Nötropenik Diyette Güncel Yaklaşımlar / Current Approaches to Neutropenic Diet

Mutlak nötrofil sayısının 1500 hücre/mm3’ün altında olması, artmış enfeksiyon riski ile ilişkilendirilmektedir. Kemoterapi, radyoterapi, hematopoetik kök hücre nakli gibi tedaviler sonucu gelişebilen nötropeninin neden olduğu enfeksiyonların engellenmesi için birçok koruyucu önlem alınmaktadır. Nötropenik diyet, gıda kaynaklı patojenlerin neden olabileceği enfeksiyonları önlemek için, bakteri ve mantar bulaşmalarını önlemeyi ve gastrointestinal sistemi kolonize eden mikroorganizmaları elimine etmeyi temel alır. Bu diyet modeliyle ilgili en çok karşılaşılan sorular; diyete ne zaman başlanılacağı, ne zaman sonlandırılacağı, hangi besinleri içereceği ve hangi hasta grubunda daha etkili olduğuna yöneliktir. Kuruluşlar arasında bir uzlaşım yok gibi görünse de en çok kısıtlanan besinlerin çiğ veya az pişmiş yumurta, et, tavuk ve deniz ürünleri ile pastörize edilmemiş süt ve süt ürünleri olduğu bilinmektedir. Ancak çalışma sonuçlarının nötropenik diyetin üstünlüğünü kanıtlayamaması nedeniyle kısıtlayıcı diyet yaklaşımları yerine besin güvenlinin temel alınmasının daha önemli olduğu düşünceleri de mevcuttur. Gelişmemiş ve gelişmekte olan ülkelerde besin hijyeninin istenilen ölçüde sağlanamaması nedeniyle bu yaklaşımlar hastalar için büyük önem taşımaktadır. Bu nedenle ulusal ya da uluslararası ortak yaklaşımları içeren önerilerin, kuruluşların kullanabileceği ortak kılavuzlar ile uygulamaya sunulmasının gerekli olduğu düşünülmektedir.

Anahtar Kelimeler:

onkoloji, nötropeni, nötropenik diyet

Current Approaches to Neutropenic Diet

The absolute neutrophil count of less than 1500 cells/mm3 is associated with increased risk of infection. Many protective measures are being taken to prevent infections caused by neutropenia because of treatments such as chemotherapy, radiotherapy, hematopoietic stem cell transplantation. The neutropenic diet is based on preventing bacterial and fungal contamination and eliminating colonizing microorganisms in the gastrointestinal tract to prevent infections caused by foodborne pathogens. The most common questions about this diet model are when to start, when to terminate, which foods to contain, and to which group of patients it is more effective. Although there seems to be no consensus among establishments, it is known that the most restricted foods are raw and undercooked eggs, meat, poultry and seafood and unpasteurized milk and dairy products. However, there are also considerations that it is more important to base nutritional safety than restrictive diet approaches because the results of the study cannot prove the superiority of the neutropenic diet. These approaches have great importance to this patients since food hygiene cannot be achieved at the desired level in undeveloped and developing countries. It is considered necessary that the proposals including the national or international agreed approaches should be put into practice with the common guidelines that organizations can be used. In this review, it is aimed to examine the content of the neutropenic diet and its use in the light of current literature.

Keywords:

Oncology, neutropenia,

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1. Jubelirer SJ. The benefit of the neutropenic diet: fact or fiction? The Oncologist 2011;16(5):704-7.
2. Zinner SH. Changing epidemiology of infections in patients with neutropenia and cancer: Emphasis on gram-positive and resistant bacteria. Clinical Infectious Diseases 1999;29(3):490-4.
3. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clinical Infectious Diseases 2011;52(4): 56-93.
4. Marrs JA. Care of patients with neutropenia. Clinical Journal of Oncology Nursing 2006;10(2):164.
5. De Naurois J, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F, et al. Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology 2010;21(Supply 5): 252-6.
6. Shelton BK. Evidence-based care for the neutropenic patient with leukemia. Seminars in Oncology Nursing 2003;19(2):133-41.
7. Shelton BK. Infection. In: Yarbro CH, Wujcik D, Gobel BH, eds. Cancer Nursing Principles and Practice. 7.th. ed. United States of America: Jones and Bartlett Publishers (LLC); 2013. p.713-28.
8. Wison BJ. Dietary recommendations for neutropenic patients. Seminars in Oncology Nursing 2002;18(1):44-49.
9. Berg RD. Bacterial translocation from the gastrointestinal tract. Trends in Microbiology 1995;3(4):149-54.
10. Sözeri E, Kutlutürkan S. Kanser Tedavisi Sırasında Nötropenik Diyet Uygulaması [Neutropenic diet application during chemoterapy] Yıldırım Beyazıt Üniverstesi Hemşirelik E-Dergisi [Yıldırım Beyazıt University Journal of Nursing] 2015;3(3):42-48.
11. Nicole Fox R, LMNT C, Freifeld AG. The neutropenic diet reviewed: Moving toward a safe food handling approach. Oncology 2012;26(6):572-585.
12. Garofolo A. Neutropenic diet and quality of food: a critical analysis. Brazilian Journal of Hematology and Hemotherapy 2013;35(2):79-80.
13. Martin-Salces M, de Paz R, Canales MA, Mesejo A, Hernandez-Navarro F. Nutritional recommendations in hematopoietic stem cell transplantation. Nutrition 2008;24(7-8):769-75.
14. Akbulut G. Medical Nutritional Therapy in Hematopoietic Stem Cell Transplantation (HSCT). International Journal of Hematology and Oncology 2013;23(1):55-65.
15. DeMille D, Deming P, Lupinacci P, Jacobs LA, editors. The effect of the neutropenic diet in the outpatient setting: a pilot study. Oncology Nursing Forum 2006;3(2):37-343.
16. Vicenski PP, Alberti P, do Amaral DJ. Dietary recommendations for immunosuppressed patients of 17 hematopoietic stem cell transplantation centers in Brazil. Brazilian Journal of Hematology and Hemotherapy 2012;34(2):86-93.
17. Mank AP, Davies M, research subgroup of the European Group for B, Marrow Transplantation Nurses G. Examining low bacterial dietary practice: a survey on low bacterial food. European Journal of Oncology Nursing 2008;12(4):342-8.
18. Carr SE, Halliday V. Investigating the use of the neutropenic diet: a survey of U.K. dietitians. Journal of Human Nutrition and Dietetics 2015;28(5):510-5. 19. Braun LE, Chen H, Frangoul H. Significant inconsistency among pediatric oncologists in the use of the neutropenic diet. Pediatr Blood Cancer 2014;61(10):1806-10.
20. Baumgartner A, Bargetzi M, Bargetzi A, Zueger N, Medinger M, Passweg J, et al. Nutritional support practices in hematopoietic stem cell transplantation centers: A nationwide comparison. Nutrition 2017; 35:43-50.
21. Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009;15(10):1143-238.
22. Lipkin AC, Lenssen P, Dickson BJ. Nutrition issues in hematopoietic stem cell transplantation: state of the art. Nutrition in Clinical Practice 2005;20(4):423-39.
23. Tatar T, Çekici H, Akbulut G. [Medical Nutrition Therapy for Oncologic Patients]. Akbulut G, editör. Tıbbi Beslenme Tedavisinde Güncel Uygulamalar. 9.Baskı. Ankara: Nobel Tıp Kitapevi; 2017. p.99-106.
24. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Food Safety for People with Cancer, September 2011. Erişim adresi: https://www.fda.gov/food/foodborneillnesscontaminants/peopleatrisk/ucm312565.htm
25. Sonbol MB, Firwana B, Diab M, Zarzour A, Witzig TE. The Effect of a Neutropenic Diet on Infection and Mortality Rates in Cancer Patients: A Meta-Analysis. Nutrition and Cancer 2015;67(8):1230-8.
26. Van Tiel F, Harbers MM, Terporten PH, van Boxtel RT, Kessels AG, Voss GB, et al. Normal hospital and low-bacterial diet in patients with cytopenia after intensive chemotherapy for hematological malignancy: a study of safety. Annals of Oncolgy 2007;18(6):1080-4.
27. Lassiter M, Schneider SM. A pilot study comparing the neutropenic diet to a non-neutropenic diet in the allogeneic hematopoietic stem cell transplantation population. Clinical Journal of Oncology Nursing 2015;19(3):273-8.
28. Gardner A, Mattiuzzi G, Faderl S, Borthakur G, Garcia-Manero G, Pierce S, et al. Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia. Journal of Clinical Oncology 2008;26(35):5684-8.
29. Moody K, Finlay J, Mancuso C, Charlson M. Feasibility and safety of a pilot randomized trial of infection rate: neutropenic diet versus standard food safety guidelines. Journal of Pediatric Hematology/Oncology 2006;28(3):126-33.
30. Trifilio S, Helenowski, I, Giel, M, Gobel, B, Pi J, Greenberg D, Mehta J. Questioning the role of a neutropenic diet following hematopoetic stem cell transplantation. Biology of Blood and Marrow Transplantation 2012;18(9), 1385-1390.
31. Galati PC, Lataro RC, Souza VM, de Martinis EC, Chiarello PG. Microbiological profile and nutritional quality of raw foods for neutropenic patients under hospital care. Brazilian Journal of Hematology and Hemotherapy 2013;35(2):94-8.
32. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans 2015. Erişim adresi: http://health.gov/dietaryguidelines/2015/guidelines/.
33. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Food Safety For Transplant Recipients 2011. Erişim adresi: https://www.fda.gov/food/foodborneillnesscontaminants/peopleatrisk/ucm312570.htm
34. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition 2017;36(1):11-48.