Systematic review and meta-analysis of neutropenic diet versus liberalized diet in patients with cancer

Neutropenic diet (ND) has historically been recommended to reduce infectious complications in patients with cancer. Meta-analysis of studies comparing ND with liberalized diet (LD) in patients with cancer included 15 studies (4320 patients) published through January 2026. Primary outcomes were major infections and bacteremia/fungemia. ND versus LD was not associated with significant differences in major infections (pooled RR 1.02; p=0.795) of bacteremia/fungemia (0.97; p=0.805). As for secondary outcomes, ND versus LD also was not associated with significant differences in pneumonia (RR 0.98; p=0.933), diarrhea (1.12; p=0.159), or mortality (0.94; p=0.632). Sensitivity analyses restricted to randomized controlled trials were consistent. In hematologic malignancy/HSCT studies (9 studies, 1769 patients), no differences were observed across outcomes., ND was associated with lower bacteremia/fungemia risk (RR 0.67; p=0.023), with no differences in other outcomes. The authors conclude that these results do not support routine implementation of ND for cancer populations, although selected high-risk patients, particularly those undergoing HSCT or experiencing prolonged neutropenia related to hematologic malignancies, may still warrant cautious dietary practices.