Introduction: Cafeteria environments within universities have a significant influence over sustainable and healthy dietary behaviours. Hence, this study aimed to understand the nutritional landscape of food options in university cafeterias and to identify the factors contributing to unhealthy food options from the perspective of food service vendors. Methods: Using a mixed-methods approach, 122 food options from all 12 residential campus cafeterias in Universiti Malaya (UM) were collected between October and December 2024. All food options were grouped into (i) bread, (ii) meat dishes, (iii) drinks, (iv) Western dishes, and (v) rice- or noodle-based fried food group; they were further analysed for calories, fat, saturated fat, dietary fibre, and salt using the Malaysian Food Composition Database (MyFCD) and the Singapore Food Composition Database (SFCD). Nutrient classification (high vs. low) was based on the criteria outlined in the Labelling Guidelines 2023. Additionally, food service vendors were interviewed to explore operational challenges, with data collection ceasing upon reaching thematic saturation. The interviews were then transcribed and analysed using thematic analysis. Results: Quantitative findings showed that there were 36 bread-based meals, 16 meat-based dishes, 18 beverages, 30 Westernstyle meals, and 22 rice- or noodle-based fried foods. The study also revealed an over-reliance on high-calorie, high-fat, and low-fibre foods, with limited availability of sustainable and nutritious options. Qualitative findings highlighted the influence of affordability, vendor practices, and student preferences on campus food choices. Conclusion: The study underscored the need for internal policy intervention, improved vendor education and sustainability practices, and increased accessibility to healthier meals on campus.