{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:46:56Z","timestamp":1793332016036,"version":"4.5.0"},"reference-count":27,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011666","name":"The Ehlers-Danlos Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011666","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","clinicalnutritionjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Clinical Nutrition"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.clnu.2025.11.022","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T07:38:57Z","timestamp":1765265937000},"page":"106538","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Nutrient intake, dietary patterns and relationship to symptoms and comorbidities in hypermobile Ehlers-Danlos syndrome"],"prefix":"10.1016","volume":"56","author":[{"given":"Rabia","family":"Topan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shraya","family":"Pandya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Chance","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Zarate-Lopez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qasim","family":"Aziz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bassett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Kyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Whelan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4965-757X","authenticated-orcid":false,"given":"Asma","family":"Fikree","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.clnu.2025.11.022_bib1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/ajmg.c.31552","article-title":"The 2017 international classification of the Ehlers-Danlos syndromes","volume":"175","author":"Malfait","year":"2017","journal-title":"Am J Med Genet C Semin Med Genet"},{"issue":"2","key":"10.1016\/j.clnu.2025.11.022_bib2","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.cgh.2020.02.034","article-title":"Rome IV functional gastrointestinal disorders and health impairment in subjects with hypermobility spectrum disorders or hypermobile Ehlers-Danlos syndrome","volume":"19","author":"Lam","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"5","key":"10.1016\/j.clnu.2025.11.022_bib3","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1038\/ajg.2013.105","article-title":"Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life","volume":"108","author":"Bohn","year":"2013","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"10.1016\/j.clnu.2025.11.022_bib4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jand.2019.01.017","article-title":"Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet","volume":"120","author":"Staudacher","year":"2019","journal-title":"J Acad Nutr Diet"},{"issue":"3","key":"10.1016\/j.clnu.2025.11.022_bib5","article-title":"History of trying exclusion diets and association with avoidant\/restrictive food intake disorder in neurogastroenterology patients: a retrospective chart review","volume":"35","author":"Atkins","year":"2023","journal-title":"Neuro Gastroenterol Motil"},{"issue":"9","key":"10.1016\/j.clnu.2025.11.022_bib6","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1016\/j.cgh.2019.10.030","article-title":"Prevalence and characteristics of avoidant\/restrictive food intake disorder in adult neurogastroenterology patients","volume":"18","author":"Murray","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"6","key":"10.1016\/j.clnu.2025.11.022_bib7","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.cgh.2021.07.004","article-title":"Food avoidance and restriction in irritable bowel syndrome: relevance for symptoms, quality of life and nutrient intake","volume":"20","author":"Melchior","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"10.1016\/j.clnu.2025.11.022_bib8","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1053\/j.gastro.2020.06.099","article-title":"Behavioral and diet therapies in integrated care for patients with irritable bowel syndrome","volume":"160","author":"Chey","year":"2021","journal-title":"Gastroenterology"},{"issue":"4","key":"10.1016\/j.clnu.2025.11.022_bib9","doi-asserted-by":"crossref","first-page":"727","DOI":"10.14309\/ajg.0000000000002586","article-title":"Comprehensive assessment of nutrition and dietary influences in hypermobile ehlers-Danlos Syndrome-A cross-sectional study","volume":"119","author":"Topan","year":"2024","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"10.1016\/j.clnu.2025.11.022_bib10","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.jocd.2022.07.005","article-title":"Assessment of gastrointestinal function and its' effect on bone mineral density and body composition in hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome","volume":"25","author":"DiFrancisco-Donoghue","year":"2022","journal-title":"J Clin Densitom"},{"issue":"6","key":"10.1016\/j.clnu.2025.11.022_bib11","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1053\/j.gastro.2016.03.035","article-title":"Rome IV-Functional GI disorders: disorders of gut-brain interaction","volume":"150","author":"Drossman","year":"2016","journal-title":"Gastroenterology"},{"issue":"2","key":"10.1016\/j.clnu.2025.11.022_bib12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/BF01535722","article-title":"GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease","volume":"33","author":"Svedlund","year":"1988","journal-title":"Dig Dis Sci"},{"issue":"6","key":"10.1016\/j.clnu.2025.11.022_bib13","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"issue":"1","key":"10.1016\/j.clnu.2025.11.022_bib14","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1365-2036.2004.02007.x","article-title":"The visceral sensitivity index: development and validation of a gastrointestinal symptom-specific anxiety scale","volume":"20","author":"Labus","year":"2004","journal-title":"Aliment Pharmacol Ther"},{"issue":"2","key":"10.1016\/j.clnu.2025.11.022_bib15","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/00006842-200203000-00008","article-title":"The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms","volume":"64","author":"Kroenke","year":"2002","journal-title":"Psychosom Med"},{"issue":"12","key":"10.1016\/j.clnu.2025.11.022_bib16","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/j.mayocp.2012.10.013","article-title":"Compass 31: a refined and abbreviated composite autonomic symptom score","volume":"87","author":"Sletten","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"10.1016\/j.clnu.2025.11.022_bib17","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.appet.2017.11.111","article-title":"Initial validation of the nine item avoidant\/restrictive food intake disorder screen (NIAS): a measure of three restrictive eating patterns","volume":"123","author":"Zickgraf","year":"2018","journal-title":"Appetite"},{"issue":"3","key":"10.1016\/j.clnu.2025.11.022_bib18","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1017\/S1368980016002421","article-title":"Assessing the relative validity of the Scottish collaborative group FFQ for measuring dietary intake in adults","volume":"20","author":"Hollis","year":"2017","journal-title":"Public Health Nutr"},{"issue":"4","key":"10.1016\/j.clnu.2025.11.022_bib19","first-page":"287","article-title":"McCance and Widdowson's 'the composition of foods': supplementary information and review of new compositional data","volume":"40","author":"Paul","year":"1986","journal-title":"Hum Nutr Appl Nutr"},{"key":"10.1016\/j.clnu.2025.11.022_bib20","series-title":"Dietary reference values for food energy and nutrients: report of the panel on dietary reference values of the committee on medical aspects of food policy","year":"1991"},{"key":"10.1016\/j.clnu.2025.11.022_bib21","series-title":"Dietary reference values for energy","year":"2011"},{"key":"10.1016\/j.clnu.2025.11.022_bib22","series-title":"Dietary carbohydrates and health","year":"2015"},{"issue":"3","key":"10.1016\/j.clnu.2025.11.022_bib23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1017\/S0007114509991942","article-title":"Dietary patterns of school-age children in Scotland: association with socio-economic indicators, physical activity and obesity","volume":"103","author":"Craig","year":"2010","journal-title":"Br J Nutr"},{"issue":"3","key":"10.1016\/j.clnu.2025.11.022_bib24","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/dvdy.220","article-title":"Hypermobile Ehlers-danlos syndromes: complex phenotypes, challenging diagnoses, and poorly understood causes","volume":"250","author":"Gensemer","year":"2021","journal-title":"Dev Dyn"},{"issue":"2","key":"10.1016\/j.clnu.2025.11.022_bib25","doi-asserted-by":"crossref","DOI":"10.3390\/nu13020400","article-title":"Macro- and micronutrient intake in children with avoidant\/restrictive food intake disorder","volume":"13","author":"Schmidt","year":"2021","journal-title":"Nutrients"},{"issue":"12","key":"10.1016\/j.clnu.2025.11.022_bib26","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s11894-023-00900-w","article-title":"ARFID at 10 years: a review of medical, nutritional and psychological evaluation and management","volume":"25","author":"Fisher","year":"2023","journal-title":"Curr Gastroenterol Rep"},{"issue":"9","key":"10.1016\/j.clnu.2025.11.022_bib27","first-page":"2279","volume":"36","author":"Lal","year":"2024","journal-title":"Neuro Gastroenterol Motil"}],"container-title":["Clinical Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0261561425003176?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0261561425003176?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:00:05Z","timestamp":1777532405000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0261561425003176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":27,"alternative-id":["S0261561425003176"],"URL":"https:\/\/doi.org\/10.1016\/j.clnu.2025.11.022","relation":{},"ISSN":["0261-5614"],"issn-type":[{"value":"0261-5614","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Nutrient intake, dietary patterns and relationship to symptoms and comorbidities in hypermobile Ehlers-Danlos syndrome","name":"articletitle","label":"Article Title"},{"value":"Clinical Nutrition","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.clnu.2025.11.022","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"106538"}}