes across 132 LMICs. A stakeholder survey assessed reported implementation, alignment between planning and provision, and perceived barriers and enablers. FBDGs were identified for 63 countries, and 62 (98%) included aquatic foods. School food guidance was identified for 71 countries, and 53 (75%) included aquatic foods. Aquatic foods appeared in menus for 26 of 47 countries (55%), in recipe documents for 18 of 26 (69%), and in individual recipes for 101 of 1,502 (7%). Only 14 countries had accessible documents at all four stages of the policy-to-school-plate pathway, and ten included aquatic foods throughout. Survey respondents rated food safety and affordability as primary enablers and cost and inadequate funding as the main barriers to fish provision. Among 30 paired respondents, aquatic animal-source foods were reported in menus or recipes by 80% and as served by 57%, with moderate agreement (κ = 0.49). Documentation became less common downstream, and planning did not always align with provision. Translation of dietary guidance into school meal provision depends on feasible guidance, resources, governance, procurement and supply systems, food safety, infrastructure and cultural acceptability.