{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:05:50Z","timestamp":1779771950967,"version":"3.53.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Haematopoietic stem cell transplantation (HSCT) is associated with substantial early infectious risk, neutropenia, immunosuppression, and graft-versus-host disease (GVHD). Many centres continue to use neutropenic, low-microbial, low-bacterial, or protective diets to reduce dietary exposure to potential pathogens, despite variation in diet definitions and concerns regarding nutritional intake, patient experience, cost, and microbiota recovery. This protocol describes a systematic review and meta-analysis evaluating the benefits and harms of neutropenic diets compared with less restrictive, standard, or food-safety-based dietary approaches in HSCT recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We will include randomised and non-randomised comparative studies involving children or adults undergoing HSCT from any graft source and conditioning intensity. Eligible interventions will include neutropenic, low-microbial, low-bacterial, or protective diets; comparators will include unrestricted, less restrictive, standard hospital, or food-safety-based diets. MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, Scopus,\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      , and the WHO ICTRP will be searched from inception without language or date restrictions, supplemented by reference screening, expert contact, grey literature, and conference proceedings. Two reviewers will independently screen studies, extract data, and assess risk of bias using RoB 2 for randomised trials and RoBANS for non-randomised studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The primary outcomes will be infection rates, acute GVHD, nutritional status, time to neutrophil recovery, and patient satisfaction or quality of life. Secondary outcomes will include overall survival, relapse, chronic GVHD, length of hospitalisation, antibiotic use to day 100, micronutrient deficiency, and cost outcomes. Where appropriate, pooled estimates will be generated using random-effects models, with subgroup and sensitivity analyses used to explore heterogeneity. Certainty of evidence will be assessed using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This review will clarify whether neutropenic diets reduce infectious complications or GVHD after HSCT, and whether any potential benefit is offset by nutritional, patient-centred, microbiome-related, or economic harms. Findings will inform clinical practice, patient counselling, and future policy on dietary restrictions after HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251162724<\/jats:ext-link>\n                      , identifier PROSPERO (CRD420251162724).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1820858","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:48:15Z","timestamp":1779770895000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Role of neutropenic diet in prevention of infection and graft-versus-host disease in haematopoietic stem cell transplant recipients: systematic review and meta-analysis protocol"],"prefix":"10.3389","volume":"13","author":[{"given":"Manideepa","family":"Maji","sequence":"first","affiliation":[{"name":"Hull York Medical School, University of Hull","place":["Kingston upon Hull, United Kingdom"]},{"name":"Hull University Teaching Hospitals NHS Trust","place":["Kingston upon Hull, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saikat","family":"Mandal","sequence":"additional","affiliation":[{"name":"Nottingham Digestive Disease Centre, Translational Medical Sciences, School of Medicine, University of Nottingham","place":["England, United Kingdom"]},{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arkadeep","family":"Dhali","sequence":"additional","affiliation":[{"name":"University of Sheffield","place":["Sheffield, United Kingdom"]},{"name":"University of Edinburgh","place":["Edinburgh, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Miller","sequence":"additional","affiliation":[{"name":"Nottingham University Hospitals NHS Trust","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Grove","sequence":"additional","affiliation":[{"name":"Nottingham Digestive Disease Centre, Translational Medical Sciences, School of Medicine, University of Nottingham","place":["England, United Kingdom"]},{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Snowden","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield","place":["Sheffield, United Kingdom"]},{"name":"Sheffield Teaching Hospitals NHS Foundation Trust","place":["Sheffield, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suparno","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Action Institute for Blood Diseases, Transplantation & Cellular Therapy (AIBTraCT), Action Cancer Hospital","place":["New Delhi, India"]},{"name":"Amity Institute of Mol Med and Stem Cell Research, Amity University","place":["Noida, India"]},{"name":"Department of Translational & Clinical Research, Jamia Hamdard University","place":["New Delhi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guruprasad","family":"Aithal","sequence":"additional","affiliation":[{"name":"Nottingham Digestive Disease Centre, Translational Medical Sciences, School of Medicine, University of Nottingham","place":["England, United Kingdom"]},{"name":"NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham","place":["Nottingham, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1038\/s41409-022-01691-w","article-title":"Indications for haematopoietic cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2022","volume":"57","author":"Snowden","year":"2022","journal-title":"Bone Marrow Transplant"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"349","DOI":"10.3109\/07357907.2014.919301","article-title":"Complications of allogeneic hematopoietic stem cell transplantation","volume":"32","author":"Arnaout","year":"2014","journal-title":"Cancer Investig"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.2147\/IDR.S451781","article-title":"Epidemiology, microbiology, and risk factors of bacterial bloodstream infections in patients after allogeneic hematopoietic stem cell transplantation","volume":"17","author":"Zhang","year":"2024","journal-title":"Infect Drug Resist"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.jtct.2021.03.017","article-title":"Risk factors for mortality in hematopoietic stem cell transplantation recipients with bloodstream infection: points to be addressed by future guidelines","volume":"27","author":"Puerta-Alcalde","year":"2021","journal-title":"Transplant Cell Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.1016\/j.bbmt.2009.07.004","article-title":"Defining the intensity of conditioning regimens: working definitions","volume":"15","author":"Bacigalupo","year":"2009","journal-title":"Biol Blood Marrow Transplant"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"101476","DOI":"10.1016\/j.beha.2023.101476","article-title":"Graft versus leukemia in 2023","volume":"36","author":"Chiad","year":"2023","journal-title":"Best Pract Res Clin Haematol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"100107","DOI":"10.1016\/j.tpr.2022.100107","article-title":"Graft-versus-host disease: therapeutic prospects of improving the long-term post-transplant outcomes","volume":"7","author":"Kurya","year":"2022","journal-title":"Transplant Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"89","DOI":"10.3389\/fonc.2014.00089","article-title":"Possible implication of bacterial infection in acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation","volume":"4","author":"Fuji","year":"2014","journal-title":"Front Oncol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1007\/s00277-024-05952-0","article-title":"Recent advances in acute gastrointestinal graft versus host disease (aGvHD): aspects of steroid-resistant disease","volume":"104","author":"Kujawska","year":"2025","journal-title":"Ann Hematol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1097\/QCO.0b013e3283522038","article-title":"Predictors of survival in sepsis: what is the best inflammatory marker to measure?","volume":"25","author":"Lichtenstern","year":"2012","journal-title":"Curr Opin Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1038\/sj.bmt.1702627","article-title":"Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality","volume":"26","author":"Chakrabarti","year":"2000","journal-title":"Bone Marrow Transplant"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.bbmt.2012.11.008","article-title":"Role of the mycobiome in human acute graft-versus-host disease","volume":"19","author":"van der Velden","year":"2013","journal-title":"Biol Blood Marrow Transplant"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1038\/s41409-018-0137-1","article-title":"Variability of nutritional practices in peritransplant period after allogeneic hematopoietic stem cell transplantation: a survey by the complications and quality of life working party of the EBMT","volume":"53","author":"Peric","year":"2018","journal-title":"Bone Marrow Transpl"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1016\/j.clnu.2021.02.030","article-title":"Current practice in nutrition after allogeneic hematopoietic stem cell transplantation\u2014results from a survey among hematopoietic stem cell transplant centers","volume":"40","author":"Toenges","year":"2021","journal-title":"Clin Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1634\/theoncologist.2011-0001","article-title":"The benefit of the neutropenic diet: fact or fiction?","volume":"16","author":"Jubelirer","year":"2011","journal-title":"Oncologist"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1016\/S0002-8223(01)00292-9","article-title":"A survey of the use of low mibrobial diets in pediatric transplant programs","volume":"101","author":"French","year":"2001","journal-title":"J Am Diet Assoc"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3390\/nu17050768","article-title":"A neutropenic diet in haemato-oncological patients receiving high-dose therapy and hematopoietic stem cell transplantation: a systematic review","volume":"17","author":"Jahns","year":"2025","journal-title":"Nutrients"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1007\/s11515-018-1519-x","article-title":"The positive effects of Mediterranean-neutropenic diet on nutritional status of acute myeloid leukemia patients under chemotherapy","volume":"13","author":"Jalali","year":"2018","journal-title":"Front Biol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"489","DOI":"10.13040\/IJPSR.0975-8232.11(1).394-00","article-title":"The evaluation of vitamin C supplementation on nutritional status of patients with acute myeloid leukemia undergoing chemotherapy","volume":"11","author":"Hosseini","year":"2020","journal-title":"Int J Pharm Sci Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1016\/j.bbmt.2012.02.015","article-title":"Questioning the role of a neutropenic diet following hematopoetic stem cell transplantation","volume":"18","author":"Trifilio","year":"2012","journal-title":"Biol Blood Marrow Transplant"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1038\/bmt.2016.310","article-title":"Revisiting nutritional support for allogeneic hematologic stem cell transplantation-a systematic review","volume":"52","author":"Baumgartner","year":"2017","journal-title":"Bone Marrow Transplant"},{"key":"ref22","volume-title":"The EBMT Handbook","author":"Baumgartner","year":"2024"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: Clinical Nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr"},{"key":"ref24","first-page":"572","article-title":"The neutropenic diet reviewed: moving toward a safe food handling approach","volume":"26","author":"Fox","year":"2012","journal-title":"Oncology"},{"key":"ref25","year":"2020"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.3390\/nu17172898","article-title":"The microbiota\u2013diet\u2013immunity axis in cancer care: from prevention to treatment modulation and survivorship","volume":"17","author":"Tini","year":"2025","journal-title":"Nutrients"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1038\/bmt.2016.173","article-title":"Gut microbiota and hematopoietic stem cell transplantation: where do we stand?","volume":"52","author":"Zama","year":"2017","journal-title":"Bone Marrow Transplant"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1038\/s41591-019-0377-7","article-title":"The microbiome, cancer, and cancer therapy","volume":"25","author":"Helmink","year":"2019","journal-title":"Nat Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e60","DOI":"10.1017\/jns.2024.61","article-title":"The neutropenic diet and its impacts on clinical, nutritional, and lifestyle outcomes for people with cancer: a scoping review","volume":"13","author":"Gulliver","year":"2024","journal-title":"J Nutr Sci"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1182\/bloodadvances.2024013986","article-title":"Changes in gut microbiota predict neutropenia after induction treatment in childhood acute lymphoblastic leukemia","volume":"9","author":"S\u00f8rum","year":"2025","journal-title":"Blood Adv"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"5996","DOI":"10.1182\/bloodadvances.2023010348","article-title":"Nonrestrictive diet does not increase infections during post-HSCT neutropenia: data from a multicenter randomized trial","volume":"7","author":"Stella","year":"2023","journal-title":"Blood Adv"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1188\/15.CJON.19-03AP","article-title":"A pilot study comparing the neutropenic diet to a non-neutropenic diet in the allogeneic hematopoietic stem cell transplantation population","volume":"19","author":"Lassiter","year":"2015","journal-title":"Clin J Oncol Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1016\/j.bbmt.2019.03.017","article-title":"Comparing a neutropenic diet to a food safety-based diet in pediatric patients undergoing hematopoietic stem cell transplantation","volume":"25","author":"Taggart","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"S83","DOI":"10.1016\/j.bbmt.2015.11.379","article-title":"Let them eat! Comparing a neutropenic diet to a food safety based diet in patients undergoing hematopoietic stem cell transplantation (HSCT)","volume":"22","author":"Taggart","year":"2016","journal-title":"Biol Blood Marrow Transplant"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref37","author":"Park","year":"2011"},{"key":"ref38","first-page":"14651858","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Chandler","year":"2019"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e58327","DOI":"10.1371\/journal.pone.0058327","article-title":"The Mantel-Haenszel procedure revisited: models and generalizations","volume":"8","author":"Fidler","year":"2013","journal-title":"PLoS One"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1200\/JCO-25-00889","article-title":"Randomized noninferiority trial of a liberalized diet versus the neutropenic diet in hematopoietic stem-cell transplant patients and patients with acute leukemia","volume":"44","author":"Wingard","year":"2026","journal-title":"J Clin Oncol"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1820858\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:48:30Z","timestamp":1779770910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1820858\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":43,"alternative-id":["10.3389\/fnut.2026.1820858"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1820858","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"article-number":"1820858"}}