Neutropenic diet of no benefit in reducing infections in cancer patients: BMJ

USA: It has been suggested that neutropenic diet (ND), a diet restricted in fresh vegetables and fruits could potentially decrease the risk for infection in cancer patients by reducing the introduction of bacteria into the gut. However, a review published in the journal BMJ Supportive & Palliative Care has found that there is currently no evidence to support the use of ND or further food restrictions in neutropenic patients with cancer.

The authors instead suggest that patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the US Food and Drug Administration (FDA).

Neutropenia -- an abnormally low count of neutrophils (a type of white blood cell) -- is a major manifestation of cancer involving the bone marrow and also a side effect of many chemotherapeutic agents. It predisposes an individual to increased risk for infections contributing to increased cancer mortality and morbidity. Therefore, increasing efforts have been made to reduce the risk of infections during the neutropenic phase in cancer patients.

A significant number of neutropenic infections result from patient’s own microbiota, neutropenic patients are still at risk of foodborne organisms, such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella sp. and Proteus sp. These organisms, besides others, can be found in salads, fresh vegetables, and fruits. Hence, it has been postulated that a diet restricted in fresh vegetables and fruits, also known as neutropenic diet (ND), can potentially decrease the risk for infection by reducing the introduction of bacteria into the gut.

Many previous studies have questioned the role of ND in controlling infections in cancer patients, but recent surveys have shown that such diets are still being prescribed. Mohamad Bassam Sonbol, Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona, USA, and colleagues conducted this meta-analysis to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia.

For the purpose, the authors searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with a regular diet in neutropenic adults and children with cancer. Six studies (five randomized) consisting of total 1116 patients were included; 772 (69.1%) having undergone hematopoietic cell transplant.

• There was no statistically significant difference between the neutropenic diet and regular diet in the rates of major infections or bacteremia/fungemia.


• In hematopoietic cell transplant patients, the neutropenic diet was associated with a slightly higher risk of infections.


• No difference in mortality was seen between the neutropenic diet and regular diet.