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The Raw Truth About Neutropenic Diets?

Neutropenic patients who ate uncooked fruits and vegetables had no higher rates of serious infections than did those who ate only cooked foods.

Diets that contain no raw fruits or vegetables are often prescribed for patients with treatment- or disease-related neutropenia, even though such diets might adversely affect nutritional intake, and despite a lack of evidence showing that they diminish the likelihood of infection. To assess whether the benefits of diets for neutropenic patients outweigh the risks, investigators performed a single-institution, randomized trial of diets containing only cooked foods versus those including raw foods (i.e., fresh fruits and vegetables) for patients undergoing induction chemotherapy for acute myelogenous leukemia or high-risk myelodysplastic syndrome. All patients were treated in a high-efficiency particulate air (HEPA)-filtered environment and received antimicrobial prophylaxis with levofloxacin and valacyclovir plus itraconazole, voriconazole, or liposomal amphotericin-B.

Of 206 eligible patients, 53 declined to participate and received cooked diets. For the remaining 153 patients, rates of major infections did not differ significantly between those who were randomized to receive a cooked or a raw diet (29% and 35%; P=0.60); these infection rates were similar to the infection rate in the nonrandomized patients (36%). Overall survival did not differ between the two randomized groups. Bacteremia was more common in the raw-diet group, but most of the organisms were not associated with gut flora. Pneumonias and fevers of unknown origin were more common in the cooked-diet group.

Comment: Results of this small, prospective trial suggest limited, if any, benefit of diets that restrict fresh fruits and vegetables for neutropenic patients undergoing induction therapy for high-risk myeloid malignancies. Whether this outcome would be true for patients managed outside HEPA-filtered environments or for those receiving more-limited antimicrobial prophylaxis than in this study will need to be established in larger randomized trials. Nevertheless, these findings are consistent with those of a recent study of 20 adults with acute leukemia who — whether on normal hospital diets or on restricted diets — showed no significant difference in rates of infection or of gut colonization by gram-negative bacteria or yeasts (Ann Oncol 2007; 18:1080).

— Michael E. Williams, MD

Published in Journal Watch Oncology and Hematology January 13, 2009

Citation(s):

Gardner A et al. Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia. J Clin Oncol 2008 Dec 10; 26:5684.

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