From the Guidelines
Patients with neutropenia should not follow a restrictive neutropenic diet, as the current evidence suggests that the harms of such a diet, including limited nutrient intake and lower patient satisfaction, likely outweigh the potential benefits in preventing infection. The American Society of Clinical Oncology (ASCO) guideline, published in 2022 1, recommends against the use of neutropenic diets to prevent infection in patients with cancer during active treatment, citing low-quality evidence and a weak strength of recommendation. This guideline is based on a review of the literature, including a meta-analysis that found no significant difference in infection risk between patients assigned to a neutropenic diet and those assigned to an unrestricted diet 1.
The ASCO guideline notes that the available data do not support the use of neutropenic diets to lower infection risk in patients with hematologic malignancies, and that these diets may be less palatable to patients and limit important nutrients and bioactive compounds 1. Instead of following a restrictive diet, patients with neutropenia should focus on safe food handling practices, such as frequent handwashing, keeping cooking surfaces clean, and storing foods at proper temperatures. They should also choose pasteurized dairy products, fully cooked meats, and avoid deli meats unless reheated to steaming.
Key points to consider when advising patients with neutropenia on their diet include:
- There is no standard definition of a neutropenic diet, and the available literature is limited and heterogeneous 1
- The current evidence does not support the use of neutropenic diets to prevent infection in patients with cancer during active treatment 1
- Patients with neutropenia should focus on safe food handling practices and choose nutrient-dense foods to support their overall health and well-being
- The ASCO guideline recommends against the use of neutropenic diets, citing low-quality evidence and a weak strength of recommendation 1
From the Research
Diet Recommendations for Neutropenia Patients
The diet for patients with neutropenia is a topic of ongoing debate, with various studies suggesting different approaches.
- A study published in 2015 2 found that dietary restrictions, often referred to as 'clean', 'low bacteria', 'low-microbial', or 'neutropenic' diets, are commonly prescribed to reduce the risk of foodborne infection, despite a lack of evidence supporting their effectiveness.
- Another study from 2024 3 highlighted the potential drawbacks of the neutropenic diet, including deficiencies in dietary fiber, vitamins, and minerals, which can lead to malnutrition in cancer patients.
- A 2012 review 4 proposed adopting standard safe food handling methods instead of restrictive dietary limitations, allowing for a more liberalized diet in neutropenic patients.
- A 2014 article 5 outlined the main microbiological hazards associated with foods and described a low-microbial diet that replaces higher-risk foods with lower-risk ones.
- A meta-analysis from 2019 6 found no significant difference in infection rates between patients following a neutropenic diet and those on an unrestricted diet, suggesting that the use of neutropenic diets may not be associated with a decreased risk of infection in neutropenic cancer patients.
Key Considerations
- The variety of foods restricted in neutropenic diets can vary greatly and may be contradictory 2.
- Well-cooked vegetables can be a good source of nutrients, but the cooking process can lead to significant nutrient loss 3.
- Safe food handling practices are essential to reduce the risk of foodborne infection in neutropenic patients 4, 5.
- The effectiveness of neutropenic diets in reducing infection rates is unclear, and further research is needed to determine the best approach 6.