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.

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.

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.
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.
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.
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.

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.

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.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

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.

I have found Clinical Journal of Oncology Nursing (CJON) articles to be enlightening and well written, and I look forward to reading CJON monthly to expand my general cancer care knowledge. I have been a blood and marrow transplantation (BMT) nurse since 1976; our BMT program birthed the chimeric antigen receptor (CAR) T-cell program. In October 2020, I retired as a BMT supervisor and policy keeper from the Seattle Cancer Care Alliance (SCCA), so I am very familiar with both specialties. I was lucky to spend my career at the Fred Hutchinson Cancer Research Center (FHCRC), which has emphasized research at its core. Clinical nutrition research has been a mainstay since the beginning of the program.

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.
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.
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.
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.

BACKGROUND: 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.
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).
CONCLUSIONS: 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.