Neutropenic Diets – What is the Evidence?

Neutropenic Diets: Whats the Evidence??
By: Lisa Moloney MS, RD, LDN

Neutropenic diets contain no fresh fruits or vegetables and are often prescribed to patients with neutropenia secondary to treatment such as chemotherapy or disease states such as HIV. The theory is that raw fruits and vegetables contain harmful bacteria that may increase risk of infection. Unfortunately, a large percentage of the aforementioned population already have suboptimal intake due to decreased appetite, food aversions and/or GI symptoms. Limiting their food options may further hinder optimal nutrient intake.

So what is the evidence? Do neutropenic diets actually decrease rates of infection? A study conducted in 2006 by the Joan Karnell Cancer Center published in the Oncology Nursing Forum set out to determine if the use of neutropenic diets in the outpatient setting decreased the number of febrile admissions and positive blood cultures associated with chemotherapy-induced neutropenia. No significant differences were found in the rates of febrile admissions or positive blood cultures between compliant and noncompliant patients. Of note, the sample population was only 28 patients. Another study also from 2006 conducted by Moody etal published in the Journal of Pediatric Hematology/Oncology compared neutropenic diets and standard food safety guidelines. Patients were able to tolerate both diets, however, there was more reported difficulty adhering to the neutropenic diet. Infection rates for children with cancer on the neutropenic diet were similar to those for patients following food safety guidelines. The results of this study did suggest that 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.
The most recent article regarding the neutropenic diet was published in The Oncologist this past May. The author SJ Jubelirer states “there really should not be a debate about the use of neutropenic diet for cancer patients. Its usefulness has never been scientifically proven.” Per Jubelirer there remain many unanswered questions in regard to the neutropenic diet such as which food should be included, which food preparation techniques improve compliance and when should the diet be initiated. Currently, the Montefiore Medical Center is recruiting participants for a study that will set out to determine if FDA approved food safety guidelines are equivalent to the neutropenic diet with respect to the acquisition of infections during neutropenia in a sample of pediatric cancer patients, the estimated enrollment is 900.
In the meantime “without scientific evidence, the best advice for neutropenic patients is to follow food safety guidelines as indicated by government entities” (SJ Jubelirer).
FDA Food Safety Guidelines: US Food and Drug Administration Food Safety Guidelines
• Food preparation surfaces should be thoroughly cleaned with soap and water and dried to prevent food contamination
• Discard leftovers stored at room temperature longer than 2 hours
• Wash hands before food preparation and eating
• Leftovers should be reheated to a temperature greater than 165°F/74°C
• Discard leftovers more than 2 days old
• Use only clean eating utensils
• All raw meat should be cooked thoroughly to an internal temperature of 185°F/ 85°C
• Refrigerated foods should be stored at a temperature of 40°F/4.5°C or less
• Avoid cross-contamination by using separate cutting boards for produce and meats
• Do not drink directly from cans; wash can before opening and then pour into cup
• Thaw frozen food in the refrigerator or in cold water; do not thaw at room temperature