From the Guidelines
A neutropenic diet with no restrictions on raw fruits and vegetables is recommended for patients with neutropenic fever, as there is no significant difference in infection rates or survival between a cooked diet and a raw diet. According to a recent study published in the Journal of Clinical Oncology in 2022 1, a meta-analysis of five studies with 388 patients found no significant difference in infection rates between patients assigned to a neutropenic diet and those assigned to an unrestricted diet. Additionally, a randomized controlled trial (RCT) conducted in adults with acute myeloid leukemia found no significant difference in major infections or survival between patients assigned to a cooked diet and those assigned to a raw diet 1.
Key Components of the Diet
- Thoroughly cooked foods
- Pasteurized dairy products
- Canned or cooked fruits and vegetables
- Properly processed foods
- Strict hygiene practices, including thorough handwashing and clean cooking surfaces
Rationale
The rationale behind this approach is that the evidence for the effectiveness of highly restrictive diets in preventing infections in neutropenic patients is limited, and some medical centers have moved away from strict neutropenic diets in favor of safe food handling practices 1. Patients should follow their healthcare provider's specific recommendations, as guidelines may vary based on individual risk factors and institutional protocols.
Food Safety Practices
- Avoid communal food settings and buffets where cross-contamination is more likely
- Follow strict hygiene practices when handling and preparing food
- Ensure all food is stored and handled properly to minimize the risk of contamination.
From the Research
Neutropenic Diet Requirements
The neutropenic diet is applied when a person's neutrophil count is <2000 cells/μL, and its primary goal is to reduce the risk of infection [ 2 ]. The diet typically involves consuming well-cooked vegetables to minimize the risk of pathogen transmission [ 2 ].
Key Principles
- Consumption of well-cooked vegetables is essential to reduce the risk of pathogen transmission [ 2 ]
- Pressure cooking is a commonly used method in neutropenic diet kitchens [ 2 ]
- The cooking process can result in significant nutrient loss, particularly in vitamins C, A, and K, and minerals like calcium and iron [ 2 ]
Comparison with Standard Nutrition Treatment
Studies have shown that the neutropenic diet may be related to deficiencies in dietary fiber, vitamins, and minerals, and malnutrition in patients with cancer [ 2 ]. However, there is no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer, and patients and clinicians should follow safe food-handling guidelines [ 3 ].
Infection Risk and Mortality
Neutropenic fever can herald a life-threatening infection, and prompt recognition and treatment are crucial [ 4 ]. However, there is no statistically significant difference between neutropenic diet and regular diet in the rates of major infections or bacteremia/fungemia [ 3 ]. Additionally, no difference in mortality was seen between neutropenic diet and regular diet [ 3 ].