ABSTRACT

Objective

To describe the distribution of nutritional status and food insecurity among the adult transgender population in the Baixada Santista region of the state of São Paulo and to identify associated factors.

Methods

This was a cross-sectional study using data from the research project entitled Mapping the Transgender Population in Baixada Santista of the state of São Paulo, conducted through a structured questionnaire administered between August and December 2023. The outcomes were nutritional status and food and nutrition insecurity (FNI). The association analysis was performed using Fisher’s exact test.

Results

A total of 237 people took part in the study. High prevalence of FNI was associated with an income of less than 2 minimum wages (p < 0.001), difficulty finding a job (p < 0.001) and lack of family support related to gender (p = 0.001). Difficulty reading/writing (p = 0.025) and proximity to an open-air market (p = 0.033) were negatively or positively associated with adequate nutritional status, respectively.

Conclusion

The high prevalence of FNI among the most vulnerable population and the adequate nutritional status associated with proximity to open-air markets indicate the need for policies aimed at reducing inequities and expand access to adequate food.

Palabras clave
Personas Transgénero; Inseguridad Alimentaria; Estado Nutricional; Factores Socioeconómicos

Study contributions

Main results

The high prevalence of FNI was associated with low income, difficulty finding a job and lack of family support. Adequate nutritional status among the transgender population analyzed was associated with proximity to open-air markets.

Implications for services

Service teams should incorporate the assessment of nutritional status and food and nutrition security into their routine practices in order to provide adequate service that addresses the demands and social situation of the transgender people they serve.

Perspectives

There is a need for public policies aimed at reducing socioeconomic disparities exacerbated by discrimination against transgender people and facilitating access to establishments that offer diverse and quality food.

Palabras clave
Personas Transgénero; Inseguridad Alimentaria; Estado Nutricional; Factores Socioeconómicos

RESUMEN

Objetivo

Describir la distribución del estado nutricional y de inseguridad alimentaria de la población adulta trans en la región de Baixada Santista/Estado de San Pablo, además, identificar factores relacionados.

Métodos

Datos del estudio transversal Mapeo de la Población Trans en Baixada Santista de San Pablo, realizado mediante cuestionario estructurado entre agosto-diciembre de 2023. Los resultados fueron el estado nutricional y la inseguridad alimentaria y nutricional (IAN). Análisis de asociación mediante la prueba exacta de Fisher.

Resultados

Participaron del estudio 237 personas. La alta prevalencia de IAN se asoció con ingresos inferiores a 2 salarios mínimos (p < 0,001), dificultad para encontrar trabajo (p < 0,001) y falta de apoyo familiar relacionado con el género (p = 0,001). La dificultad para leer/escribir (p = 0,025) y acceso a un mercado callejero (p = 0,033) se asociaron negativa o positivamente con un estado nutricional adecuado, respectivamente.

Conclusión

Alta prevalencia de NIA entre la población más vulnerable y adecuación del estado nutricional asociado al acceso a mercados callejeros cercanos indican la necesidad de políticas que decrezcan las inequidades y extiendan el acceso a una alimentación adecuada.

Palabras clave
Personas Transgénero; Inseguridad Alimentaria; Estado Nutricional; Factores Socioeconómicos

INTRODUCTION

Food and nutrition security is defined as “regular and permanent access to quality food, in sufficient quantity, without compromising access to other essential needs”.¹1 Brasil. Lei nº. 11.346, de 15 de setembro de 2006. Lei Orgânica de Segurança Alimentar e Nutricional. Diário Oficial da União 2006; 18 set. Based on this concept, food and nutrition insecurity (FNI) is understood as a social problem that affects comprehensive health, due to the psycho-emotional and biological consequences associated with nutritional deficiencies, overweight and obesity.²2 Segall-Corrêa AM, Marin-Leon L. A segurança alimentar no Brasil: Proposição e usos da escala brasileira de medida da insegurança alimentar (EBIA) de 2003 a 2009. Segur. Aliment. Nutr. 2015; 16(2): 1-19. doi: 10.20396/san.v16i2.8634782.
https://doi.org/10.20396/san.v16i2.86347... .³3 Santos LP, Lindemann IL, Motta JV, Mintem G, Bender E, Gigante DP. Proposal of a short-form version of the Brazilian food insecurity scale. Rev Saude Publica. 2014 Oct;48(5):783-9. doi: 10.1590/s0034-8910.2014048005195. PMID: 25372169; PMCID: PMC4211573.
https://doi.org/10.1590/s0034-8910.20140...

Several factors can contribute to this situation. With regard to agricultural production and the fight against hunger, Brazil persists in following outdated directives of a predatory economy, expanding subsidized financing for the agribusiness sector and directing food production for export.⁴4 Leite MLS, Leite JF. (In)segurança alimentar e agricultura familiar: políticas públicas como estratégia de superação da fome. Florianópolis: R. Katál.; 2022;25(3):528-538, set.-dez. ISSN 1982-0259. doi: doi.org/10.1590/1982-0259.2022.e86341,⁵5 Grilo MF, Menezes C, Duran AC. Mapeamento de pântanos alimentares em Campinas, Brasil. Ciênc. saúde Coletiva. 2022;27(7):2717-2728. These decisions only benefit large corporations and their respective intermediaries, without taking into account the need to produce quality food for the population’s food security. Thus, reducing inequalities requires reorienting the economy to meet the needs of the population, primarily through policies to combat hunger.⁴4 Leite MLS, Leite JF. (In)segurança alimentar e agricultura familiar: políticas públicas como estratégia de superação da fome. Florianópolis: R. Katál.; 2022;25(3):528-538, set.-dez. ISSN 1982-0259. doi: doi.org/10.1590/1982-0259.2022.e86341

Furthermore, the characteristics of the food environment can interfere with physical access to healthy foods and accentuate health inequalities, leading to an increase in the consumption of unhealthy foods, due to the greater availability of establishments selling ultra-processed foods compared to those selling healthier options.⁵5 Grilo MF, Menezes C, Duran AC. Mapeamento de pântanos alimentares em Campinas, Brasil. Ciênc. saúde Coletiva. 2022;27(7):2717-2728.

Regarding the COVID-19 pandemic, it can be stated that, even before this exacerbating factor, the transgender population was already considered a vulnerable group for FNI,⁵5 Grilo MF, Menezes C, Duran AC. Mapeamento de pântanos alimentares em Campinas, Brasil. Ciênc. saúde Coletiva. 2022;27(7):2717-2728.,⁶6 Fergusson P, Greenspan N, Maitland L, Huberdeau R. Towards Providing Culturally Aware Nutritional Care for Transgender People: Key Issues and Considerations. Can J Diet Pract Res. 2018;79(2):74-79. doi: 10.3148/cjdpr-2018-001. Epub 2018. PMID: 29543495.
https://doi.org/10.3148/cjdpr-2018-001... ,⁷7 Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr. 2021;24(18):6436-6449. doi:10.1017/S1368980021001671. but this pandemic has further affected this reality.⁷7 Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr. 2021;24(18):6436-6449. doi:10.1017/S1368980021001671.,⁸8 Gomes SM, Jacob MCM, Chaves VM, et al. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One. 2023;18(5):e0284257. doi:10.1371/journal.pone.0284257.,⁹9 Gois I, da Silva, MRD, Oliva RM, La Blanca S, Vieira, DL. Income, occupation and psychosocial health of transgender people during the COVID-19 pandemic. Interfaces Científicas-Saúde e Ambiente. 2023;9(2):261-277. doi: doi.org/10.17564/2316-3798.2023v9n2p261-277. One of the first studies on FNI among the Brazilian transgender population found a prevalence of 68.8% in the sample. In addition, transgender people have other nutritional and social aspects that are shaped by gender experiences and there are gaps in the scientific literature on this topic, especially in Global South countries.⁷7 Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr. 2021;24(18):6436-6449. doi:10.1017/S1368980021001671.,⁶6 Fergusson P, Greenspan N, Maitland L, Huberdeau R. Towards Providing Culturally Aware Nutritional Care for Transgender People: Key Issues and Considerations. Can J Diet Pract Res. 2018;79(2):74-79. doi: 10.3148/cjdpr-2018-001. Epub 2018. PMID: 29543495.
https://doi.org/10.3148/cjdpr-2018-001...

Thus, the objective of this study was to describe the distribution of nutritional status and food insecurity among the adult transgender population (aged 18 years and old) in the Baixada Santista region, state of São Paulo, and to identify associated factors.

METHODS

Study design and participants

This study used data from the research project entitled Mapping the Transgender Population of the State of São Paulo: Metropolitan Region of Baixada Santista (MTP), a cross-sectional observational study, employing both a quantitative and qualitative approach that mapped the transgender population aged 18 years or old, living, working or studying in one of the nine municipalities that comprise this region of the state of São Paulo. The MTP investigated the socioeconomic and demographic characteristics of this population, including living conditions, work, health and related aspects.

Sample

The value of 1.88% was applied to the total adult population of the municipalities in Baixada Santista, the only national estimate available of the magnitude of transgender and non-binary people, obtained from a Brazilian estimate.¹⁰10 Spizzirri G, Eufrásio R, Lima MCP, de Carvalho Nunes HR, Kreukels BPC, Steensma TD, Abdo CHN. Proportion of people identified as transgender and non-binary gender in Brazil. Sci Rep. 2021 Jan 26;11(1):2240. doi: 10.1038/s41598-021-81411-4. PMID: 33500432; PMCID: PMC7838397.
https://doi.org/10.1038/s41598-021-81411... Based on 19,965 people with an expected frequency of 50%, and a design effect of 1, a sample of 377 people was calculated, proportionally distributed across the municipalities.

Recruitment and data collection

An online registration of interest in taking part in the research was used as a recruitment strategy. The link and QR code for accessing the registration were widely disseminated in the Baixada Santista region and on social media (Instagram and Meta® WhatsApp groups). Transgender, transvestites and non-binary people who completed this registration and responded positively to the question Can we contact you? by providing contact information were invited to participate in this study.

In order to enable contact with those who had agreed to participate in the study, an Excel spreadsheet was generated from the database on the REDCap (Research Electronic Data Capture) platform, which was updated weekly and made available to the field supervisor and a trained interviewer for scheduling. These contacts were made via WhatsApp (Meta®), email or telephone, and for those who agreed to take part, an interview was scheduled, either face-to-face or remotely, using the Zoom ® platform, depending on their preference.

In addition to registration, active searches were conducted at primary health care centers specialized in transgender health care, as well as locations serving as reference points for welcoming this population in the study region.

Data collection involved administering a structured questionnaire on the REDCap platform. The complete questionnaire had 11 thematic blocks (Box 1). For this study, we used the variables from blocks 1, 2 and 4.

The data collection period for this study, planned for October and November 2023, was extended by one month to approximate the initially calculated sample size. However, the sample was not achieved in all municipalities, and, due to the exhaustion of recruitment strategies, it was decided to conclude the fieldwork.

Variables

The primary outcomes of this study were nutritional status (NS) and FNI. In order to analyze socioeconomic and demographic characteristics, the following variables were selected: age (18 to 24, 25 to 30 and over 30 years old); gender identities collected as trans woman, transvestite, trans man, transmasculine individual, non-binary person, agender and pangender and categorized into “transfeminine” (trans women and transvestites), “ transmasculine” (trans man and transmasculine individual) and “non-binary” (non-binary person, agender and pangender); self-declared race/skin color; schooling (incomplete and complete elementary education, incomplete and complete high school, incomplete and complete higher education, and postgraduate degree); income in the last month (no income, up to one minimum wage and above one minimum wage); difficulty finding a job (yes or no); source of income (internship/scholarship, formal work (Consolidation of Labor Laws – Consolidação das Leis do Trabalho - CLT, legal entity – LE, public servant, contract, informal work and benefits (pension, Bolsa Família, sickness benefit and social security retirement); and existence of family support, considering the respondent as a trans person (family does not know about transgenderism, fully supportive, partially supportive, unsupportive, indifferent, and has no contact with family/completely disapproves).

Nutritional status was analyzed using the body mass index (BMI) [weight/height² (kg/m²)], according to the World Health Organization (WHO) classification for the adults, which categorizes the population into underweight grade III (BMI < 16), underweight grade II (BMI 16 to 16.99), underweight grade I (BMI 17 to 18.49), eutrophy (ideal weight for height) (18, 50 to 24.99), overweight (25 to 29.99), grade I obesity (30.00 to 34.99), grade II obesity (35.00 to 39.99) and grade III obesity (over 40) . These categories were regrouped into underweight (BMI < 18.50 kg/m² ), eutrophy (18.50 to 24.99 kg/m²), overweight (24.99 to 30.00 kg/m²) and obesity (BMI above 30.00 kg/m²);¹¹11 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. (2000). World Health Organization technical report series, 894, i–253. the BMI classification for individuals aged 60 years and older is categorized as underweight (BMI < 22.0 kg/m² ), eutrophy (22.0 to 27.0 kg/m² ) and overweight/obesity (BMI above 27 kg/m2);¹¹11 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. (2000). World Health Organization technical report series, 894, i–253. degree of FNI was calculated according to the Brazilian Food Insecurity Scale - 2014 (eight questions) and classified as mild (1-3 points), moderate (4-5 points) and severe (6-8 points);⁴4 Leite MLS, Leite JF. (In)segurança alimentar e agricultura familiar: políticas públicas como estratégia de superação da fome. Florianópolis: R. Katál.; 2022;25(3):528-538, set.-dez. ISSN 1982-0259. doi: doi.org/10.1590/1982-0259.2022.e86341.⁵5 Grilo MF, Menezes C, Duran AC. Mapeamento de pântanos alimentares em Campinas, Brasil. Ciênc. saúde Coletiva. 2022;27(7):2717-2728. and, to assess the quality of access, they were asked about the types of establishments near their residence that sell fruits and vegetables.¹²12 Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994 Mar;21(1):55-67. PMID: 8197257.

Statistical analysis

Results were presented descriptively, including frequency, percentage, mean and standard deviation. Fisher’s exact test was used to analyze the factors associated with the outcomes, considering a p-value < 0.05 for statistical significance. Data were analyzed using the Jamovi 2.3.21 statistical software. ¹⁴14 The jamovi project (2022). jamovi. (Version 2.3) [Computer Software]. Disponível em: https://www.jamovi.org.
https://www.jamovi.org...

Ethical aspects

The MTP research project was submitted to and approved by the Research Ethics Committees of the Centro de Referência e Treinamento em IST/Aids de São Paulo (CRT) and the Universidade Federal de São Paulo, under Certificate of Submission for Ethical Appraisal No. 64010722.8. 0000.5375.

RESULTS

The sample consisted of 237 people, representing 62.9% of the calculated sample, from the nine municipalities of the Metropolitan Region of Baixada Santista. The most represented municipalities were Santos (27.8%), São Vicente (23.6%) , Guarujá (23.2%), Praia Grande (8.9%) and Itanhaém (8.9%). Regarding gender identity, 42.6% of people identified as transfeminine; 36.3%, as transmasculine; and 21.1%, as non-binary. The median age was 27 years (minimum 18 and maximum 68 years old), and 67.5% were under 30 years old.

Table 1 shows selected socioeconomic and demographic characteristics. Regarding the level of education, 80.5% had completed at least high school. However, 5.5% of the sample reported difficulty reading and writing. With regard to income and the labor market, 65.8% stated that they had difficulty finding a job, 63.7% reported having no income or an income of up to one minimum wage in the 30 days prior to the interview, and among those who had a source of income, 46.3% reported formal employment.

Full (34.9%) and partial (32.3%) family support for gender identity was indicated by 67.2% of participants. Approximately 5% reported that their family was unaware of their gender identity and 27.7% reported some form of lack of family support.

Participants had an average BMI of 25.7 ± 5.57 kg/m² and 50.8% were overweight or obese. FNI was present in nearly 65% of the sample, with 53.3% of those categorized as having moderate and severe FNI (Table 1).

Regarding access to places selling fruit and vegetables near the participant’s residence, the most frequently mentioned were neighborhood markets, open-air markets, hypermarkets and large supermarket chains and greengrocers, respectively. A total of 14.8% of the participants reported either not buying fruits and vegetables, or not buying them near their residences (Table 1).

Taking into consideration the bivariate analysis, factors associated with the presence of FNI included difficulty finding a job (p < 0.001) (Figure 1) and having no income in the month prior to the interview (p = 0.009) (Figure 2). Furthermore, participants who reported earning less than 2 minimum wages (81%) were more likely to experience some degree of FNI (p < 0.001). It is worth highlighting that lack of income was associated with the age group of 18 to 24 years (p = 0.001).

In addition to the aspect of income and employability, a positive association between lack of family support and the presence of FNI was observed. Participants who reported partial or total family support were less likely to experience FNI (p = 0.006); on the other hand, those who reported indifference, lack of support or disapproval from the family due to being trans, were more likely to have moderate and severe FNI (p = 0.001). Another aspect related to these degrees of FNI was the report of not buying fruits and vegetables near the residence or not routinely purchasing fruit and vegetables (p = 0.050).

Nutritional status was associated with certain socioeconomic factors. Difficulty reading and writing was associated with being overweight and negatively associated with eutrophy (p = 0.025). Moreover, people with access to establishments that sell fruit and vegetables, such as the presence of a street market near their residence, were more likely to be classified as having adequate nutritional status compared to those classified as overweight and obese (p = 0.033) (Figure 3).

In this sample, race/skin color and gender identity variables were not associated with any socioeconomic and food insecurity variables.

DISCUSSION

The study identified high prevalence of FNI in the study population, which was associated with income, difficulty finding a job and lack of family support related to gender, as well as aspects of access to the purchase of vegetables and fruits.

In Brazil, according to the Food and Agriculture Organization of the United Nations (FAO) report, approximately 34% of the population experiences FNI.¹⁵15 FAO, FIDA, OMS, PMA y UNICEF. 2023. Versión resumida de El estado de la seguridad alimentaria y la nutrición en el mundo 2023. Urbanización, transformación de los sistemas agroalimentarios y dietas saludables a lo largo del continuo rural-urbano. Roma, FAO. doi: doi.org/10.4060/cc6550es However, data regarding FNI among the transgender population in the country is twice as high.⁸8 Gomes SM, Jacob MCM, Chaves VM, et al. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One. 2023;18(5):e0284257. doi:10.1371/journal.pone.0284257. This study, conducted during the COVID-19 pandemic, found prevalence of FNI in a sample of 109 Brazilian transgender people from all regions of the country similar to that of this study (68.8% versus 63.3%). The authors emphasize that access to adequate food was already difficult for this population, even before the pandemic, and the main associations found for this prevalence were due to income and unemployment,⁸8 Gomes SM, Jacob MCM, Chaves VM, et al. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One. 2023;18(5):e0284257. doi:10.1371/journal.pone.0284257. similar to the present study.

In order to discuss high social vulnerability and FNI in the transgender population, it is necessary to take into account discrimination based on gender identity,⁸8 Gomes SM, Jacob MCM, Chaves VM, et al. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One. 2023;18(5):e0284257. doi:10.1371/journal.pone.0284257. as well as socioeconomic disparities between transgender people, which may be associated with passability related to the duration of transition, social acceptance and family support.⁸8 Gomes SM, Jacob MCM, Chaves VM, et al. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One. 2023;18(5):e0284257. doi:10.1371/journal.pone.0284257. The high proportion of people experiencing FNI in this study, associated with a lack of family support, high rates of difficulty finding a job and, consequently, low income, are probably related to discrimination based on gender identity and structural transphobia.⁷7 Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr. 2021;24(18):6436-6449. doi:10.1017/S1368980021001671..⁸8 Gomes SM, Jacob MCM, Chaves VM, et al. Food insecurity in a Brazilian transgender sample during the COVID-19 pandemic. PLoS One. 2023;18(5):e0284257. doi:10.1371/journal.pone.0284257.

With regard to nutritional status, a systematic review showed that there is higher prevalence of overweight and obesity among the transgender population, especially after the use of sexual steroids for phenotypic and body changes.⁷7 Gomes SM, Jacob MC, Rocha C, Medeiros MF, Lyra CO, Noro LR. Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations. Public Health Nutr. 2021;24(18):6436-6449. doi:10.1017/S1368980021001671. In this study, we did not assess the use of hormones. However, the prevalence and distribution of nutritional status, according to BMI classification categories, were similar to those of the general adult population in the city of São Paulo, despite the fact that the considered database being from 2015, derived from the ISA Capital Population-Based Health Survey.¹⁶16 São Paulo (SP). Secretaria Municipal da Saúde. Coordenação de Epidemiologia e Informação - CEInfo. Boletim ISA Capital 2015, nº 6, 2017: Estado nutricional da população da cidade de São Paulo. São Paulo: CEInfo, 2017, 83 p. Disponível em: http://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/arquivos/publicacoes/ISA_2015_EN.pdf. Acesso em: 22 jan. 2024.
http://www.prefeitura.sp.gov.br/cidade/s...

Furthermore, the eutrophic nutritional status of the sample was associated with the presence of open-air markets near the residence. A Brazilian study showed that an environment with favorable access to a greater variety of healthy foods, such as fruits and vegetables, can promote the prevalence of lower overweight and obesity.¹⁷17 Matozinhos FP, Gomes CS, Andrade AC, et al. Neighbourhood environments and obesity among adults: A multilevel analysis of an urban Brazilian context. Prev Med Rep. 2015 Apr. 29;2:337-341. doi:10.1016/j.pmedr.2015.04.019.

Regarding the limitations of the study, the weight and height data used to calculate BMI were self-reported. In the sample, applying the same percentage across all municipalities may not correspond to the actual distribution of this population in the territory. In addition, as the sample came from just one metropolitan region in the state of São Paulo and reached only 62.9% of the calculated sample, the conclusion of this study may not be representative of the entire adult transgender population.

There is a scarcity of research on general nutritional aspects in the transgender population, especially in the least developed countries located in the Global South.⁶6 Fergusson P, Greenspan N, Maitland L, Huberdeau R. Towards Providing Culturally Aware Nutritional Care for Transgender People: Key Issues and Considerations. Can J Diet Pract Res. 2018;79(2):74-79. doi: 10.3148/cjdpr-2018-001. Epub 2018. PMID: 29543495.
https://doi.org/10.3148/cjdpr-2018-001... Furthermore, national surveys conducted by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) do not include transgender categories. Thus, this study contributes to the literature by filling a gap in data on nutritional status and FNI in this population, while also providing a basis for comparison with other studies, as we use validated measures. Therefore, the data provided by this study can contribute to informed discussions that guide the need for policies aimed at reducing the high prevalence of FNI observed in this population.

Thus, it is recommended that health service teams, especially nutrition and social care professionals, be vigilant in assessing the nutritional status and signs of FNI, in order to provide adequate care that meets the demands and social status of transgender people.⁶6 Fergusson P, Greenspan N, Maitland L, Huberdeau R. Towards Providing Culturally Aware Nutritional Care for Transgender People: Key Issues and Considerations. Can J Diet Pract Res. 2018;79(2):74-79. doi: 10.3148/cjdpr-2018-001. Epub 2018. PMID: 29543495.
https://doi.org/10.3148/cjdpr-2018-001... .¹⁸18 São Paulo (SP). Secretaria Municipal da Saúde. Coordenação da Área Técnica de Saúde Integral da População LGBTIA+. “Protocolo para o cuidado integral à saúde de pessoas trans, travestis ou com vivências de variabilidade de gênero no município de São Paulo”, 2ª ed. Secretaria Municipal da Saúde|SMS|PMSP, 2023 – p. 374. The data from this study also corroborate the need for specific intersectoral public policies, aimed at reducing socioeconomic disparities exacerbated by discrimination,⁹9 Gois I, da Silva, MRD, Oliva RM, La Blanca S, Vieira, DL. Income, occupation and psychosocial health of transgender people during the COVID-19 pandemic. Interfaces Científicas-Saúde e Ambiente. 2023;9(2):261-277. doi: doi.org/10.17564/2316-3798.2023v9n2p261-277. which contributed to a higher rate of FNI in the transgender population. In addition, it is necessary to develop policies aimed at facilitating access to open-air markets and other establishments that offer diverse and quality food.

These recommendations align with the proposals outlined at the 16^th National Health Conference regarding the training of health teams to care for LGBTI+ people and the implementation of public health policies targeting this population.¹⁹19 Araújo FR, Castro APB, Silva EB, Melecchi DR, Both V e Ferla AA (org.). 16ª Conferência Nacional de Saúde: Relatório Final. - 1. ed. - Porto Alegre, RS: Editora Rede Unida, 2022.

The main findings of this study were the high prevalence of FNI among transgender people, in association with those who were more socially vulnerable and who reported a lack of family support due to their gender identity. On the other hand, adequate nutritional status was associated with the presence of establishments such as open-air markets near the residence of this population. These data underscore the need for public policies and actions aimed at reducing social inequities and expanding access to adequate food for the transgender population.

REFERENCES

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