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Neutopenic Diet

nephroplus | April 10, 2018

Neutropenia or low neutrophil count is common after kidney transplantation and is associated with an increased occurrence  of infections.  If your immune system is low, body has a hard time protecting itself form bacteria. Neutopenic diet helps protect the body from bacteria and other food borne infection. You can minimize most of the food-borne illnesses when you know and use proper ways to handle, store, and prepare food.

Drug toxicities are the main causes of post transplant neutropenia (PTN), mainly related to immunosuppressive drugs and anti-infectious agents, but some PTN remain unexplained.

Neutropenic or Low microbial diets are intended to reduce the ingestion of bacterial and fungal contaminants by the elimination of uncooked fruits and vegetables, undercooked eggs and meat, un-sterilized water, un-pasteurized dairy products.  Evidence supporting this practice is lacking however, and the actual efficacy of neutropenic diets remains  .

A blood test called an absolute neutrophil count (ANC) can help determine the body’s ability to fight off infection. When the ANC is less than 500 cells/mm3, the patient can amend to neutropenic diet. This diet can be followed atleast till 3 month post transplant or until the doctor tells the patient to resume on his or her regular diet or until they no longer take immunosuppressive drugs.

Below are the guidelines you need to follow while on neutopenic diet

FOOD GROUP STOP GO AHEAD
Vegetable All raw fruits and vegetables, including all fresh garnishes. Cooked vegetables
Chicken And Poultry Raw or rare-cooked meat, fish, and eggs. Meat should be cooked to the “well- done” stage. All eggs should be thoroughly cooked (no runny yolks). Use a thermometer to check that meat and poultry are completely cooked. Cook to an internal temperature of:at least 60-65 C for roasts and steaks 80-85 C for whole poultry.
Miscellenious Salad bars, fruit bars, and deli counters Vacuum-packed lunch meats. Brewed herbal tea, Brewed tea and Coffee.
Nuts and Oil seeds Raw Nuts Baked Vacuum packed products, Roasted Nuts.
Dairy Curd, Buttermilk, Raw Milk, Avoid yogurt and yogurt products with live and active cultures.

 

Patuserised Milk and Paneer

 

General Tips:

  • Wash your hands before handling food.
  • Cook foods thoroughly to kill harmful bacteria.
  • Wash all surfaces, cutting boards and cutting utensils thoroughly.  Use 2 cutting boards. Use 1 cutting board for raw meat, poultry, and seafood, and use the other cutting board for fresh fruits and vegetables.
  • If you choose to use bottled water, be sure it is labeled as follows:

Reverse osmosis or Distillation or filtered through an absolute1 micron or smaller filter.

  • Keep your refrigerator temperature at 4 C to 7 C. Keep your freezer at 0 C.
  • Do not  leave perishable, cooked food at room temperature longer than 2 hours.

 

The more restricted the diet of the patient is, the greater the risk of malnutrition. Thus, there will be greater need for nutritional monitoring  and supplementation. During the cooking process, including soaking, boiling and pressure cooking, various nutritional losses are observed. Hence, resulting in reductions in the B vitamins, vitamin C and other water souluble vitamins.  These can affect the appearance, taste, and texture of food, thereby decreasing patients desire to eat and maintain their nutritional status at a time when it is critically important to maintain nutritional  intake especially calories. The available evidence does not support the widespread use of neutropenic diets. Moreover, neutropenic diets are not standardized and intensive research has been suggested . But the diet is still prescribed in many institutions with the hope that it will prevent foodborne infection and/or bacteremia in neutropenic patients.

Several studies have emphasized the importance of food in patients quality of life. Hence, it is better to propose safe food purchasing, food preparation, and good hand  hygiene which  will likely offer better infection prevention for recipients of transplantation and more liberal food choices thus,better quality of life.

 

Sample Diet  Chart

Time Menu Serving Size
7:00 am

Early Morning

Pasteurised Milk

High Protein Supplement

1  cup

1 scoop

8:30am

Breakfast

Daliya Upma/ Moong Cheela/ Tomato Omlette/ Ragi Dosa

Egg White – Well cooked

 

1 Bowl

3

 

11 :00 am

Mid-Morning

Stewed Fruits

Roasted Nuts

1 cup

5-6 in no

1:00 pm

Lunch

Millet Roti (Jowar/Bajra) or Chapati

Dal

Vegetable

Salad boied

2 n no

1 cup

1 cup

1 Plate

4:00 pm

Tea

Boiled Tea without sugar 1 cup
5:30 pm

Mid Eve Snacks

High Protein Snacks

Pasteurized Paneer with boiled Vegetables/ Moong Dal Cheela/Cooked Mushroom/Chicken (Internal temp 80-85 C)/ Soya Chunks/Pateurised Tofu/ Boiled Corn

1 plate
7:30 pm

Dinner

Millet Roti (Jowar/Bajra)

Dal

Vegetable (All Soft Gourd Vegetables)

Salad boiled.

1 cup

1 in no

1 cup

1 Plate

10:00 pm

Bed Time

Pateurised Milk( No added Sugar)

High Protein Supplement

1  cup

1 scoop

 

Note: Do not treat this article as the sole source of information, kindly consult your Nephrologist/ Nutritionist before making any changes in your daily diet  regime.

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