Comparing a Neutropenic Diet to a Food Safety-Based Diet in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Neutropenic diets were adopted as a way to decrease the infection risks in immunocompromised individuals, but these diets result in significant restrictions in the variety and types of foods an individual may consume. We used a controlled before-and-after study design in consecutive pediatric and young adult patients who underwent hematopoietic stem cell transplant at our center between January 1, 2014, and December 31, 2014. From January through June, all patients were placed on a traditional neutropenic diet; on July 1, we liberalized the bone marrow transplant (BMT) diet to a modified BMT diet. We compared the incidence of bloodstream infections in the first 100 days post-transplant, incidence of norovirus in the first 100 days, total parenteral nutrition days through day 100, incidence of grade 3 to 4 graft-versus-host disease at day 100, gastrointestinal graft-versus-host disease (any stage), and 100-day overall survival. In addition, we administered an investigator-created survey to evaluate food cravings, nausea, diet limitations, and subjective quality of life. In total, 102 patients underwent hematopoietic stem cell transplant during the study period. Forty-nine (48%) received the neutropenic diet and 53 (52%) the BMT diet. Other than more males receiving the neutropenic diet (67% versus 47%, P = 0.05), there were no statistical demographic and outcome differences between the 2 groups. Additionally, 46 subjects (45%) completed the investigator-created questionnaire. There was no difference in the perceived food cravings, nausea, diet limitations, and subjective quality of life between the 2 cohorts. These data demonstrate noninferiority of the modified BMT diet over the traditional neutropenic diet. We believe the food safety-based diet offers a greater variety of food, which may assist in the transition to a normal diet.

Management of Nutritional Needs in Pediatric Oncology: A Consensus Statement

“…To date, the use of a restrictive neutropenic diet has not proven to be superior to regular diets with respect to safe food handling [ 29 , 34 , 35 , 36 , 37 , 38 ]. It is now clear that restrictive diets have little scientific support and represent an unnecessary burden for the patients and the family, with the risk of further inadequate food intake.…”

The role of nutrition in children with cancer

“…The use of a restrictive neutropenic diet has not proven to be superior to regular diets with respect to safe food handling. [26][27][28][29][30][31] Oral supplements are indicated when the patient has a moderate nutritional risk or is unable to fully meet daily requirements orally. For this aim, commercial supplementation (liquid, semi-solid, or powder), energy dense foods or ready-to-use therapeutic foods may be suggested.…”

“…The use of a restrictive neutropenic diet has not proven to be superior to regular diets with respect to safe food handling. 26-31…”

Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute

“…The KRINKO is strongly opposed to a strict “neutropenic diet”, as the benefits are unproven and such a diet can significantly reduce the patient’s quality of life [ 7 ], [ 77 ], [ 169 ], [ 170 ], [ 171 ], [ 172 ], [ 173 ], [ 174 ], [ 175 ], [ 176 ], [ 177 ], [ 178 ] (cat. II).…”