Optimal nutritional status is imperative for growth, development, immune function, and bone health. Patients with thalassemia are known to have poor growth, altered puberty, and immune function as well as reduced bone mineral acquisition. The etiology of these comorbidites is typically ascribed to the toxic effects of transfusion-related iron-overload. Recently, our group and others have observed marked nutritional deficiencies in key fat and water-soluble vitamins as well as important essential minerals. Depressed circulating levels of nutrients have been observed despite seemingly adequate dietary intake. This disconnect between intake and circulating levels suggests that patients with thalassemia may have increased needs for certain nutrients due to either poor nutrient absorption, elevated losses, or increased nutrient turnover. Randomized controlled clinical trials are needed to test the efficacy of nutritional therapies toward improving the overall health in thalassemia, as well as decreasing long-term comorbidities such as reduced bone mass.