Reevaluating the Neutropenic Diet: Time to Change

Melissa Foster, MS, RN, WHNP-BC, OCN


Clin J Oncol Nurs. 2014;18(2):239-241. 

In This Article


The neutropenic diet historically has been a mainstay in oncology practice, with many providers continuing to adhere tightly to the diet for patients with neutropenia. However, clinically sound evidence remains limited and weak and does not support the diet as a foundation for policy and practice. Therefore, two questions remain: Does evidence exist to support the effectiveness of the neutropenic diet in reducing infection rates in the neutropenic oncology population? Based on limited evidence supporting the neutropenic diet in this population, what clinically sound diet strategies are best for these patients?

The neutropenic diet was established as the so-called rules of the road for patients with absolute neutrophil counts less than 1,000 cells/mm3. The diet restricted all fresh fruits and vegetables from patients with neutropenia, with the intent to support germ-free or germ-reduced environments. In some cases, diet principles and restrictions were softened to allow family members to peel foods, such as oranges or bananas, to give to the patient (Jubelirer, 2011).

The neutropenic diet originated in the 1960s and 1970s when diets were treated as sterile—autoclaved and irradiated, then given to patient in germ-free environments. That environment was popularized with reference to the television character "The Bubble Boy" (Jubelirer, 2011).

Meanwhile, patients prescribed a neutropenic diet have been shown to have poor nutritional status, to the extent that a nutritional consultation is required. As a result of the restrictive diet, some patients even require supplementation via total parenteral nutrition (Murray & Pindoria, 2009). The diet and its effects led patients to become dissatisfied with their food choices and restrictions. Therefore, diets for patients with neutropenia eventually were changed to a cooked diet (allowing fully cooked fruits and vegetables and not requiring sterilization), although evidence supporting the change in practice was limited (Jubelirer, 2011).

Although many other restrictions for this population have been lifted, such as strict or reverse isolation, use of the neutropenic diet has continued in practice despite limited evidence from well-designed and statistically proven studies (Boeckh, 2012; Centers for Disease Control and Prevention [CDC], 2013; Jubelirer, 2011; National Institutes of Health, 2010).