Search

Nutritional support measures for paediatric patients who have undergone organ, bone marrow, or hematopoietic stem cell transplantation need to be implemented to prevent infection during immunosuppressive therapy and to speed up recovery after the procedure. Children undergoing immunosuppressive therapy are at high risk of infection. Typical examples of foods with a high risk of infection are raw and uncooked foods. Special care should be taken to maintain an adequate nutritional status and provide all the nutrients and energy necessary for the child‘s growth and development, which will also improve recovery. It is essential to educate healthcare workers, kitchen staff and parents on proper hygiene, safe handling of high-risk foods and appropriate food preparation based on existing microbiological food safety guidelines.

Infections pose a significant threat to morbidity and mortality during treatments for pediatric cancer patients. Efforts to minimize the risk of infection necessitate preventive measures encompassing both environmental and host-focused strategies. While a substantial number of infections in oncologic patients originate from microorganisms within their native microbiological environment, such as the oral cavity, intestines, and skin, the concrete risk of bloodstream infections linked to the consumption of contaminated food and beverages in the community cannot be overlooked. Ensuring food quality and hygiene is essential to mitigating the impact of foodborne illnesses on vulnerable patients. The neutropenic diet (ND) has been proposed to minimize the risk of sepsis during neutropenic periods. The ND aims to minimize bacterial entry into the gut and bacterial translocation. However, a standardized definition for ND and consensus guidelines for specific food exclusions are lacking. Most centers adopt ND during neutropenic phases, but challenges in achieving caloric intake are common. The ND has not demonstrated any associated benefits and does not ensure improved overall survival. Consequently, providing unified and standardized food safety instructions is imperative for pediatric patients undergoing hematopoietic cell transplantation (HCT). Despite the lack of evidence, ND is still widely administered to both pediatric and adult patients as a precautionary measure. This narrative review focuses on the impact of foodborne infections in pediatric cancer patients and the role of the ND in comparison to food safety practices in patients undergoing chemotherapy or HCT. Prioritizing education regarding proper food storage, preparation, and cooking techniques proves more advantageous than merely focusing on dietary limitations. The absence of standardized guidelines underscores the necessity for further research in this field. [ABSTRACT FROM AUTHOR]

Objective: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. Source of data: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. Summary of the findings: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. Conclusion: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.

A low immune response is fatal for humans because increased infection risk is related to both morbidity and mortality. The neutropenic diet is applied if a person's neutrophil count is <2000 cells/μL. When compared with standard nutrition treatment, the neutropenic diet is found to be related to deficiencies in dietary fiber, vitamins C, A, and D, magnesium, and calcium. This is also related to malnutrition in patients diagnosed with cancer. Although raw vegetables are good sources of these nutrients, they can also be sources of pathogen microorganisms. Thus, the consumption of well-cooked vegetables is an essential principle in the neutropenic diet. Although many cooking methods are available, pressure cooking is the most commonly used in neutropenic diet kitchens to reduce pathogen transmission risk. According to many studies, the cooking process is associated with significant nutrient loss. In particular, boiling is found to be related to losses in vitamins C, A, and K, phenolic compounds, flavonoids, calcium, zinc, manganese, magnesium, copper, and iron in different types of vegetables. Even though some studies have shown that standard nutrition treatment with the adoption of food safety guidelines does not increase infection risk and the neutropenic diet is related to malnutrition, no guidelines have thus far suggested the application of standard nutrition treatment in neutropenic patients. Consequently, additional studies are required to compare the beneficial and harmful effects of the neutropenic diet to a standard nutrition treatment and support the application of standard nutrition treatment with the adoption of food safety guidelines at least in mildly neutropenic patients. The neutropenic diet is characterized by packaged, 1-use, and well-cooked food consumption to reduce foodborne infection risk. Although the neutropenic diet is seen as the only choice for patients with moderate and severe neutropenia, this diet model can potentially increase malnutrition risk in patients. In particular, the well-cooked vegetable consumption principle of this diet model is related to dietary fiber, vitamin, and mineral loss and thus their deficiencies. [Display omitted] [ABSTRACT FROM AUTHOR]

The neutropenic diet (ND) is often recommended to people with cancer to reduce infection risk despite recommendations of clinical guidelines advising against its use. While recent literature suggests the ND does not reduce infection risk, other outcomes related to health, nutrition, and lifestyle are unknown. The aim of this review is to systematically scope the literature on the ND in people with cancer for all outcomes related to clinical health, nutrition, and lifestyle. Scientific databases were systematically searched. Eligible studies were in English, people with any cancer type, consuming an ND, any age group, date, or setting. Eligible study types were randomised control trials, observational studies, systematic reviews, and meta-analyses. Twenty-one studies met the inclusion criteria. Outcomes of interest found were infection rates, fever, mortality, antibiotic use, gastrointestinal side effects, comorbidities, biochemistry, hospitalisation, nutritional status, quality of life (QoL), well-being, and financial costs. Most research has focused on infection and mortality rates with few assessing hospitalisation rates, nutritional status, financial costs, and QoL. Most included studies found no significant differences between ND and comparator diet for mortality, antibiotics use, comorbidities, and QoL; however, several studies reported the ND significantly increased the risk of infection. Gaps in the literature included effect of ND on QoL in an adult population, microbiome, lifestyle changes, and financial burden. Further research is needed regarding how the ND affects the microbiome and QoL of its consumers, but in the interim, it is important for hospitals providing an ND to their patients to liberalise the ND wherever possible.

The low-bacterial diet (LBD) is a widely used dietary regimen to reduce the risk of food-borne infections in patients with neutropenic cancer, but its role is controversial due to its unclear benefits. The purpose of this study was to provide an updated analysis of the available evidence on the efficacy of the LBD to reduce the risk of infections, mortality rates, and quality of life (QoL) in neutropenic patients with cancer. A systematic literature search was conducted in the biomedical databases Cochrane Library, PubMed, CINHAL, and EMBASE. The process of the screening, selection, inclusion of articles, and assessment of risk of bias and methodological quality was conducted by two reviewers. Of the 1985 records identified, 12 were included. The LBD demonstrated heterogeneity in definition, composition, and initiation timing; moreover, the LBD did not demonstrate a reduction in infection and mortality rates compared to a free diet, showing a negative correlation with quality of life. The LBD, in addition to not bringing benefits in terms of reductions in infection and mortality rates, has been shown to worsen the quality of life due to the reduced palatability and limited variety of the food supply, negatively impacting nutritional status. [ABSTRACT FROM AUTHOR]

The current society consists of an increasing number of people vulnerable to infections. For certain people with severe immunodeficiency, a neutropenic or low-microbial diet is being prescribed, which substitutes high-risk foods that are more likely to contain human (opportunistic) pathogens with lowerrisk alternatives. These neutropenic dietary guidelines are typically set up from a clinical and nutritional perspective, rather than from a food processing and food preservation perspective. In this study, the current guidelines in use by the Ghent University Hospital were evaluated based on the current knowledge of food processing and preservation technologies and the scientific evidence on microbiological quality, safety, and hygiene of processed foods. Three criteria are identified to be important: (1) the microbial contamination level and composition; (2) the potential presence of established foodborne pathogens such as Salmonella spp. (to which a zero-tolerance policy is recommended); and (3) an increased vigilance for L. monocytogenes as an opportunistic foodborne pathogen with a high mortality rate in immunocompromised individuals (to which a zerotolerance policy should apply). A combination of these three criteria was used as a framework for the evaluation of the suitability of foodstuffs to be included in a low-microbial diet. Differences in processing technologies, initial contamination of products, etc., however, lead to a high degree of variability in microbial contamination and make it difficult to unambiguously accept or reject a certain type of foodstuff without prior knowledge of the ingredients and the processing and preservation technologies applied during manufacturing and subsequent storage conditions. A restricted screening on a selection of (minimally processed) plant-based foodstuffs on the retail market in Flanders, Belgium supported decision-making on the inclusion of these food types in a low-microbial diet. Still, when determining the suitability of a foodstuff to be included in a low-microbial diet, not only the microbiological status but also nutritional and sensorial properties should be assessed, which requires multidisciplinary communication and collaboration. [ABSTRACT FROM AUTHOR]

The current society consists of an increasing number of people vulnerable to infections. For certain people with severe immunodeficiency, a neutropenic or low-microbial diet is being prescribed, which substitutes high-risk foods that are more likely to contain human (opportunistic) pathogens with lower-risk alternatives. These neutropenic dietary guidelines are typically set up from a clinical and nutritional perspective, rather than from a food processing and food preservation perspective. In this study, the current guidelines in use by the Ghent University Hospital were evaluated based on the current knowledge of food processing and preservation technologies and the scientific evidence on microbiological quality, safety, and hygiene of processed foods. Three criteria are identified to be important: (1) the microbial contamination level and composition; (2) the potential presence of established foodborne pathogens such as Salmonella spp. (to which a zero-tolerance policy is recommended); and (3) an increased vigilance for L. monocytogenes as an opportunistic foodborne pathogen with a high mortality rate in immunocompromised individuals (to which a zero-tolerance policy should apply). A combination of these three criteria was used as a framework for the evaluation of the suitability of foodstuffs to be included in a low-microbial diet. Differences in processing technologies, initial contamination of products, etc., however, lead to a high degree of variability in microbial contamination and make it difficult to unambiguously accept or reject a certain type of foodstuff without prior knowledge of the ingredients and the processing and preservation technologies applied during manufacturing and subsequent storage conditions. A restricted screening on a selection of (minimally processed) plant-based foodstuffs on the retail market in Flanders, Belgium supported decision-making on the inclusion of these food types in a low-microbial diet. Still, when determining the suitability of a foodstuff to be included in a low-microbial diet, not only the microbiological status but also nutritional and sensorial properties should be assessed, which requires multidisciplinary communication and collaboration.

Cancer patients, who face increased foodborne illness susceptibility and severity, are often placed on neutropenic diets (NDs), which eliminate the consumption of fresh produce, among other foods perceived as high-risk. Such diets are clinically disputed because they have never been proven effective in reducing foodborne illness, leading to unstandardized dietary guideline content, format, and delivery methods. To inform a strategic communication approach, this study explored the produce safety handling behavior, barriers, motivators, and beliefs of pediatric cancer patient caretakers using a mixed methods convergent parallel design. A quantitative survey revealed high frequencies (>60%) for generally recommended produce safety behaviors, such as rinsing produce and washing cutting boards, and more mixed responses for restrictive produce safety behaviors, such as peeling produce and avoiding precut, self-serve, and school cafeteria produce. Total produce safety frequency scores were not significantly affected by demographic factors or Child Vulnerability Scale (CVS) scores. Qualitative interviews established a wide domain of caretaker produce safety experiences and beliefs, finding that eight of seventeen interview participants from different hospitals received produce restrictions typical of the ND. Ultimately, five caretaker archetypes were identified, with common motivators and barriers linked to materials received, child's health and perceived susceptibility, and self-efficacy beliefs. Finally, response-driven communication strategy improvements were recommended. Although sample sizes in this work were small, and further validation is advised, this work highlights the inconsistent use of the restrictive ND, advances understanding of the drivers of produce safety behaviors in cancer patient caretakers, and supports future endeavors to streamline communication strategy interventions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Carly Gomez reports financial support was provided by the National Science Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper”., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The neutropenic diet (ND) is often recommended to people with cancer to reduce infection risk despite recommendations of clinical guidelines advising against its use. While recent literature suggests the ND does not reduce infection risk, other outcomes related to health, nutrition, and lifestyle are unknown. The aim of this review is to systematically scope the literature on the ND in people with cancer for all outcomes related to clinical health, nutrition, and lifestyle. Scientific databases were systematically searched. Eligible studies were in English, people with any cancer type, consuming an ND, any age group, date, or setting. Eligible study types were randomised control trials, observational studies, systematic reviews, and meta-analyses. Twenty-one studies met the inclusion criteria. Outcomes of interest found were infection rates, fever, mortality, antibiotic use, gastrointestinal side effects, comorbidities, biochemistry, hospitalisation, nutritional status, quality of life (QoL), well-being, and financial costs. Most research has focused on infection and mortality rates with few assessing hospitalisation rates, nutritional status, financial costs, and QoL. Most included studies found no significant differences between ND and comparator diet for mortality, antibiotics use, comorbidities, and QoL; however, several studies reported the ND significantly increased the risk of infection. Gaps in the literature included effect of ND on QoL in an adult population, microbiome, lifestyle changes, and financial burden. Further research is needed regarding how the ND affects the microbiome and QoL of its consumers, but in the interim, it is important for hospitals providing an ND to their patients to liberalise the ND wherever possible., Competing Interests: None., (© The Author(s) 2024.)

Listeria monocytogenes is a foodborne pathogen of concern for cancer patients, who face higher morbidity and mortality rates than the general population. The neutropenic diet (ND), which excludes fresh produce, is often utilized to mitigate this risk; however, an analysis weighing the theoretical listeriosis risk reduction of produce exclusion aspects of the ND and possible negative tradeoffs has never been conducted. Consequently, this work constructed decision analytic models using disability-adjusted life years (DALYs) to compare the impacts of the ND, such as increased neutropenic enterocolitis (NEC) likelihood, with three alternative dietary practices (safe food handling [SFH], surface blanching, and refrigeration only) across five age groups, for cancer patients who consume ready-to-eat salad. Less disruptive diets had fewer negative health impacts in all scenarios, with median alternative diet DALYs per person per chemotherapy cycle having lower values in terms of negative health outcomes (0.088-0.443) than the ND (0.619-3.102). DALYs were dominated by outcomes associated with NEC, which is more common in patients following the ND than in other diets. Switchover point analysis confirmed that, because of this discrepancy, there were no feasible values of other parameters that could justify the ND. Correspondingly, the sensitivity analysis indicated that NEC mortality rate and remaining life expectancy strongly affected DALYs, further illustrating the model's strong dependence on NEC outcomes. Given these findings, and the SFH's ease of implementation and high compliance rates, the SFH diet is recommended in place of the ND., (© 2024 The Author(s). Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

The neutropenic diet has long been a dietary prescription for immunocompromised patients. However, its effectiveness and consistency have been constantly challenged. Researchers and health care policymakers call for liberalization of the neutropenic diet, which shifts risk management strategies from excluding “high-risk” food items to focus on safe food handling. The responsibility of food safety falls on food service workers in a health care setting. The objective of the present study was to develop and conduct psychometric testing to determine the validity and reliability of a self-assessment survey instrument tool targeting beliefs, attitudes, and behaviors of health care food service workers regarding safe food handling practices. This survey validation study was conducted in four phases. First, the tool was developed based on the Theory of Planned Behavior. After the initial draft, the survey was tested to establish face validity and test-retest reliability to measure temporal stability. The 40-item survey was then pilot tested to assess internal consistency and construct validity. Pilot testing was conducted over a 16-month period on 211 health care food service workers across six acute care hospitals that serve immunocompromised people. The original survey comprised 46 items. Six items were removed due to low content validity scores and temporal instability. Pilot testing revealed acceptable internal consistency (Cronbach's alpha = 0.79). The linear regression model was a good fit (P ≤ 0.0001) after assumptions were tested and met to predict behavior from attitude. A reliable and valid self-assessment survey instrument tool was developed for use in a health care food service operation. Results of this tool can help organizations pinpoint areas in which they can improve food safety practices of food service workers who serve immunocompromised people. [ABSTRACT FROM AUTHOR]

Background: The purpose of this systematic review and meta-analysis was to evaluate the effect of a neutropenic diet and a control diet on infection and mortality rates in oncology patients with neutropenia. Methods: We searched the following English electronic databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar Engine. Published studies involving neutropenic diets (study group) and control diets (control group) in oncology patients with neutropenia were searched. The focus of the meta-analysis was on the outcomes of infection and mortality rates. A subgroup analysis was also performed. Results: A total of 6 studies were included, with a total sample size of 1114 patients. The patients in the study group had a similar infection rate compared with the patients in the control group (P = 0.11). The patients in the study group had a similar mortality rate compared with the patients in the control group (P = 0.74). Another subgroup analysis showed that the incidence of infection was also similar for pediatric (P = 0.74) and adult (P = 0.11) oncology patients between the study and control groups. Conclusions: Based on the current evidence, this meta-analysis showed that the application of a neutropenic diet cannot reduce the risk of infection and mortality in oncology patients with neutropenia. However, more rigorous randomized controlled trials are needed to confirm this conclusion in the future. [ABSTRACT FROM AUTHOR]

This article presented a review of the literature on the features of nutritional support for oncohematological patients who have undergone allogeneic (alloHSCT)/autologous hematopoietic stem cell transplantation (autoHSCT). Bone marrow transplantation associated with a high risk of developing nutritional deficiencies. Nutritional support (NP) is indicated for patients undergoing alloHSCT and autoHSCT in order to reduce the incidence of infectious complications and reduce the risk of developing severe forms of acute and chronic GVHD. Currently, there are recommendations for conducting NP in alloHSCT, while there are no recommendations for patients with autoHSCT. An important task in planning NP is the calculation of the daily energy requirement. Bone marrow transplantation accompanied by a prolonged negative nitrogen balance. The protein requirement for alloHSCT is significantly higher than for patients with chemotherapy alone – 1.5–2 g/kg per day. An effective method of controlling the needs of hematological patients during the analysis of HSCT and alloHSCT is the calculation of the nitrogen balance and the daily protein norm. In this article was analyzed the role of macronutrients and immunonutrients in the recovery of patients during alloHSCT. It has been shown that low levels of vitamin D and vitamin A increase the risk of development and the severity of the transplant versus host reaction. The addition of omega-3 fatty acids helps maintain an optimal proportion of calorie intake from lipids, as well as maintain the necessary level of triglycerides in the blood. The article presents data on reducing the risk of developing acute GVHD with systemic addition of omega-3 fatty acids. For a final assessment of the effect of the neutropenic diet on the development of infectious complications in oncohematological patients, randomized prospective multicenter studies with the development of a unified approach in choosing a diet for HSCT are needed.

BackgroundThe purpose of this systematic review and meta-analysis was to evaluate the effect of a neutropenic diet and a control diet on infection and mortality rates in oncology patients with neutropenia.MethodsWe searched the following English electronic databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar Engine. Published studies involving neutropenic diets (study group) and control diets (control group) in oncology patients with neutropenia were searched. The focus of the meta-analysis was on the outcomes of infection and mortality rates. A subgroup analysis was also performed.ResultsA total of 6 studies were included, with a total sample size of 1114 patients. The patients in the study group had a similar infection rate compared with the patients in the control group (P = 0.11). The patients in the study group had a similar mortality rate compared with the patients in the control group (P = 0.74). Another subgroup analysis showed that the incidence of infection was also similar for pediatric (P = 0.74) and adult (P = 0.11) oncology patients between the study and control groups.ConclusionsBased on the current evidence, this meta-analysis showed that the application of a neutropenic diet cannot reduce the risk of infection and mortality in oncology patients with neutropenia. However, more rigorous randomized controlled trials are needed to confirm this conclusion in the future.

Background: The use of a neutropenic diet after hematopoietic stem cell transplantation (HSCT) was instituted more than 30 years ago. This diet was targeted toward preventing from infection with organisms colonizing the gastrointestinal tract and the food-borne pathogens, which are the most important cause of illness and death in developing countries. Regarding this, the present study aimed to evaluate neutropenic diet in patients undergoing bone marrow transplantation in a selected hospital. This study also sought to investigate the role of hospital foods in the transmission of clinically important bacteria to the hospitalized patients. Materials and Methods: This cross-sectional study was conducted on the specimens of the foods served in the Bone Marrow Transplant Department of Shariati Hospital, Tehran, Iran. The samples were evaluated in terms of bacterial contamination using the standard method ‎of American Public Health Association and Food and Drug Administration (FDA). Results: According to total bacteria and coliform counts, No contamination was detected in any of the tested specimens. Conclusion: As the findings indicated, the neutropenic diet, was found to be fully in line with the standards of the Ministry of Health and FDA both in terms of guidelines and food analysis.

BACKGROUND: Strong evidence supports the benefits of the Mediterranean diet, but little is reported among patients and nurses regarding knowledge about the diet and its health benefits. OBJECTIVES: A pre-/post-test practice initiative was implemented to identify level of knowledge about the Mediterranean diet in patients with cancer and nursing staff and to provide education about the diet's health benefits. METHODS: A 17-item survey was developed to assess knowledge and willingness to try or recommend the Mediterranean diet, current practices, and general nutrition knowledge. A 10-minute education session was provided to patients and nursing staff. Descriptive statistics were used. FINDINGS: The majority of patients reported eating from one to four servings of fruits and vegetables daily. For patients and nursing staff, post--education session scores demonstrated increased knowledge, willingness to try the diet, and perceived effectiveness of the diet. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is associated with inferior survival and increased chemotherapy toxicity. The present study was conducted to evaluate the level of knowledge regarding nutrition and prevalent misconceptions about diet in families with children undergoing therapy for cancer. Procedure: Mothers of children

Objective: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients., Source of Data: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form., Summary of the Findings: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes., Conclusion: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

• Neutropenic diet; low bacterial diet; hematopoietic stem cell transplant; bloodstream infections; nutrition; supportive care 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. [ABSTRACT FROM AUTHOR]

Abstract In Europe and North America up to 20% of the population is particularly susceptible to foodborne and other sources of infection because of age, pregnancy, illness, treatment or medication. These people may be in hospitals, nursing homes, long-term care homes or living in the community. In order to control the microbiological safety of food, including that supplied to vulnerable people, food businesses must have in place a Food Safety Management System based on Hazard Analysis and Critical Control Point principles, Good Manufacturing Practice and Good Hygienic Practice. Vulnerable people should be advised about measures to maintain food safety and should be advised of, and supplied with, a diet in which lower-risk foods are substituted for higher-risk foods. The main microorganisms responsible for the burden of foodborne disease are discussed, examples of outbreaks in healthcare settings are given, and factors leading to outbreaks are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Cancer and chemotherapy-induced malnutrition increase death, reduce the response to treatment, and increase multiple kinds of side effects. The aim of this study was to investigate the effects of Mediterranean-neutropenic diet on the nutritional status of acute myeloid leukemia patients under chemotherapy.Materials and Methods: 50 patients were divided into two groups by a random allocation scheme: the Mediterranean-neutropenic diet (n = 25) and the neutropenic diet group (n = 25). The intervention was implemented during a one month period. The nutritional status was evaluated based on PG-SGA. Serum albumin levels and dietary intake were also measured.Results: After the intervention, the mean serum albumin level in the intervention group was significantly higher than the beginning of the study (p = 0.09) and in comparison with the control group (p = 0.01). Also, the mean serum albumin level in the control group significantly decreased at the end of the study compared to the beginning of the study (p = 0.03). After intervention, the nutritional status of the patients in the intervention group was significantly improved compared to the control group.Conclusion: In general, based on the results of this study, the Mediterranean neutropenic diet improves nutritional status during chemotherapy by increasing food intake, preventing weight loss and increasing serum albumin levels [ABSTRACT FROM AUTHOR]

Introduction: The use of a neutropenic diet after hematopoietic stem cell transplantation (HSCT) was instituted more than 30 years ago. This diet was targeted toward preventing from infection with organisms colonizing the gastrointestinal tract and the food-borne pathogens, which are the most important cause of illness and death in developing countries. Regarding this, the present study aimed to evaluate neutropenic diet in patients undergoing bone marrow transplantation in a selected hospital. This study also sought to investigate the role of hospital foods in the transmission of clinically important bacteria to the hospitalized patients. Methods: This cross-sectional study was conducted on the specimens of the foods served in the Bone Marrow Transplant Department of Shariati Hospital, Tehran, Iran. The samples were evaluated in terms of bacterial contamination using the standard method of American Public Health Association and Food and Drug Administration (FDA). Results: According to total bacteria and coliform counts, No contamination was detected in any of the tested specimens. Conclusion: As the findings indicated, the neutropenic diet, was found to be fully in line with the standards of the Ministry of Health and FDA both in terms of guidelines and food analysis. [ABSTRACT FROM AUTHOR]

Hematopoietic Stem Cell Transplantation (HSCT) is a method used for the treatment of patients with severe aplastic anemia, leukaemia and some other malignancies. As it causes many adverse sequelaes (anorexia, nausea, vomiting, diarrhea, and mucositis), adequate oral diet is usually unachievable and artificial nutrition support is required. In order to reduce the risk of infections, the protective benefit of "low-microbial / neutropenic diets" is suggested to use in immunosuppressed patients. Traditionally, total parenteral nutrition (TPN) has been the chosen method for the nutritional support of patients undergoing HSCT. Secondly enteral nutrition (especially with enteral tube feeding - ETF) is an alternative method for nutritional support. It is important that dietary guidance for HSCT patients to minimize the risk of microbial exposure, optimize nutrient consumption and energy intake is very important. [ABSTRACT FROM AUTHOR]

There really should not be a debate about the use of neutropenic diet for cancer patients. Its usefulness has never been scientifically proven. However, neutropenic diets remain in place in many institutions even though their usefulness is controversial. Neutropenic diets were once thought to be important in protecting patients from having to succumb to infection from neutropenia while undergoing chemotherapy. Although food may contain harmful organisms and research has shown that bacterial translocation is possible, recent studies have been unable to obtain significant differences between placebo and intervention groups. The dietetic challenges neutropenic patients struggle with include decreased quality of life, malnutrition, gastrointestinal side effects, food aversion, and impaired cell-mediated immunity from vitamin deficiency. Unanswered questions in regard to the neutropenic diet include the following: (a) which food should be included; (b) which food preparation techniques improve patient compliance; (c) which patient populations benefit most; and (d) when should such a diet be initiated. Without scientific evidence, the best advice for neutropenic patients is to follow food safety guidelines as indicated by government entities. [ABSTRACT FROM AUTHOR]

Introduction: Multiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review., Materials and Methods: We searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random-effects meta-analyses using the Der-Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection., Results: We included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50)., Conclusion: There is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The role of the neutropenic diet in the development of infections in oncology and stem cell transplant (SCT) patients is controversial. There is no data on the use of the neutropenic diet among pediatric oncologists., Methods: A self-administered electronic survey was sent to 1,639 pediatric oncologists at 198 institutions who are members of Children's Oncology Group. A pediatric dietitian and pediatric oncologists developed, pretested, and modified the survey for item clarification., Results: Five hundred fifty-seven physicians (34%) responded representing 174 (87%) of the 198 member institutions. More than half of respondents (57%) report implementing the neutropenic diet at their facility. In a multivariate analysis, being a stem cell transplant (SCT) center was the only significant factor associated with implementing a neutropenic diet (OR: 6.06, 95% CI, 2.88-12.738, P < 0.001) after controlling for years in practice, gender, center size, and academic versus private practice. Among physicians who implemented a neutropenic diet, absolute neutrophil count was the trigger for initiating the diet in oncology patients (72%) while admission and start of preparative regimen was used for SCT patients (84%). The majority of respondents (82%) stop the neutropenic diet when oncology patients are no longer neutropenic while the practice varied significantly with SCT patients. Providers at the same institution were not consistent with implementation of the diet, patient populations placed on the neutropenic diet and parameters for initiation, discontinuation of the diet and specific food restrictions., Conclusion: The implementation of the neutropenic diet by pediatric oncologists remains quite variable even among those at the same institution., (© 2014 Wiley Periodicals, Inc.)