title: The Effect of a Neutropenic Diet on Infection and Mortality Rates in Cancer Patients: A Meta-Analysis.
abstract: Neutropenic diets (ND) are often prescribed to cancer patients aiming to reduce infection risk. The goal of this meta-analysis was to determine if ND indeed reduced the risk of infection and death in cancer patients compared to regular diets (RD). We identified studies in cancer patients that compared the effect of ND vs. RD on the risk of infections and mortality of any cause. The overall effect was calculated by use of a random effects model. Four studies were identified encompassing 918 patients. There was no difference in major infection or mortality rates between ND and RD groups. When analyzing for the overall composite outcome of any infection or fever, the hazard ratio was significantly higher in the ND arm (relative risk = 1.18, confidence interval: 1.05 to 1.34, P= 0.007). When the analysis was restricted to only the randomized trials, both groups had a comparable composite outcome. This meta-analysis shows no superiority with respect to mortality or infection of using a neutropenic diet in cancer patients. Larger studies are needed that study a broader range of nutritional issues, including the microbiome, in this patient population. Until then, it may be time to relax the restrictions of ND.
authors.affiliation: a Department of Internal Medicine , Georgia Regents University , Augusta , Georgia , USA.
authors.forename: Mohamad Bassam
authors.initials: MB
authors.lastname: Sonbol
authors.affiliation: b Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.
authors.forename: Belal
authors.initials: B
authors.lastname: Firwana
authors.affiliation: c Department of Internal Medicine , Wayne State University , Detroit , Michigan , USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Diab
authors.affiliation: d Department of Internal Medicine , Cleveland Clinic , Cleveland , Ohio , USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zarzour
authors.affiliation: e Department of Internal Medicine , Division of Hematology, Mayo Clinic Cancer Center, Mayo Clinic , Rochester , Minnesota , USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
mesh_terms: D004032:Diet; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D007958:Leukocyte Count; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D009503:Neutropenia / Q000150:complications*; D009504:Neutrophils; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors