Sex and gender differences in nutrition
Keywords:
nutrition, food insecurity, oncology, malnutrition, obesity, microbiota, pollutionAbstract
Proper nutritional intake is essential for human wellbeing. To ensure effective nutrition, it is necessary to follow a healthy diet; in order to provide all nutritional elements adequate to lifespan, it is important to take into account sex, gender and age. Particularly, sex refers to the sum of biological characteristics that determine whether an individual is female, male and/or intersex, gender includes the roles, behaviours, activities, and attributes that a given society, at a given time, considers appropriate for men and women. Climate changes, pollution and global socio-economic disparities can compromise food production, making healthy diet more expensive and less available. There are still large areas of food insecurity, mainly in low and middle-income countries, where women are disadvantaged in term of access to healthy food. The eating habits of women and men are influenced by differences in body composition and energy expenditure, but also by stereotypes and psychological factors. Malnutrition, either for “defect” or for “excess”, has different effects in both sexes with important consequences on individual health, but can also damage the offspring with epigenetic mechanism.
References
1. FAO, IFAD, UNICEF, WFP, WHO. The state of food security and nutrition in the world 2024: Financing to end hunger, food insecurity and malnutrition in all its forms. Rome: FAO; 2024. doi:10.4060/cd1254en
2. ISTAT. Rapporto SDGs 2024 per l’Agenda 2030. Informazioni statistiche Italia. [Internet]. Available from: https://www.istat.it/storage/rapporti-tematici/sdgs/2024/Rapporto-SDGs2024-Ebook.pdf
3. FAO. FAOSTAT: Cost and affordability of a healthy diet (CoAHD). [Internet]. FAO; 2023 May. Available from: www.fao.org/faostat/en/#data/CAHD
4. Cattaneo A, Adukia A, Brown DL, Christiaensen L, et al. Economic and social development along the urban–rural continuum: New opportunities to inform policy. World Dev. 2022;157:105941. doi:10.1016/j.worlddev.2022.105941
5. World Food Program USA. Women are hungrier. [Internet]. Available from: https://www.wfpusa.org/women-are-hungrier-infographic/
6. Sistema di sorveglianza PASSI. Istituto Superiore di Sanità. [Internet]. Available from: https://www.epicentro.iss.it/passi/
7. Attia E, Walsh BT. Eating disorders: A review. JAMA. 2025;333(14):1242–52. doi:10.1001/jama.2025.0132
8. Donini L, Nizzoli U, Bosello O, et al. Manuale per la cura e la prevenzione dei disturbi del comportamento dell’alimentazione e delle obesità (DA&O). Milano: SICS Editore; 2017.
9. Domini LM. Nutrizione e genere. L’Endocrinologo. 2018;19(5):128–31. doi:10.1007/s40619-018-0449-9
10. Barrag R, Coltell O, Portoles O, et al. Bitter, sweet, salty, sour and umami taste perception decreases with age: Sex-specific analysis, modulation by genetic variants and taste-preference associations in 18 to 80 year-old subjects. Nutrients. 2018;10(10):1539. doi:10.3390/nu10101539
11. Società Italiana di Nutrizione Umana (SINU). Livelli di assunzione di riferimento di nutrienti ed energia (LARN) per la popolazione italiana. 5a ed. Milano: Biomedia; 2024.
12. Gómez-García I, Trepiana J, Fernández-Quintela A, et al. Sexual dimorphism in brown adipose tissue activation and white adipose tissue browning. Int J Mol Sci. 2022;23(15):8250. doi:10.3390/ijms23158250
13. Wibmer AG, Becher T, Eljalby M, et al. Brown adipose tissue is associated with healthier body fat distribution and metabolic benefits independent of regional adiposity. Cell Rep Med. 2021;2(7):100332. doi:10.1016/j.xcrm.2021.100332
14. Cederholm T, Bosaeus I. Malnutrition in adults. N Engl J Med. 2024;391:155–65.
15. Jabbour J, Khalil M, Ronzoni AR, et al. Malnutrition and gender disparities in the Eastern Mediterranean Region: The need for action. Front Nutr. 2023;10:1113662. doi:10.3389/fnut.2023.1113662
16. The University of Dublin. The Irish Longitudinal Study on Ageing (TILDA). [Internet]. Available from: https://tilda.tcd.ie/data/
17. Beirer A. Malnutrition and cancer: Diagnosis and treatment. Memo. 2021;14:168–73. doi:10.1007/s12254-020-00672-3
18. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guidelines: Clinical nutrition in cancer. Clin Nutr. 2021;40:2898–913.
19. Muscaritoli M, Lucia S, Farcomeni A, et al. Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget. 2017;8(45):79884–96. doi:10.18632/oncotarget.20168
20. Allen LH. Micronutrients: Assessment, requirements, deficiencies, and interventions. N Engl J Med. 2025;392:1006–16.
21. World Health Organization. Micronutrients. [Internet]. Available from: https://www.who.int/health-topics/micronutrients#tab=tab_1
22. Passarelli S, Free CM, Shepon A, et al. Global estimation of dietary micronutrient inadequacies: A modelling analysis. Lancet Glob Health. 2024;12:e1590–9. doi:10.1016/S2214-109X(24)00276-6
23. Levi M, Simonetti M, Marconi E, et al. Gender differences in determinants of iron-deficiency anemia: A population-based study conducted in four European countries. Ann Hematol. 2019;98(7):1573–82.
24. De Angelis S, Medda E, Rotondi D, et al. Fifteen years of iodine prophylaxis in Italy: Results of a nationwide surveillance (period 2015–2019). J Clin Endocrinol Metab. 2024;109(2):e495–e507. doi:10.1210/clinem/dgad593
25. Mojadadi A, Au A, Salah W, et al. Role for selenium in metabolic homeostasis and human reproduction. Nutrients. 2021;13(9):3256.
26. Gomes F, Ashorn P, Askari S, et al. Calcium supplementation for the prevention of hypertensive disorders of pregnancy: Current evidence and programmatic considerations. Ann N Y Acad Sci. 2022;1510(1):52–67.
27. Fallah A, Mohammad-Hasani A, Colagar AH. Zinc is an essential element for male fertility: A review of Zn roles in men's health, germination, sperm quality, and fertilization. J Reprod Infertil. 2018;19(2):69–81.
28. Souza ACR, Vasconcelos AR, Dias DD, et al. Integral role of magnesium in muscle integrity and aging: A comprehensive review. Nutrients. 2023;15(24):5127. doi:10.3390/nu15245127
29. Christakos S, Dhawan P, Verstuyf A, et al. Vitamin D: Metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev. 2016;96(1):365–408. doi:10.1152/physrev.00014.2015
30. Amling M. Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment. Unfallchirurg. 2015;118:995–9.
31. Wierzbicka A, Oczkowicz M. Sex differences in vitamin D metabolism, serum levels and action. Br J Nutr. 2022;128:2115–30.
32. Renke G, Starling-Soares B, Baesso T, et al. Effects of vitamin D on cardiovascular risk and oxidative stress. Nutrients. 2023;15(3):769. doi:10.3390/nu15030769
33. McDonnell SL, Baggerly CA, French CB, et al. Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concentrations ≥60 vs <20 ng/ml (150 vs 50 nmol/L): Pooled analysis of two randomized trials and a prospective cohort. PLoS One. 2018;13(6):e0199265. doi:10.1371/journal.pone.0199265
34. Murdaca G, Tagliafico L, Page E, et al. Gender differences in the interplay between vitamin D and microbiota in allergic and autoimmune diseases. Biomedicines. 2024;12:1023.
35. Mishra J, Tomar A, Puri M, et al. Trends of folate, vitamin B12, and homocysteine levels in different trimesters of pregnancy and pregnancy outcomes. Am J Hum Biol. 2020;32(5):e23388. doi:10.1002/ajhb.23388
36. Travica N, Ried K, Hudson I, et al. Gender differences in plasma vitamin C concentrations and cognitive function: A pilot cross-sectional study on healthy adults. Curr Dev Nutr. 2020;6:867.
37. NCD Risk Factor Collaboration. Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403:1027–50.
38. Costa-Font J, Györi M. The weight of patriarchy? Gender obesity gaps in the Middle East and North Africa (MENA). Soc Sci Med. 2020;266:113353. doi:10.1016/j.socscimed.2020.113353
39. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403:1027–50. [DUPLICATED]
40. Novelli G, Busetto L, Corsaro L, et al. Obesity monitor. Obesità la pandemia del futuro. Milano: IBDO Foundation; 2024. [Internet]. Available from: https://www.creasanita.it/obesity-italian-monitor-2024/
41. Cena H, Conino D, Coss A, et al. Nutrition in pregnancy: Three crucial periods for mothers and newborns. Ital J Gynaecol Obstet. 2018;30(2):27–37.
42. Vineis P, Robinson O, Chadeau-Hyam M, et al. What is new in the exposome? Environ Int. 2020;143:105887. doi:10.1016/j.envint.2020.105887
43. Rahman Kabir E, Rahman MS, Rahman I. A review on endocrine disruptors and their possible impact on human health. Environ Toxicol Pharmacol. 2015;40(1):241–53.
44. Dolce A, Della Torre S. Sex, nutrition, and NAFLD: Relevance of environmental pollution. Nutrients. 2023;15:2335.
45. Yin J, Ju Y, Qian H, et al. Nanoplastics and microplastics may be damaging our livers. Toxics. 2022;10:586.
46. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). Clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492–542.
47. Tarracchini C, Alessandri G, Fontana F, et al. Genetic strategies for sex-biased persistence of gut microbes across human life. Nat Commun. 2023;14:4220.
48. García-Montero CC, Fraile-Martínez O, Gómez-Lahoz AM, et al. Nutritional components in Western diet versus Mediterranean diet at the gut microbiota–immune system interplay: Implications for health and disease. Nutrients. 2021;13(2):699.
49. Kim YS, Unno T, Kim BY, Park MS. Sex differences in gut microbiota. World J Mens Health. 2020;38:48–60. doi:10.5534/wjmh.190009
50. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas. 2017;103:45–53. doi:10.1016/j.maturitas.2017.06.025
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Paola Sbisà, Fabiola Bologna, Melania Cappuccio, Enrica Ciccarelli, Luciana Bovone, Elisabetta Dall'Aglio, Federica Grosso, Stefania Lingua, Donatella Zavaroni, Concetta Laurentaci, Antonella Vezzani, Associazione Italiana Donne Medico (AIDM)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
