Sonbol, M.B., Firwana, B., Diab, M., Zarzour, A., & Witzig, T.E. (2015). The effect of a neutropenic diet on infection and mortality rates in cancer patients: A meta-analysis. Nutrition and Cancer, 67, 1230–1238. 

STUDY PURPOSE: To evaluate the evidence to determine if a neutropenic diet decreases infection and the mortality rates of patients with cancer at risk for neutropenia

TYPE OF STUDY: Meta-analysis and systematic review

• DATABASES USED: MEDLINE, EMBASE, COCHRANE CENTRAL
• INCLUSION CRITERIA: Randomized, controlled trials and comparative observational studies. A neutropenic diet was any diet that excluded fresh fruits and vegetables, raw meats, and other types of food like soft cheese.
• EXCLUSION CRITERIA: Not specified

• TOTAL REFERENCES RETRIEVED: 537
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias tool and the Newcastle Ottawa Scale for observational studies. Risk of bias found was related to lack of blinding, which is not always possible in such studies.

• FINAL NUMBER STUDIES INCLUDED = 4 
• TOTAL PATIENTS INCLUDED IN REVIEW = 918
• SAMPLE RANGE ACROSS STUDIES: 19–363 patients
• KEY SAMPLE CHARACTERISTICS: Multiple tumor types, one study of 19 pediatric patients

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Pediatrics

No differences in major infection rates were observed between those on regular diets and those on neutropenic diets. The risk of infection was higher in the neutropenic diet group (risk ratio [RR] = 1.18, p = 0.007), based upon inclusion of a large observational study. When removed, no differences existed between groups. No differences in mortality rates were observed.

The use of a neutropenic diet is not shown to reduce infection or mortality rates among patients with cancer at risk for neutropenia.

• Limited search
• Limited number of studies included

Questions have been raised regarding whether diet restrictions in neutropenic patients should be recommended or whether the focus should be on patient food choices and relaxing diet restrictions to improve nutritional intake and associated quality of life. Larger randomized controlled trials are needed to provide strong evidence in this area.