John Bryan O.

Jamison
2, 2016
UPLB ERU

May

NEUTROPENIC DIET
I.

Introduction
Immunocompromised patients need different treatments for them
to live. One of the dietary interventions is to keep the food extra safe
since they are very susceptible to various pathogens. Neutrophils
constitutes 60-65% of the total white blood cells and its function is for
maintaining normal host defenses against invading bacteria, fungi, cell
debris and variety of foreign substances. Neutropenia, on the other hand,
is the condition where the number of neutrophils is abnormally low
(<1500/uL). It is shown in Table 1 the different grades of neutropenia
(Porth, 2011).
Table 1. Different grades of neutropenia.
Grade
Neutrophil Count
Mild
>1500 /uL
Moderate
500-1000/uL
Severe
<500/uL

II.

General Information
Neutropenic diet is used as a nutrition intervention to address this
condition. According to NDAP (2010), this is also called low-bacteria and
low-microbial diet. The preparation and service is employed under strict
sanitary conditions for minimizing the count of microbes and pathogens.
The guidelines for food sanitation is strictly followed. The general
guidelines are listed below in table 2. The suggested food plan on the
other hand is that it should provide adequate nutrients for the patient. The
indications for use of neutropenic diet is that the neutrophils should be
less than 500/uL. Other indications include, organ transplantation,
chemotherapy treatment and HIV/AIDS patients that may cause the
patient to be immunocompromised.
Table 2. General Guidelines for Food Sanitation
1 Restriction of fresh fruits and vegetables
.
2 Cooking food adequately
.
3 Covering all food items properly
.
4 Serving immediately after preparation
.
5 Keeping hot foods hot, and cold foods cold

.
6
.
7
.
8
.
9
.

Observing recommended temperatures for food safety

and storage
Avoiding cross-contamination
Thawing fish, meat and poultry in the refrigerator
Cooking thoroughly are observed

Taken from NDAP Manual

This diet is the same as the regular diet but fresh fruits and
vegetables are restricted. Dried fruits and raw nuts, yoghurt, and other
raw or rare cooked foods are avoided. Thus, this diet focuses more on
the cooking process rather than the types of foods to avoid (NDAP,
2010).
III.

Computations
(Note: All values and data are assigned by the student)
Patient Profile:
An Immunocompromised 30 year old male with low neutrophil
count (<500/uL) was admitted to the hospital. His height is 58 and
currently weighs 68 kg. His physical activity is sedentary.
DBW (using Tannhausers method):
58 ~ 68 inches ~ 172.72
172.72 100 = 72.72
72.72 7.272 = 65.448 kg ~ 65 kg
TER (Using Krauses method):
DBW x PA = TER
65 x 30 (sedentary) = 1950 Kcal

Distribution of TER into CPF (using the average (60-15-25)

percentage distribution):
Carbohydrates = 1950 x 0.60 = 1170 kcal /4 = 292.5 g ~ 295 g
C
Proteins = 1950 x 0.15 = 292.5 kcal/4 =73.125 g ~ 75 g P
Fats = 1950 x .25 = 487.5 kcal/ 9 = 54.16 ~ 55 g F
Drx 1950 Kcal 295 g C 75 g P 55 g F
Distribution to Exchanges
Food Group
Vegetables
Fruit

Ex
3
3

CHO
(g)
9
30

PRO
(g)
3

FAT
(g)

KCAL
48
120

Milk (Whole)
Milk (Low Fat)
Milk (Very Low Fat)
Sugar
Rice
Meat (Lean Meat)
Meat (Medium Fat)
Meat (High Fat)
Fat

1
0
0
7
9
5
1
0
6

12
0
0
35
207

293

TOTAL

8
0
0
18
40
8
0

77

10
0

5
6
0
30

170
0
0
140
900
205
86
0
270

51

193
9

Distribution of exhanges into meals

Food group
Vegetables
Fruit
Milk (Whole)
Milk (Low Fat)
Milk (Very Low
Fat)
Sugar
Rice
Meat (Lean
Meat)
Meat (Medium
Fat)
Meat (High Fat)
Fat
IV.
% Of the meal
Three Day Menu Sample

Breakfast

A.M
Snack

1
1

Lunch

P.M
Snack

1
1

Dinner

1
1

1
3

3
3

2
27%

2
27%

1
2
31%

A. Macronutrients Computations (FEL)

12%

3%

B. Micronutrients Computations (FEL)

V.

REFERENCES

Porth, C.M (2010) Essentials of Pathophysiology: Concepts of Altered Health States.

3rd ed. USA: Lippincrott Williams & Wilkins
Nutritionist-Dietitians Association of the Philippines (2010) Diet Manual 5 th ed. Phil:
NDAP