Differences in Dietary Quality by Sexual Orientation and Sex in the United States: NHANES 2011-2016

Published:December 08, 2021DOI:



      There are persistent disparities in weight- and diet-related diseases by sexual orientation. Lesbian and bisexual females have a higher risk of obesity and cardiovascular disease compared with heterosexual females. Gay and bisexual males have a higher risk of diabetes and cardiovascular disease compared with heterosexual males. However, it remains unknown how sexual orientation groups differ in their dietary quality.


      This study aimed to determine whether dietary quality differs by sexual orientation and sex among US adults.


      This was a cross-sectional study of 24-hour dietary recall data from a nationally representative sample of adults aged 20 through 65 years participating in the 2011-2016 National Health and Nutrition Examination Survey.


      Study participants were adults (n = 8,851) with complete information on dietary intake, sexual orientation, and sex.

      Main outcome measures

      The main outcome measures were daily energy intake from 20 specific food and beverage groups and Healthy Eating Index-2015 (HEI-2015) scores for sexual orientation groups (heterosexual vs gay/lesbian/bisexual).

      Statistical analyses performed

      Ordinary least squares regressions were used to calculate adjusted means for each food and beverage group and HEI-2015, stratified by sex and controlling for covariates (eg, age and race/ethnicity) and survey cycles (2011-2012, 2013-2014, and 2015-2016).


      Among males, red and processed meat/poultry/seafood (P = .01) and sandwiches (P = .02) were smaller contributors to energy intake for gay/bisexual males compared with heterosexual males. Among females, cereals (P =.04) and mixed dishes (P = .02) were smaller contributors to energy intake for lesbian/bisexual females compared with heterosexual females. Gay/bisexual males had significantly higher total HEI-2015 scores than heterosexual males (mean ± standard deviation 53.40 ± 1.36 vs 49.29 ± 0.32, difference = 4.14; P = .004). Lesbian/bisexual females did not differ in total or component HEI-2015 scores from heterosexual females.


      Although gay/lesbian/bisexual groups were similar for a variety of dietary outcomes compared with heterosexual groups, gay and bisexual men displayed healthier dietary quality for processed meat (by consuming smaller amounts) and overall dietary quality (according to HEI-2015) compared with heterosexual males.


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      C. E. Prestemon is a project coordinator, Carolina Population Center, University of North Carolina, Chapel Hill.


      A. H. Grummon is a postdoctoral fellow, Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA; and a research fellow, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.


      P. E. Rummo is an assistant professor, Department of Population Health, New York University School of Medicine, New York.


      L.S. Taillie is an assistant professor, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill; and a fellow, Carolina Population Center, University of North Carolina, Chapel Hill.

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