P387 Nutrient intake, dietary patterns and phenotype in hypermobile ehlers danlos syndrome

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Introduction Patients with Hypermobile Ehlers Danlos Syndrome(hEDS) have a high prevalence of Disorders of Gut-Brain Interaction(DGBI) and can pose complex nutritional challenges. Despite this, little is known about their habitual dietary intake. We aimed to assess nutrient intake and adequacy in hEDS, phenotype patients according to identifiable dietary patterns and determine the factors associated with these. Methods In a cross-sectional study, patients with hEDS completed a validated food frequency questionnaire alongside questionnaires characterising: DGBI(Rome IV), gastrointestinal(GI) symptoms, GI specific anxiety, Avoidant Restrictive Food Intake Disorder(ARFID), nutritional supplementation and previous use of nutrition support. Principal component analysis and cluster analysis was used to classify patients into dietary phenotypes. Results 425 participants were included(mean: 41 years, 96% female). 197(46.4%) were overweight or obese. Overall, patients consumed high protein(mean: 77.2 g, SD: 37.8), high fat(mean: 79.1, SD: 36.9) diets and only 105(24.7%) achieve requirements for fibre. Membership of a specific dietary pattern was associated with significant differences in energy and macronutrients including fibre, fat and carbohydrates. Patients belonging to the low food intake pattern(n=149) had the highest scores for ARFID(p<0.001) and report previous use of nutrition support(n=26, 24%, p=0.02). The vegetarian/health conscious pattern(n=120) had higher fibre intake(median: 31 g [IQR: 25,39], p<0.001). The prudent/low residue pattern(n=35) was the most common pattern in the tertiary clinic(n=16, 46%, p<0.001). The refined/highly processed pattern was strongly associated with indigestion(p=0.007), a positive ARFID screen(p<0.001) and high GI-specific health anxiety(p=0.02). Conclusions This is the first study to robustly measure nutrition intake, adequacy and dietary patterns in hEDS. Intake of numerous nutrients are impaired in hEDS. Those with low food intake or a refined/highly processed diet are associated with disordered eating behaviours. Further research is needed to establish how these dietary patterns can best be utilised in clinical practice, to optimise intake and minimise the use of artificial nutrition support.

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