The most common cause of death is cardiac failure resulting from transfusional iron overload. However, as chelation
therapies have improved, subjects are living longer and nutritional status is becoming increasingly important. Patients
with thalassemia commonly exhibit inadequate growth, poor immune function, increased oxidative stress, and decreased
bone mineralization, all morbidities with links to poor nutritional status. Recently, it has been shown that subjects with
thalassemia have reduced body fat and lean mass and that these alterations in body composition are related to both reducedgrowth and decreased bone density. In addition, Claster and colleagues reported that more than half of a sample of regularly transfused subjects with thalassemia residing in Los Angeles had deficient circulating levels of vitamins A, C,
D, and selenium.10 However, there is a paucity of data on the contribution of dietary intake to these possible nutritional
deficiencies in thalassemia.