Background: Patients suffering from thalassemia have impaired body composition and increased nutritional risk. To assess body composition and vitamin D levels of thalassemic patients in relation to nutritional risk.Methods: A total of 67 consecutive adult patients who were diagnosed with thalassemia major and followed a regular blood transfusion scheme were included in this study. Demographic and clinical data were registered for each participant. Blood samples were collected to assess 25-hydroxy-vitamin D (25-OH-D) levels. The assessment of patients’ nutritional risk was based on the Malnutrition Universal Screening Tool. Body composition assessment was based on bioelectrical impedance analysis.Results: Eleven patients (16.4%) and five patients (7.5%) were at moderate and high risk for malnutrition, respectively. Moreover, 86.6% of patients had low fat-free mass index (FFM) and 74.6% of patients had high fat mass (FM) index. The prevalence of sarcopenic obesity and 25-OH-D deficiency was 64.2% and 92.2%, respectively. Medium and high-risk patients had significantly lower BMI (18.81 ± 1.29 vs 23.90 ± 2.65 kg/m2, p<0.001), lower FFM index (12.80 ± 1.38 vs 14.19 ± 1.89 kg/m2, p=0.009) and lower FM index (5.97 ± 1.86 vs 9.70 ± 2.70 kg/m2, p<0.001) than their low-risk counterparts.Conclusions: Adult patients with β-thalassemia major had low levels of vitamin D and altered body composition, presenting with increased adiposity, low levels of lean body mass and high rates of sarcopenic obesity. Timely detection of patients at risk could lead to prioritization of patients that could benefit from nutritional interventions.