Abstract
BACKGROUND: Food preferences and dietary habits are influenced by social determinants, yet the intersection of sexual orientation and nutrition remains understudied in the Global South. We aimed to examine the relationship between sexual orientation and food consumption. METHODS: We analyzed cross-sectional data from 85,859 individuals aged 18 or older (84,359 heterosexual, 980 homosexual, and 520 bisexual) from the 2019 Brazilian National Health Survey (PNS). The consumption frequencies of unprocessed or minimally processed foods (e.g., beans, vegetables, fruits), animal-based foods, ultra-processed foods (soft drinks, sweets), and alcoholic beverages were estimated. Generalized linear models with a Poisson distribution were employed to calculate Prevalence Ratios (PR), stratified by sex and adjusted for sociodemographic variables. RESULTS: Significant disparities were observed across sexual orientations. Bisexual women exhibited the highest nutritional vulnerability, with a higher prevalence of consuming alcoholic beverages (PR: 1.59; 95%CI: 1.26–2.02), soft drinks (PR: 1.36; 95%CI: 1.09–1.70), and sweets (PR: 1.22; 95%CI: 1.01–1.47) compared to heterosexual women, alongside a lower intake of beans and vegetables. Lesbian women similarly showed higher alcohol consumption (PR: 1.44; 95%CI: 1.09–1.89) and lower frequency of healthy diet markers. Among men, gay individuals reported significantly lower consumption of red meat (PR: 0.85; 95%CI: 0.77–0.94) and beans, but higher consumption of chicken, contrasting with traditional masculine dietary patterns. CONCLUSIONS: Sexual orientation was associated with less healthy dietary patterns and increased alcohol intake, particularly among bisexual and lesbian women. These findings highlight sexual orientation as a relevant social determinant of health and suggest that the male preference for red meat may be moderated by sexual identity. Public health strategies must be inclusive to address these inequities. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40795-026-01285-5.