Dietary recommendations for immunosuppressed patients of 17 hematopoietic stem cell transplantation centers in Brazil

Abstract

IntroductionLow-microbial diets are recommended to reduce the risk of foodborne infections when hematopoietic stem cell transplantation patients have neutropenia. However there is no pattern concerning the composition of such a diet.ObjectiveTo collect information concerning the structure of nutrition departments and the diets recommended for immunosuppressed patients in transplant centers in Brazil.MethodsQuestionnaires were sent to the 45 Bone Marrow Transplantation Centers listed by the Sociedade Brasileira de Transplante de Medula Óssea (SBTMO). Completed questionnaires were returned by 17 centers. The questions were related to the profile and the structure of the nutrition department, at what point a general diet is allowed after transplantation, and which food is allowed during the critical period of immunosuppression and soon after transplantation.ResultsOf the 17 centers that participated, 82% have a professional nutritionist exclusively for the Transplant Department but only 41% have an area specifically for the preparation of diets for immunosuppressed patients. The patients are released from the low-microbial diet to general diets 90-100 days after allogeneic hematopoietic stem cell transplantation by 29% of the centers and only after suspension of immunosuppressive drugs in 24%. Most centers (88%) restrict the consumption of raw fruits, all restrict the consumption of raw vegetables and 88% forbid the consumption of yogurt in the critical period of immunosuppression. There was no consensus on forbidden foods soon after transplantation.ConclusionMajor differences in diets recommended to hematopoietic stem cell transplantation patients were observed between the different centers.

Microbiological profile and nutritional quality of raw foods for neutropenic patients under hospital care

“…Vicenskiet al found that of the 17 hematopoietic stem cell transplantation centers studied in Brazil, 100% forbid thin-skinned fruits and 88% forbid thick-skinned fruit (15) . In international centers, thin-skinned fruits are allowed as long as they have been washed well (5) .…”

Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

“…There is considerable variation in practices in dietary restrictions of specific food items between HSCT-centers ( 28 , 29 ). However, the growing body of evidence of the lack of benefit of a neutropenic diet has led to an increasing number of cancer centers replacing the strict neutropenic diet with safe food handling guidelines ( 30 , 31 ).…”

Neutropenic diet and quality of food: a critical analysis

“…Although there is an international trend in not maintaining severe dietary restrictions for immunosuppressed patients, including HSCT, a Brazilian study carried out recently showed that there are still differences among professionals concerning which foods are allowed, especially during the critical period of immunosuppression (CPI) (7) .…”

“…However, the study by Vicenski et al. demonstrated that in most Brazilian centers (88%) the consumption of these foods is not allowed (7) .…”