{
  "abstract": "Background Neutropenic diets (ND) have been widely implemented across transplant centres to prevent infection in the early post-transplant period, yet current guidelines from the European Society for Blood and Marrow Transplantation (EBMT) and European Society for Clinical Nutrition and Metabolism (ESPEN) recommend moving away from restrictive dietary approaches in favour of safe food-handling practices. This systematic review and meta-analysis evaluate the efficacy of neutropenic, low-bacterial, or low-microbial diets compared with liberal dietary or food safety-based approaches in preventing gastrointestinal complications, infection, and graft-versus-host disease (GVHD) in hematopoietic stem cell transplant (HSCT) recipients.Methods MEDLINE, Embase, and Scopus databases were searched for randomised and non-randomised comparative studies. After screening 461 studies, seven eligible studies (four randomised controlled trials, one controlled before-and-after study, and two retrospective cohort studies) enrolling 1,573 participants were included. Studies compared neutropenic, low-bacterial, or low-microbial diets with liberal dietary or food-safety-based approaches. Primary outcomes included gastrointestinal GVHD (GI-GVHD), infection rates, acute GVHD (grades I–IV), and nutritional parameters. Random-effects meta-analysis was performed to calculate risk ratios (RR) with 95% confidence intervals (CI).Results Gastrointestinal GVHD analysis (n=295) demonstrated significantly increased risk with neutropenic diet [RR 1.86 (95% CI: 1.10–3.16); p=0.021; I 2=0%]. Meta-analysis of six studies (n=1,381) demonstrated that ND did not significantly reduce overall infection compared to liberal or food safety-based dietary approaches [RR 1.09 (95% CI: 0.89–1.35); p=0.4; I2=38.5%]. On sensitivity analysis restricted to randomised controlled trials (n=481), infection rates remained comparable [RR 0.90 (95% CI: 0.62–1.31); p=0.588; I2=46.4%]. Severe acute GVHD (grade ≥3, n=112) analysis yielded no significant protective benefit of ND [RR 1.60 (95% CI: 0.72–3.55); p=0.248]. TPN use and nutritional parameters were comparable between dietary groups [RR 0.93 (95% CI: 0.67–1.30)]. Most included studies demonstrated no protective benefit of ND, with evidence of improved patient satisfaction with liberal approaches.Conclusions This systematic review reveals that neutropenic diets potentiate the risk of GI GVHD whilst providing no protective benefit against infection in HSCT recipients. Nutritional outcomes remain comparable between dietary approaches. These findings support current EBMT and ESPEN recommendations favouring safe food-handling practices over restrictive neutropenic diets for preventing gastrointestinal complications in transplant recipients.",
  "authors": [
    {
      "affiliations": [
        "University of Nottingham, Nottingham, United Kingdom"
      ],
      "name": "Saikat Mandal"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom",
        "Hull York Medical School, Hull, United Kingdom"
      ],
      "name": "Manideepa Maji"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom",
        "Imperial College, London, United Kingdom"
      ],
      "name": "Arkadeep Dhali"
    },
    {
      "affiliations": [
        "University of Nottingham, Nottingham, United Kingdom",
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Guruprasad Aithal"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom",
        "University of Sheffield, Sheffield, United Kingdom"
      ],
      "name": "John Snowden"
    },
    {
      "affiliations": [
        "University of Nottingham, Nottingham, United Kingdom",
        "Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Laura Miller"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom"
      ],
      "name": "Avik Roy"
    },
    {
      "affiliations": [
        "All India Institute of Medical Sciences, New Delhi, India"
      ],
      "name": "Suhasini Sil"
    },
    {
      "affiliations": [
        "All India Institute of Medical Sciences, Bibinagar, India"
      ],
      "name": "Aswin K Mohan"
    }
  ],
  "title": "O43 Does neutropenic diet increase gastrointestinal complications in haematopoietic stem cell transplant recipients? A systematic review and meta-analysis",
  "uid": "e83f4939-f28b-533b-8a41-33a445665dc0"
}