Dietary iron intake and anemia: food frequency questionnaire in patients with hereditary hemorrhagic telangiectasia
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RESEARCH
Dietary iron intake and anemia: food frequency questionnaire in patients with hereditary hemorrhagic telangiectasia Federica Cavalcoli1* , Alberto Gandini1, Irene Aglaia Matelloni1, Francesca Catalano2, Saverio Alicante1, Guido Manfredi1, Gianfranco Brambilla1, Fernanda Menozzi1, Federica Perolini1, Egon Costi1, Roberto Bertè1 and Elisabetta Buscarini1
Abstract Background: Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic inherited vascular disease characterized by a heterogeneous clinical presentation and prognosis. Dietary evaluation is relevant in HHT patients to provide adequate iron and nutrient intake. Additionally, different dietary items have been reported to precipitate epistaxis in this setting. Our primary aim was to investigate the dietary habits of HHT patients through a food-frequency questionnaire (FFQ) to evaluate the presence of precipitants and/or protective factors for epistaxis and the occurrence of possible dietary modifications. The secondary aims were to evaluate the nutritional intake of iron in HHT patients and the self-reported effect of iron treatments on epistaxis. From April 2018 to October 2018, a 138-item FFQ was provided to HHT patients followed up at the HHT Referral Center of Crema Maggiore Hospital. The relationship between food items and epistaxis was ascertained on a separate form. Daily iron intake was calculated to establish the mean iron content of food items reported in the FFQ. Results: One hundred forty-nine questionnaires were evaluated [72 females, median age 54 years (12–76). Overall, 26 (18%) patients reported dietary items that improved epistaxis (mostly blueberries and red fruits, green vegetables and legumes), while 38 (26%) reported some dietary items that exacerbated epistaxis (spices, chocolate, alcohol, strawberries and ginger). Dietary modifications were reported in up to 58% of cases. In HHT patients, the mean daily iron intake was 8.46 ± 2.78 mg, and no differences were observed in the iron intake of patients reporting a diet modification and those who did not. Conclusions: In the comprehensive management of HHT a healthy and balanced diet, with increased consumption of dietary items with a high iron content, should be encouraged. Keywords: Hereditary hemorrhagic telangiectasia, Nutrition, Iron deficiency, Epistaxis, Iron supplementation Introduction Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic inherited vascular disease characterized by telangiectasia and arteriovenous malformations (AVMs) in *Correspondence: [email protected] 1 Gastroenterology Department, HHT Reference Center, Maggiore Hospital, ASST Crema, Largo Ugo Dossena 2, 26013 Crema, Italy Full list of author information is available at the end of the article
visceral and mucocutaneous vascular beds. HHT is estimated to affect approximately 85,000 patients in Europe [1]. However, because most health care providers have limited specific knowledge about this disease, the diagnosis may be delayed [1, 2]. To date, the diagnosis of HH
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