Braun etal. 2014,1313 Braun LE, Chen H, Frangoul H. Significant inconsistency among pediatric oncologists in the use of the neutropenic diet. Pediatr Blood Cancer. 2014;61:1806–10. United States of America |
Cross-sectional |
To determine the practice across pediatric cancer centers with the implementation of the neutropenic diet and to determine factors influencing current practices in an effort to standardize the care of pediatric oncology and transplant patients. |
A self-administered electronic survey was sent to 1639 pediatric oncologists at 198 institutions who are members of Children’s Oncology Group. The questionnaire contained 18 questions related to the use of the neutropenic diet, parameters for starting and stopping the diet and usually restricted foods. |
87% of the 198 member institutions answered the questionnaire. 57 % [557 pediatric oncologists] utilize the neutropenic diet in clinical practice. Among physicians who implemented a neutropenic diet, absolute neutrophil count was the trigger for initiating the diet in oncology patients. The majority of respondents [82 %] stop the neutropenic diet when oncology patients are no longer neutropenic. However, facilities vary significantly with regard to specific dietary restrictions and patient populations placed on the neutropenic diet. |
There is a lack of standardized nutrition guidelines, specifically in use of the neutropenic diet among pediatric cancer centers and providers within the same institution. |
French etal. 2001,1414 French MR, Levy-Milne R, Zibrik D. A survey of the use of low microbial diets in pediatric bone marrow transplant programs. J Am Diet Assoc. 2001;101:1194–8. England |
Cross-sectional |
To determine the implementation of the neutropenic diet in pediatric oncology centers. |
A questionnaire with six questions was applied in ten pediatric hospitals to obtain information about the protocol of neutropenic diet in these institutions. |
Half of the interviewees use the neutropenic diet during the treatment of pediatric cancer patients undergoing bone marrow transplantation. However, there is no standardization of diets adopted among hospitals. |
Most hospitals acknowledge the potential for food to cause infection in patients with compromised immune systems by imposing dietary restrictions to limit pathogen exposure |
Gupta etal. 2022,1515 Gupta A, Gupta AK, Meena JP, Khan MA, Agarwala A, Seth R. A pilot randomised controlled trial examining the benefit of a neutropenic diet for children undergoing cancer treatment. Nutr Cancer. 2022;74:2930–6. India |
Randomized Controlled Trial |
To evaluate the effectiveness of the neutropenic diet compared to the standard Indian diet. |
Children [n = 42] who were scheduled to receive chemotherapy were randomized to receive either a neutropenic diet or a standard Indian diet for a chemotherapy cycle. |
57 % in the neutropenic diet 43 % of the patients in the standard diet arm developed febrile neutropenia. Patients who received neutropenic diet had significantly higher chance of getting neutropenic entero-colitis [33.33% vs 4.76% p = 0.044] |
The neutropenic diet was not effective in reducing the rate of febrile neutropenia and was associated with a higher rate of pneumonia and neutropenic enterocolitis when compared to the standard diet. |
Maia etal. 2018,1616 Maia JE, Da Cruz LB, Gregianin LJ. Microbiological profile and nutritional quality of a regular diet compared to a neutropenic diet in a pediatric oncology unit. Pediatr Blood Cancer. 2018;65(3). Brazil |
Experimental |
To analyze the microbiological and nutritional composition of neutropenic diets offered to pediatric patients [between 4 and 10 years old] admitted to the university hospital in Porto Alegre and compare them with the regular hospital diet. |
Analysis of the microbiological and nutritional composition of the regular diet and two versions of the neutropenic diet used in the hospital: a stricter version [excludes raw and fresh foods] and a second version that includes thick-skinned fruits. |
The nutrient content of the regular and neutropenic diets analyzed were very similar, except that the fiber and vitamin C content was lower in the neutropenic diet. In relation to the microbiological content, the neutropenic diet analyzed did not present a lower microbial load compared to the regular hospital diet that was analyzed. |
The neutropenic diet that was analyzed did not have a lower microbial load compared to the regular hospital diet that was analyzed. Thus, the regular diet appears safe, and possibly provides greater benefits, for pediatric patients with neutropenia. |
Moody etal. 2002,1717 Moody K, Charlson ME, Finlay J. The neutropenic diet: what’s the evidence? J Pediatr Hematol Oncol. 2002;24:717–21. United States of America |
Narrative review |
Discuss the evolution of the neutropenic diet and explore the theories that support its use; review the dietary evidence from clinical trials and current patterns of use; discuss potential disadvantages of the diet and the basis for a randomized pilot study using this diet. |
Narrative review, search for clinicals trials evidence and discussion of published studies on the neutropenic diet. |
Although the use of the neutropenic diet is theoretically plausible, clinical data proving its effectiveness in reducing infections are insufficient. In addition, there are some disadvantages such as the restriction of fruits and vegetables that can lead to a deficiency of vitamins and minerals. |
More research is needed to determine the ability of patients to adhere to the neutropenic diet given their often-decreased caloric intake, gastrointestinal symptoms, and the diet’s impact on their quality of life. |
Moody et al. 2006,99 Moody K, Finlay J, Mancuso C, Charlson M. Feasibility and safety of a pilot randomized trial of infection rate: neutropenic diet versus standard food safety guidelines. J Pediatr Hematol Oncol. 2006;28:126–33. United States of America |
Randomized, Controlled Trial |
To demonstrate a safe and feasible methodology for assessing the rate of infection in pediatric cancer patients randomized to the neutropenic diet or FDA-approved food safety guidelines. |
Randomization of pediatric patients diagnosed with malignant brain tumor, acute lymphocytic leukemia or sarcoma on active treatment with myelosuppressive chemotherapy recruited from clinics and wards. |
Infection rates were similar in both groups. The adherence rate was 99.99 % for the food safety guidelines and 94.1 % for the neutropenic diet. |
A larger randomized trial to determine the effectiveness of food safety guidelines in minimizing the risk of food borne infection is safe and feasible in children with cancer. |
Polat etal. 2020,1818 Polat EB, Bakir BO, Aycicek A. The effect of neutropenic diet adherence on malnutrition and duration of hospital stay in children with acute lymphoblastic leukemia. Acʅbadem Üniversitesi Sağlʅk Bilimleri Dergisi. 2020(4):631–40. Turkey |
Cross-sectional |
To investigate the effect of adherence to a neutropenic diet, prevalence of malnutrition and length of stay in children with acute lymphoblastic leukemia. |
Demographic and anthropometric information such as body weight, height, arm circumference and skinfolds were included in the data collection. Medical history and adherence to the neutropenic diet was assessed with a dietary survey method based on the frequency of foods consumed within limited food categories. |
The adherence rate to the neutropenic diet was 61.7 %. Patients adhering to the neutropenic diet did not show statistically significant differences in the risk of malnutrition. The length of stay was longer for patients adhering to the neutropenic diet. |
Neutropenic diet extends the length of stay in the hospital while it does not affect malnutrition status. Dietary guidelines with fewer limitations for children with cancer would be helpful for improving nutritional status and shortening hospital stays. |
Sonboletal. 2019,1919 Sonbol MB, Jain T, Firwana B, Hilal T, Deleon T, Murad A, et al. Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis. BMJ Support Palliat Care. 2019;9:425–33. United States of America |
Systematic review and meta-analysis |
To evaluate the effectiveness of the neutropenic diet in decreasing infection and mortality in neutropenic pediatric patients with cancer. |
Searched different databases to identify comparative studies that investigated the effect of the neutropenic diet compared to the regular diet. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection. |
There was no statistically significant difference between the neutropenic diet and the regular diet in rates of serious infections or bacteremia/fungemia. No difference in mortality was observed between the neutropenic diet and the regular diet. |
There is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration. |
Tramsen et al. 2016,2020 Tramsen L, Salzmann-Manrique E, Bochennek K, Klingebiel T, Reinhardt D, Creutzig U, et al. Lack of effectiveness of neutropenic diet and social restrictions as anti-infective measures in children with acute myeloid leukemia: an analysis of the AMLBFM 2004 trial. J Clin Oncol. 2016;34:2776–83. Germany |
Randomized Clinical Trial |
To evaluate the effectiveness of non-pharmacological anti-infective measures used in children treated for acute myeloid leukemia [AML], including the neutropenic diet. |
Clinical trial analyzing non-pharmacological measures in 799 children with AML treated at 37 German pediatric hematology oncology centers. |
Data suggest that a strict neutropenic diet, strict policies on restrictions on social contacts, and restrictions on pets at home during intensive chemotherapy for pediatric AML do not decrease the rate of infections. |
The lack of effectiveness of dietary restrictions and restrictions regarding social contacts and pets should result in reconsideration of anti-infective policies. |