A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients

Abstract

Background: The neutropenic diet (ND) is prescribed to avoid introduction of bacteria into a host's gastrointestinal tract and reduce infection. Due to a lack of evidence to support the ND, there continues to be debate among pediatric oncologists regarding its usefulness. This prospective randomized controlled trial evaluated the difference in neutropenic infection rates in pediatric oncology patients randomized to Food and Drug Administration approved food safety guidelines (FSGs) versus the ND plus FSGs during one cycle of chemotherapy.Procedure: Pediatric patients receiving cancer treatment with myelosuppressive chemotherapy were eligible. Neutropenic infection was the primary outcome and defined as (i) fever with neutropenia or (ii) hospital admission and treatment for clinical infection and neutropenia. The rate of neutropenic infection was compared with Student's t-test for independent samples. Documented infections were identified by comprehensive chart review and compared between groups using a 2 test.Results: : One hundred fifty patients were randomly assigned to FSGs (n = 73) or ND + FSGs (n = 77). The most common diagnoses were acute lymphoblastic leukemia (32%) and sarcoma (32%).There was no significant difference between the groups in the percentage of patients who developed neutropenic infection: FSGs 33% versus ND + FSGs 35% (P = 0.78). Patients randomized to ND + FSGs reported that following the diet required more effort than those on FSGs alone. Conclusion:The ND offers no benefit over FSGs in the prevention of infection in pediatric oncology patients undergoing myelosuppressive chemotherapy and adherence requires more effort for patients and families. Institutions caring for children with cancer should consider replacing ND guidelines with FSGs. K E Y W O R D Schemotherapy, febrile neutropenia, infections in immunocompromised hosts, nutrition, pediatric hematology/oncology

Things We Do For No Reason: Neutropenic Diet

“…A study involving 153 patients receiving chemotherapy for acute myeloid leukemia or myelodysplastic syndrome randomized 78 patients to a diet that restricted raw fruits and vegetables and 75 patients to a diet that included those foods. 8 The groups had similar rates of major infection (29% in the cooked group versus 35% in the raw group, P = .60) with no difference in mortality. 7 In a randomized, multi-institutional trial of 150 pediatric oncology patients, 77 patients received a neutropenic diet plus a diet based on the food safety guidelines approved by the Food and Drug Administration (FDA), while 73 children received a diet based on FDA-approved food safety guidelines.…”

“…14 Patients and family members reported that following the neutropenic diet requires considerably more effort than following a less restrictive diet. 8 Maintaining nutrition in this patient population is already challenging, and the restriction of a wide variety of food items (fresh fruits, vegetables, dairy, certain meats, eggs) can cause malnutrition, low patient satisfaction, and poor quality of life. 13,14 WHEN MIGHT THE NEUTROPENIC DIET BE HELPFUL?…”

“…Despite additional flexibility, patients following the FDA diet guidelines do not have increased risk of infection. 8 At our hospitals, the neutropenic diet can no longer be ordered. Neutropenic patients are free to consume all items on the general hospital menu, including eggs, meat, soft cheeses, nuts, and washed raw fruits and vegetables.…”

Integrative Medicine in Childhood Cancer

“…Although the scientific support for the neutropenic diet is largely empirical, adherence to these diets is difficult and provides further restraints on the individual's dietary intake. 13 Most importantly, clinical trials have not found this diet to be effective in the prevention of infection over and above that of food safety guidelines. [13][14][15] It is plausible that incorporating foods and supplements high in pre-or probiotics may be safe and beneficial within the context of childhood cancer; however, additional research is needed.…”

“…13 Most importantly, clinical trials have not found this diet to be effective in the prevention of infection over and above that of food safety guidelines. [13][14][15] It is plausible that incorporating foods and supplements high in pre-or probiotics may be safe and beneficial within the context of childhood cancer; however, additional research is needed. It is essential that dietary counseling within integrative oncology adheres to food safety guidelines to reduce the risk of food-borne illnesses.…”