Diet quality and nutritional health among transgender and gender-diverse youth and young adults: mixed methods results from Project Gender NutriScope

There is a need for exploratory nutrition research among transgender and gender-diverse (TGD) youth and young adults (YYA), an underrepresented population facing unique nutrition-related health challenges. The objective of Project Gender NutriScope was to characterize the diet quality, nutritional health, and nutrition-related perspectives of TGD YYA. This was a community-engaged, convergent parallel mixed-methods study. Estimated intake was assessed via 24-h dietary recalls. Healthy Eating Index (HEI)-2020 total and component scores were calculated to assess diet quality. Skin carotenoid levels (Resonance Raman spectroscopy (RRS)) were measured as a biomarker of fruit/vegetable intake. Hemoglobin (Hb) was assessed as an indicator of iron status (g/dL). Physical measures included waist circumference (WC) (cm) and systolic/diastolic blood pressure (SBP/DBP) (mmHg)). Semi-structured interviews captured qualitative data. Quantitative and qualitative data were analyzed using descriptive statistics and reflexive thematic analysis, respectively. A metropolitan area in central Ohio. A purposive sample of 16 TGD YYA (mean age 18.4 ± 3.5 y; range: 14–25; 12 assigned female at birth, 9 trans men; 12 non-Hispanic white). Mean (SD) diet quality was suboptimal with a Healthy Eating Index (HEI))-2020 total score of 46/100. Mean (SD) daily energy intake was 1,675.9 (678.5) kcal, with lower intake among youth [1,318.2 (399.1) kcal] compared with young adults [2,105.0 (702.6) kcal], and similar intake by sex assigned at birth. Mean (SD) skin carotenoid levels (RRS) were 21,437.5 for youth and 29,357.1 for young adults, reflecting low–moderate fruit and vegetable intake. Participants were at low risk for anemia (youth mean (SD) Hb: 14.7 (1.1); young adult mean (SD) Hb: 15.1 g/dL). Anthropometric and biometric measures indicated moderate cardiometabolic risk (youth: mean (SD) WC = 92.3 (16.8) cm, SBP/DBP percentiles = 84.3/74.4; young adults: mean (SD) WC = 101.5 (22.5) cm, SBP/DBP = 134/84 mmHg). BMI percentiles among youth were generally high (median = 91.0; IQR: 34.1–97.7), while young adults exhibited considerable variability in BMI (mean = 30.9 ± 9.0 kg/m2; range: 18.4–45.3). Qualitative interviews contextualized these findings, revealing four themes: dissatisfaction with diet quality, concerns about weight and body image, perceived gaps in nutrition knowledge, and the role of dietary behaviors in gender affirmation. TGD YYA experience multifaceted nutrition-related health challenges, including suboptimal dietary intake and cardiometabolic risk. Food choices and gender affirmation appear to influence each other—sometimes dietary practices serve as a form of affirmation—but this relationship varies across individuals. These findings underscore the need for evidence-based, gender-affirming nutrition education that aligns with the interests and priorities of the TGD community.