IMMUNOCOMPROMISED DIET (Neutropenic Diet)

Description
The Immunocompromised Diet eliminates certain foods in order to serve a diet requiring a lower level of bacteria than is present in a typical hospital diet.  Foods from the Regular Diet are served with the exception of unwashed raw fruits and vegetables, meat cooked less than well done, cured meats, yogurt, aged cheese and prepared salads.

Indications
Persons with decreased immune function due to chemotherapy or radiation are at a higher risk of developing a food-related infection.  There are not controlled studies that document the efficacy of this diet.  The premise of the diet is to avoid specific foods that could potentially introduce infection causing organisms into the gastrointestinal tract.  When the diet is being  considered, the length of time the patient has been neutropenic (absolute neutrophil count of <2,000/mm3), the patient’s current nutritional status, and anticipated nutrition related side effects that will occur from the treatment should be considered (1). .  

Nutritional Adequacy
The Immunocompromised Diet can be planned to meet the Dietary Reference Intakes (DRIs) as outlined in the Statement on Nutritional Adequacy.

How to Order the Diet
Order as “Immunocompromised Diet” or “Neutropenic Diet.”

Planning the Diet
The diet does not differ significantly from the Regular Diet except it eliminates foods that are higher in pathogenic organisms.  Although raw fruits and vegetables are eliminated, the Fred Hutchinson Cancer Research Center (2) allows raw fruits and vegetables (including peel) if they have been washed under “running water,” except raw vegetable sprouts.  There is little evidence in the literature to support the “Immunocompromised Diet.”  The diet outlined below is the consensus of staff members of individual hospitals, not a consensus from the literature.

Foods to Exclude (1-4)
Vegetables	all raw vegetables; prepared salads
Fruits	all raw fruits; prepared salads
Meats, Poultry, Fish, and Eggs	raw or undercooked products; cured, smoked or pickled meats, such as bacon, sausage, luncheon meats, and lox; shellfish
Milk, Yogurt, and Cheese	raw milk/milk products, unpasteurized yogurt, aged cheese, such as Brie, Camembert, blue, sharp cheddar, and feta
Fats and Oils	refrigerated cheese-based salad dressing, such as blue cheese, that is not shelf stable
Beverages	cold-brewed tea made with warm or cold water

References

1. Neutropenia. In: American Dietetic Association Nutrition Care Manual.  Chicago, Ill: American Dietetic Assoication; 2004. Available at: nutritioncaremanual.org.  Accessed November 14, 2005.
2. Diet Guidelines for Immunosuppressed Patients.  Fred Hutchinson Research Center, 2005.  Available at: www.fhcrc.org.  Accessed November 14, 2005.
3. L Fanning. Written communication. Charlottesville, Va: University of Virginia Health Science Center; December 1999.
4. M Kockley. Written communication. St Louis, Mo: St. Louis Children Hospital; December 1999.