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Frontiers in Biology

Front. Biol.    2018, Vol. 13 Issue (6) : 475-480
The positive effects of Mediterranean-neutropenic diet on nutritional status of acute myeloid leukemia patients under chemotherapy
Jalali, Seyyed Mostafa, Morteza Abdollahi(), Atiyeh Hosseini, Dehghani Kari Bozorg, Ajami, Marjan Azadeh, Kimia Moiniafshar
7th Floor, Bldg No.2 SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, Tehran 19839-63113, Iran
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INTRODUCTION: Cancer and chemotherapy-induced malnutrition increase death, reduce the response to treatment, and increase multiple kinds of side effects. The aim of this study was to investigate the effects of Mediterranean-neutropenic diet on the nutritional status of acute myeloid leukemia patients under chemotherapy.

MATERIALS AND METHODS: 50 patients were divided into two groups by a random allocation scheme: the Mediterranean-neutropenic diet (n = 25) and the neutropenic diet group (n = 25). The intervention was implemented during a one month period. The nutritional status was evaluated based on PG-SGA. Serum albumin levels and dietary intake were also measured.

RESULTS: After the intervention, the mean serum albumin level in the intervention group was significantly higher than the beginning of the study (p = 0.09) and in comparison with the control group (p = 0.01). Also, the mean serum albumin level in the control group significantly decreased at the end of the study compared to the beginning of the study (p = 0.03). After intervention, the nutritional status of the patients in the intervention group was significantly improved compared to the control group.

CONCLUSION: In general, based on the results of this study, the Mediterranean neutropenic diet improves nutritional status during chemotherapy by increasing food intake, preventing weight loss and increasing serum albumin levels

Keywords nutritional status      Mediterranean diet      neutropenic diet      AML      chemotherapy     
Corresponding Authors: Morteza Abdollahi   
Online First Date: 07 November 2018    Issue Date: 30 November 2018
 Cite this article:   
Jalali,Seyyed Mostafa,Morteza Abdollahi, et al. The positive effects of Mediterranean-neutropenic diet on nutritional status of acute myeloid leukemia patients under chemotherapy[J]. Front. Biol., 2018, 13(6): 475-480.
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Seyyed Mostafa
Morteza Abdollahi
Atiyeh Hosseini
Dehghani Kari Bozorg
Marjan Azadeh
Kimia Moiniafshar
Variables* Mediterian-neutropenic group Control group p value€#
Number 25 25
Male 15 (60%) 14 (56) 0/7
Female 10 (40%) 11(44%)
Age (yrs) 41±14/3 40±12/8 0/9
Height (cm) 167/3±0/8 169/6±8/95 0/35
Weight (kg) 69/41±11/3 74/78±11/94 0/1
BMI (kg/m2) 24/74±3/63 26/21±5 0/23
Tab.1  participant's basic information in intervention and control group before and after intervention
variable* Intervention group Control group p value#€
Albumin (gr/dlit)
Before intervention 3/28±0/6 3/51±0/79 0/25
After intervention 3/55±0/79 3/09±0/5 0/01
p valueb 0/09 0/03
Tab.2  serum albumin level before and after intervention
variable* Intervention group Control group p value#€
Energy (kcal)
Before intervention 1090/6±402/79 1174/95±410/88 0/46
After intervention 1430/6±488/8 1270/22±319/49 0/17
p valueb >0/001 0/33
Protein (gr)
Before intervention 56/95±19/71 56/29±19/14 0/9
After intervention 72/2±24/12 64/82±21/56 0/26
P value 0/001 0/2
Carbohydrate (gr)
Before intervention 169/54±75/06 179/19±68/27 0/63
After intervention 198/77±69/22 176/86±58/72 0/22
P value 0/04 0/91
Total fat (gr)
Before intervention 30/49±15/27 30/26±11/15 0/95
After intervention 42/8±9/86 33/46±9/7 >0/001
p value >0/001 0/39
Tab.3  participant's calorie and macronutrients intake
variable* Intervention group Control group p value#€
Before intervention 69/41±11/3 74/78±11/94 0/1
After intervention 70/3±11/74 71/38±12/64 0/75
p valueb 0/049 0/13
Before intervention 24/74±3/63 26/21±5 0/23
After intervention 25/09±4/02 24/69±4/76 0/89
p value 0/03 0/12
Tab.4  bodyweight, BMI before and after intervention
variable* Intervention group Control group p value µ€
Nutritional status 0/6
Before intervention
appropriate 8(32%) 5(20%)
Prone to malnutrition 8(32%) 10(40%)
severe 9(36%) 10(40%)
After intervention 0/001<
appropriate (76%)19 1(4%)
Prone to malnutrition 5(20%) 6(24%)
sever 1(4%) 18(72%)
Tab.5  nutritional status before and after intervention
1 Agnoli C, Grioni S, Sieri S, Palli D, Masala G, Sacerdote C (2013). Italian Mediterranean Index and risk of colorectal cancer in the Italian section of the EPIC cohort. Int J Cancer, 132(6): 1404–1411
2 Bauer J, Capra S, Ferguson M (2002). Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr, 56(8): 779–785 pmid: 12122555
3 Beer T M, Bubalo J S (2004). Prevention and management of prostate cancer chemotherapy complications. Urol Clin North Am, 31(2): 367–378 pmid: 15123414
4 Benetou V, Trichopoulou A, Orfanos P, Naska A, Lagiou P, Boffetta P, Trichopoulos D, the Greek EPIC cohort (2008). Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer, 99(1): 191–195 pmid: 18594542
5 Buckley S A, Jimenez-Sahagun D, Othus M, Walter R B, Lee S J (2018). Quality of life from the perspective of the patient with acute myeloid leukemia. Cancer, 124(1): 145–152 pmid: 28881384
6 Couto E, Boffetta P, Lagiou P, Ferrari P, Buckland G, Overvad K, Dahm C C, Tjønneland A, Olsen A, Clavel-Chapelon F, Boutron-Ruault M C, Cottet V, Trichopoulos D, Naska A, Benetou V, Kaaks R, Rohrmann S, Boeing H, von Ruesten A, Panico S, Pala V, Vineis P, Palli D, Tumino R, May A, Peeters P H, Bueno-de-Mesquita H B, Büchner F L, Lund E, Skeie G, Engeset D, Gonzalez C A, Navarro C, Rodríguez L, Sánchez M J, Amiano P, Barricarte A, Hallmans G, Johansson I, Manjer J, Wirfärt E, Allen N E, Crowe F, Khaw K T, Wareham N, Moskal A, Slimani N, Jenab M, Romaguera D, Mouw T, Norat T, Riboli E, Trichopoulou A (2011). Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer, 104(9): 1493–1499 pmid: 21468044
7 D’Alessandro A, De Pergola G, Silvestris F (2016). Mediterranean Diet and cancer risk: an open issue. Int J Food Sci Nutr, 67(6): 593–605 pmid: 27251477
8 Esfahani A, Ghoreishi Z, Abedi Miran M, Sanaat Z, Ostadrahimi A, Eivazi Ziaei J, Ghayour Nahand M, Asghari Jafarabadi M, Sorusheh Y, Esmaili H (2014). Nutritional assessment of patients with acute leukemia during induction chemotherapy: association with hospital outcomes. Leuk Lymphoma, 55(8): 1743–1750 pmid: 24128069
9 Esposito K, Kastorini C M, Panagiotakos D B, Giugliano D (2011). Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord, 9(1): 1–12 pmid: 20973675
10 Fazeli Z, Pourhoseingholi M A, Vahedi M, Abadi A, Fazeli Bavand-Pour F S, Baghestani A R (2013). Leukemia cancer mortality trend in iran, from 1995 to 2004. Iran J Cancer Prev, 6(3): 170–173 (eng.)
pmid: 25250129
11 Filomeno M, Bosetti C, Garavello W, Levi F, Galeone C, Negri E, La Vecchia C (2014). The role of a Mediterranean diet on the risk of oral and pharyngeal cancer. Brit J Cancer,111(5): 981–986
12 Grosso G, Buscemi S, Galvano F, Mistretta A, Marventano S, La Vela V, Drago F, Gangi S, Basile F, Biondi A (2013). Mediterranean diet and cancer: epidemiological evidence and mechanism of selected aspects. BMC Surg, 13(Suppl 2): S14 pmid: 24267672
13 Held-Warmkessel J (2011). Taming three high-risk chemotherapy complications. Nursing, 41(11): 30–37 pmid: 21986902
14 Khoshnevis N, Ahmadizar F, Alizadeh M, Akbari M E (2012). Nutritional assessment of cancer patients in Tehran, Iran. Asian Pac J Cancer Prev, 13(4): 1621–1626 pmid: 22799378
15 Lassiter M, Schneider S M (2015). A pilot study comparing the neutropenic diet to a non-neutropenic diet in the allogeneic hematopoietic stem cell transplantation population. Clin J Oncol Nurs, 19(3): 273–278 pmid: 26000578
16 Lopez-Moreno J, Quintana-Navarro G M, Delgado-Lista J, Garcia-Rios A, Delgado-Casado N, Camargo A, Perez-Martinez P, Striker G E, Tinahones F J, Perez-Jimenez F, Lopez-Miranda J, Yubero-Serrano E M (2016). Mediterranean Diet Reduces Serum Advanced Glycation End Products and Increases Antioxidant Defenses in Elderly Adults: A Randomized Controlled Trial. J Am Geriatr Soc, 64(4): 901–904 pmid: 27100598
17 Zarif Yeganeh M, Eghtesadi S , Vakili M, Faghih A H, Haghani, H E (2007). Ph.DII, M. Vakili MAHF, MDIV H. Haghani, MScV, I. Noormohammadi PDAG, MDVII. Nutritional Assessment of Cancer Patients during Chemotherapy in Iran University of Medical Sciences Affiliated Hospitals, 2006–2007. Nephrology, 18(18) :644–645
18 Martínez-González M A, Guillén-Grima F, De Irala J, Ruíz-Canela M, Bes-Rastrollo M, Beunza J J, López del Burgo C, Toledo E, Carlos S, Sánchez-Villegas A (2012). The Mediterranean diet is associated with a reduction in premature mortality among middle-aged adults. J Nutr, 142(9): 1672–1678 pmid: 22810987
19 Oliva E N, Nobile F, Alimena G, Ronco F, Specchia G, Impera S, Breccia M, Vincelli I, Carmosino I, Guglielmo P, Pastore D, Alati C, Latagliata R (2011). Quality of life in elderly patients with acute myeloid leukemia: patients may be more accurate than physicians. Haematologica, 96(5): 696–702 pmid: 21330327
20 Ostan R, Lanzarini C, Pini E, Scurti M, Vianello D, Bertarelli C, Fabbri C, Izzi M, Palmas G, Biondi F, Martucci M, Bellavista E, Salvioli S, Capri M, Franceschi C, Santoro A (2015). Inflammaging and cancer: a challenge for the Mediterranean diet. Nutrients, 7(4): 2589–2621 pmid: 25859884
21 Owens J L, Hanson S J, McArthur J A, Mikhailov T A (2013). The need for evidence based nutritional guidelines for pediatric acute lymphoblastic leukemia patients: acute and long-term following treatment. Nutrients, 5(11): 4333–4346 pmid: 24177709
22 Rasool M, Farooq S, Malik A, Shaukat A, Manan A, Asif M, Sani S, Qazi M H, Kamal M A, Iqbal Z, Hussain A (2015). Assessment of circulating biochemical markers and antioxidative status in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients. Saudi J Biol Sci, 22(1): 106–111 pmid: 25561892
23 Richard C, Couture P, Desroches S, Lamarche B (2013). Effect of the Mediterranean diet with and without weight loss on markers of inflammation in men with metabolic syndrome. Obesity (Silver Spring), 21(1): 51–57 pmid: 23505168
24 Rotelli M T, Bocale D, De Fazio M, Ancona P, Scalera I, Memeo R, Travaglio E, Zbar A P, Altomare D F (2015). IN-VITRO evidence for the protective properties of the main components of the Mediterranean diet against colorectal cancer: A systematic review. Surg Oncol, 24(3): 145–152 pmid: 26303826
25 Sanches F L, Nitsch T M, Vilela M M, Sgarbieri V C (2015). Comparison of biochemical and immunological profile of pediatric patients with acute myeloid leukemia in relation to healthy individuals. J Pediatr (Rio J), 91(5): 478–484 pmid: 26120012
26 Sarvarian R K N, Amiri Z, Haghighian Roudsari A, Rashidi A (2013). Prevalence of malnutrition and its relationship to socio-economic variables forcancer patients admitted to Shohada-ye-Tajrish hospital in 1389. Iran J Nutr Sci Food Technol, 8(3)
27 Sonbol M B, Firwana B, Diab M, Zarzour A, Witzig T E (2015). The Effect of a Neutropenic Diet on Infection and Mortality Rates in Cancer Patients: A Meta-Analysis. Nutr Cancer, 67(8): 1230–1238 pmid: 26400721
28 Tinsley S M, Sutton S K, Thapa R, Lancet J, McMillan S C (2017). Treatment Choices: A Quality of Life Comparison in Acute Myeloid Leukemia and High-risk Myelodysplastic Syndrome. Clin Lymphoma Myeloma Leuk, 17S: S75–S79 pmid: 28760305
29 Turedi A, Demir C, Dilek I (2010). Assessment of malnutrition in adult acute leukemia cases. Asian Pac J Cancer Prev, 11(3): 703–707 (eng.)
pmid: 21039039
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