Applied Veterinary Clinical Nutrition

List of Contributors xx Preface xxiii Acknowledgments xxiv 1 Integration of Nutrition into Clinical Practice 1 Sean J. Delaney, Andrea J. Fascetti, Jennifer A. Larsen, and Paul Brentson Introduction 1 Average Revenue from Food Sales and the Potential 1 Strategies to Increase Product Sales 2 Recommending an Effective Therapeutic Food 2 Establishing Expectations 2 Performing a Nutritional Assessment 3 Monitoring Patient Response 3 Providing a Variety of Options 3 Recommending Therapeutic Treats 4 Recommending Nutraceuticals and Dietary Supplements 4 Creating or Increasing Revenue from Nutritional Advice 4 Nutritional Advice for Healthy Patients 5 Nutritional Advice for Unhealthy Patients 7 References 7 2 Basic Nutrition Overview 8 Sean J. Delaney and Andrea J. Fascetti Energy 8 Energy Requirements 9 Essential Nutrients 9 Protein and Amino Acids 10 Fat 12 Carbohydrates 13 Minerals 13 Macrominerals 13 Trace Minerals (Microminerals) 14 Vitamins 14 Water Soluble 14 Fat Soluble 14 Storage Pools for Essential Nutrients 15 Essential Nutrient Deficiency Signs and Clinically Available or Relevant Methods of Assessing Nutrient Status 15 Protein 16 Amino Acids 16 Arginine 16 Histidine 16 Isoleucine 16 Leucine 16 Lysine 16 Methionine (Spared by Cystine) 16 Phenylalanine (Spared by Tyrosine) 17 Threonine 17 Tryptophan 17 Valine 17 Taurine 17 Fat 17 Linoleic Acid 17 Arachidonic Acid (Cat, Not Dog) 18 Minerals 18 Macrominerals (Typically Required at 100 mg/Mcal) 18 Calcium 18 Phosphorus 18 Magnesium 18 Sodium 18 Potassium 18 Chloride 19 Microminerals (Typically Required at <100 mg/Mcal) 19 Iron 19 Copper 19 Zinc 19 Manganese 19 Selenium 19 Iodine 19 Vitamins 20 Fat-Soluble Vitamins 20 Vitamin A 20 Vitamin d 20 Vitamin E 20 Vitamin K 20 Water-Soluble Vitamins 20 Thiamin, Vitamin B 1 20 Riboflavin, Vitamin B 2 21 Pyridoxine, Vitamin B 6 21 Niacin, Vitamin B 3 21 Pantothenic Acid, Vitamin B 5 21 Cobalamin, Vitamin B 12 21 Folic Acid, Vitamin B 9 22 Biotin, Vitamin H or B 7 22 Choline 22 Diagnostic and Food Analysis Laboratories and Diet Computer Analysis 25 Nutrient Requirements 25 Key Clinical Nutritional Excesses and Signs 26 Additional Education on Nutrition 27 References 27 3 Determining Energy Requirements 29 Jon J. Ramsey Units 29 Basic Concepts and Terminology 30 Diet Records or History 32 Calculating the Energy Content of a Diet 33 Practical Equations for Predicting the Metabolizable Energy Content of Dog and Cat Foods 37 Calculating Energy Requirement from Body Weight 39 Methods of Determining Energy Expenditure and Energy Requirements 39 Methods of Calculating Energy Expenditure and Energy Requirements 42 Energy Requirements for Maintenance 42 Example Calculation 47 Example Calculation 48 Example Calculation 48 Energy Requirements for Growth 48 Example Calculation 50 Energy Requirements for Pregnancy and Lactation 51 Example Calculation 52 Calculating Energy Requirements in States of Disease 53 Summary 55 References 56 4 Nutritional and Energy Requirements for Performance 58 Richard C. Hill How Much Should Exercising Dogs Be Fed? 58 Energy Requirements for Performance and Work 59 Types of Exercise and Nutrient Requirements 62 The Importance of Training 64 Nutritional Recommendations for Dogs Undertaking Different Types of Exercise 64 Long-Distance Submaximal Aerobic Exercise 65 Short-Distance Supramaximal Anaerobic Exercise 66 Fluid and Electrolyte Requirements, Hydration, and “Sports Drinks” 67 Antioxidants 68 Other Vitamins, Trace Minerals, and Other Essential Nutrients 68 Other Nutritional Supplements 68 Time of Feeding 69 Summary 69 References 69 5 Pet Food and Supplement Regulations: Practical Implications 72 David A. Dzanis and Isabel Marzo US Regulation 72 US Regulation of Pet Foods and Supplements 72 Definitions, Abbreviations, and Acronyms 72 US Regulatory Oversight 73 General Labeling Requirements 74 Labeling Claims 77 Descriptive Terms 77 Supplements 78 Therapeutic Pet Foods 79 Dog Chews 83 Summary 83 European Union Regulation 83 Definitions, Abbreviations, and Acronyms 84 General Pet Food Regulations 85 Complementary Pet Food: Composition, Uses, and Labeling 86 Feed Additives 87 Claims 87 Labeling 87 Dietetic Pet Food 90 Practical Implications 95 Summary 96 References 96 6 Using Pet Food Labels and Product Guides 98 Sean J. Delaney and Andrea J. Fascetti “Reading” a Pet Food Label 98 Overview of Regulatory Oversight 98 Principal Display Panel or Front Display Panel 98 Product Name 99 Back Panel 99 Nutritional Adequacy 100 Ingredient Declaration 100 Nutrient Concentrations or Guaranteed Analysis 101 Company’s Contact Information 101 Feeding Directions or Guidelines 101 Calorie Content 101 Caloric Distribution Calculation 102 Using Product Brochures and Guides 103 Converting Nutrient Concentrations to a Dry Matter Basis 103 Converting Nutrient Concentrations to an Energy Basis 104 Converting to Other Units 104 Product Guide Recommendations for Conditions and Diseases 104 Summary 105 Recommended Resources 105 7 Feeding the Healthy Dog and Cat 106 Andrea J. Fascetti and Sean J. Delaney Feeding the Healthy Dog and Cat 108 How Much to Feed 108 When and How to Feed 112 Free-Choice (Ad Libitum, Self-Feeding) 112 Time-Restricted Meal Feeding 113 Portion-Controlled Feeding 113 Snacks and Treats 113 Jerky Treats and Fanconi Syndrome in Dogs 115 What to Feed 116 Feeding Guidelines for Different Life Stages 117 Gestation and Lactation 117 Cats 117 Dogs 118 Supplementation during Gestation and Lactation 119 Assessment 119 Growth 119 Orphan Kittens and Puppies 119 Assessment 120 Weaning to Adult 120 Kittens 120 Puppies 120 Neutering and the Prevention of Weight Gain in Kittens and Puppies 121 Assessment 122 Adult Cats and Dogs 122 Assessment 122 Senior Dogs and Cats 122 Physiological Changes Associated with Aging 123 Nutrient Requirements of Older Pets 126 Feeding Recommendations for Mature Dogs and Cats 128 Summary 129 References 129 8 Commercial and Home-Prepared Diets 136 Andrea J. Fascetti and Sean J. Delaney Introduction 136 Commercial Diets 136 Types of Pet Foods 136 Dry Food 136 Moist Foods 137 Semi-Moist Foods 137 Raw 138 Terminology 138 Market Segments 140 Commercial Dog and Cat Diet Formulation and Considerations 140 Ingredient Database Population 140 Ingredient Safety and Legality First 140 Ingredient Regulatory Considerations 141 Ingredient Availability and Cost 141 Establishing Reliable Nutrient Profiles for Ingredients 142 Ingredient Procurement 143 Sustainability 143 Consistency 143 Ingredient Declaration 144 Formulation Software 144 Options 144 Limitations 145 Equipment 145 Extruder 145 Canning/Retorting Line 146 Availability of Pilot Plant or Line 146 Guaranteed Analysis Target 146 Ingredient Declaration Order 147 Functionality 147 Shelf Life 147 Palatability 148 Least Cost 148 Stool Quality and Digestibility 149 Labeling 149 Continuous Improvement 149 Home-Prepared Diets 150 Nutritional Adequacy 150 Managing Patients Using Home-Prepared Diets 154 Protein and Amino Acids 154 Fatty Acids 155 Carbohydrates 156 Vitamin and Mineral Supplements 156 General Considerations 156 Assessment while on a Home-Prepared Diet 158 Raw Food Feeding 158 Summary 160 References 160 9 Nutritional Management of Body Weight 163 Kathryn E. Michel and Robert C. Backus The Health Consequences of Overweightness and Obesity 164 Obesity as a Risk Factor for Canine Orthopedic Disease 164 Obesity as a Risk Factor for Feline Diabetes Mellitus 164 Additional Health Risks of Obesity in Dogs and Cats 165 Increasing Awareness of Overweightness and Obesity 165 Targeting Optimal Weight 166 Body Condition Scoring 166 Understanding the Risk Factors for Weight Gain 170 Accurate Accounting of Caloric Intake 171 Formulation of the Weight-Loss Plan 172 Dietary Considerations 173 Exercise 176 Tailoring the Program to the Patient 176 Assessment of the Weight-Loss Plan 177 Safety and Efficacy of Weight-Loss Programs for Companion Animals 177 Adjustment of the Weight-Loss Plan 178 Summary 180 References 180 10 Nutritional Management of Orthopedic Diseases 186 Herman Hazewinkel Bone Composition and Calciotropic Hormones 186 Chemical Composition of Bone 187 Mineral Composition During Growth 188 Hormonal Regulation of Calcium 189 The Role of Nutrition During Skeletal Growth and Development 192 Energy 192 Calcium, Phosphorus, and Vitamin d 193 Calcium Deficiency 193 Phosphorus Deficiency 198 Vitamin D Deficiency (Rickets or Hypovitaminosis D) 198 Deficiency of Other Trace Minerals 201 Calcium Excess (Alimentary Hypercalcitoninism) 201 Vitamin D Excess 205 Vitamin A Excess 206 Nutrient Requirements for Skeletal Maintenance in Adult Animals 208 Implementation of Nutrition in Clinical Orthopedics 210 Influence of Nutrition in the Occurrence of Orthopedic Diseases 211 Elbow Dysplasias 211 Role of Nutrition in Elbow Dysplasias 212 Hip Dysplasia 213 Nutritional Influences Seen in Hip Dysplasia 214 Hypertrophic Osteodystrophy (or Metaphyseal Osteopathy) in Dogs 216 Prevention of Nutritionally Related Orthopedic Diseases 217 Diets to Support Treatment of Patients with Osteoarthrosis 218 Causative Role of Nutrition 219 Therapeutic Role of Nutrition 220 Osteoarthrosis in Cats 225 Summary 226 References 226 11 Nutritional Management of Gastrointestinal Diseases 235 Nick Cave, Sean J. Delaney, and Jennifer A. Larsen Key Dietary Variables 235 Protein 235 Glutamine 236 Fat 236 Fiber and Prebiosis 237 Fiber Viscosity 239 Fiber as a Luminal Adsorbent 239 Fiber Fermentability 240 Effects of Short-Chain Volatile Fatty Acids on the Colon 240 Effects of Butyrate on Intestinal Immunity 241 Effect of Fiber on Intestinal Flora: Prebiosis 241 Choice of Fiber 242 Immune Response to Dietary Antigens (Oral Tolerance) 243 Immunologic Basis for Oral Tolerance 243 Loss of Tolerance to Dietary Antigens 244 Food Immunogenicity 245 Acute Gastrointestinal Disease 246 Withholding Food for Acute Non-specific Gastroenteritis 246 Provides Bowel Rest 247 Reduces the Risk of Vomiting 247 Decreases Bacterial Proliferation 248 Decreases Osmotic Diarrhea 248 Decreases Presence of Food Antigens 248 Benefits of Luminal Nutrition in Acute Gastroenteritis 248 Intestinal Recovery and Adaptation 249 Effect of Luminal Nutrients on Inflammation 249 Veterinary Evidence 251 Recommendations 252 Chronic Gastrointestinal Disease 254 Periodontal Disease 254 Periodontitis in Feral and Wild Animals 255 Evidence of the Protective Effect of Chewing Activities 255 Dental Diets 256 The Effect of Gingival Stimulation 257 The Influence of Diet on Saliva and the Flora 258 Recommendations 258 Esophageal Disease 259 Motility Disorders and Megaesophagus 259 Esophagitis 259 Small Intestinal Disease 261 Chronic Intestinal Inflammation and Idiopathic Enteropathy 261 Protein-Losing Enteropathies 270 Adverse Food Reactions and Food-Responsive Enteropathy 270 Short Bowel Syndrome 271 Large Intestinal Disease 273 Colitis 273 Acute Colitis 273 Chronic Colitis 274 Idiopathic Large-Bowel Diarrhea 275 Constipation and Megacolon 276 Intestinal Gas and Flatulence 277 Intestinal Gas Transit and Borborygmus 277 Flatulence 277 Summary 279 References 280 12 Nutritional Management of Exocrine Pancreatic Diseases 299 Cecilia Villaverde and Marta Hervera Pancreatitis 300 Pathophysiology 301 Nutritional Management 302 Controversies Regarding Nutritional Management 302 When to Start Feeding in Acute Pancreatitis? 302 How Low Is a “Low-Fat” Diet? 303 Does Fat Have to Be Restricted in Canine Acute Pancreatitis? 304 How Important Is Fat Restriction in Feline Pancreatitis? 304 Dietary Management 304 When to Feed 305 Route of Feeding 305 Diet Selection 306 Energy Requirements 307 Long-Term Management 307 Foods to Avoid in Chronic Pancreatitis 308 Exocrine Pancreatic Insufficiency 309 Pathophysiology 309 Nutritional Management 310 Controversies Regarding Nutritional Management 310 Is a Low-Fat Diet Important for Management? 310 Are Medium-Chain Triglycerides Preferred over Long-Chain Triglycerides? 311 Dietary Management 311 Summary 313 References 313 13 Nutritional Management of Hepatobiliary Diseases 319 Stanley L. Marks and Aarti Kathrani Metabolic Alterations in Liver Failure 319 Carbohydrate Metabolic Alterations 320 Protein and Amino Acid Metabolic Alterations 321 Lipid Metabolic Alterations 322 Vitamin and Mineral Abnormalities 322 Malnutrition in Liver Disease 324 Nutritional Management of Common Hepatobiliary Disorders 324 Feline Idiopathic Hepatic Lipidosis 325 Energy 325 Protein 326 Potassium 327 l-Carnitine 327 Cyanocobalamin/Vitamin B 12 328 Other Nutrient Considerations 328 Copper-Associated Hepatotoxicity in Dogs 328 Energy 329 Dietary Copper Restriction 329 Pharmacologic Reduction of Copper 330 Antioxidants 331 Portosystemic Shunts and Hepatic Encephalopathy 332 Dietary Protein 334 Nonabsorbable Disaccharides 335 Antimicrobials 336 Chronic Hepatitis 336 Summary 337 References 337 14 Nutritional Management of Skin Diseases 345 Catherine A. Outerbridge and Tammy J. Owens Evaluation of Diet in the Context of Dermatologic Disease 345 Nutritional Deficiencies and Excesses 346 Protein 346 Essential Fatty Acids 348 Zinc 350 Zinc-Responsive Dermatoses 350 Zinc-Unresponsive Lethal Acrodermatitis in White Bull Terriers 353 Copper 354 Vitamin A 354 Vitamin E 355 Vitamin B Complex 356 Vitamin c 358 Generic Dog Food Dermatosis 358 Skin Diseases That Benefit from Nutritional or Dietary Management 359 Cutaneous Adverse Food Reactions 359 Clinical Signs 360 Diagnosis and Treatment 362 Cutaneous Xanthomatosis 366 Superficial Necrolytic Dermatitis 366 Clinical Presentation 369 Diagnosis and Treatment 371 Nutritional Supplementation for Management of Skin Disease 372 Fatty Acid Supplementation 372 Zinc Supplementation for Skin Disease 376 B Vitamin Supplementation 376 Vitamin A–Responsive Skin Diseases 376 Vitamin E–Responsive Skin Diseases 377 Therapeutic Diets for Skin Health 377 Summary 378 References 378 15 Nutritional Management of Kidney Disease 384 Yann Queau and Denise A. Elliott Chronic Kidney Disease 384 Water 384 Energy 385 Protein 385 Stage I/II: Progression 385 Stage III/IV: Uremia 386 Phosphate 387 Electrolytes 389 Sodium 389 Potassium 390 Acid–Base Balance 391 Long-Chain Omega-3 Fatty Acids 392 Fiber 393 Antioxidants 393 Nutrients That Target the Endothelium 394 Clinical Efficacy 395 Administration 396 Concurrent Diseases 396 Home-Prepared Diets 397 Monitoring 397 Acute Kidney Injury 398 Glomerular Disease 400 Fanconi Syndrome 401 Conclusion 401 Summary 402 References 402 16 Nutritional Management of Lower Urinary Tract Disease 412 Joe Bartges and Ronald J. Corbee Crystal-Related Lower Urinary Tract Disease 412 Urolithiasis 413 Calcium Oxalate 413 Struvite 420 Purines 423 Cystine 428 Compound Uroliths 429 Surgically and Minimally Invasive Management of Uroliths 430 Matrix-Crystalline Urethral Plugs 430 Idiopathic Cystitis 431 Urinary Tract Infections 432 Summary 433 References 433 17 Nutritional Management of Endocrine Diseases 441 Andrea J. Fascetti and Sean J. Delaney Diabetes Mellitus 441 Nutritional Factors 441 Water 441 Energy 442 Fiber 442 Fat 444 Protein 444 Digestible Carbohydrates 444 Minerals and Vitamins 446 Food Type 447 Feeding Recommendations and Assessment 447 Hyperlipidemia 448 Classification and Etiology 448 Clinical Signs and Diagnosis 449 Management and Assessment 449 Hypothyroidism and Hyperadrenocorticism in Dogs 451 Dietary Hyperthyroidism in Dogs 452 Feline Hyperthyroidism and Idiopathic Hypercalcemia 453 Hyperthyroidism 453 Feline Idiopathic Hypercalcemia 454 Summary 455 References 455 18 Nutritional Management of Cardiovascular Diseases 461 Lisa M. Freeman and John E. Rush Feeding the Cat with Cardiac Disease 461 Hypertrophic Cardiomyopathy 462 Dilated Cardiomyopathy 465 Hypertension 467 Feeding the Dog with Cardiac Disease 467 Asymptomatic Cardiac Disease (Myxomatous Mitral Valve Disease, Dilated Cardiomyopathy, or Other Cardiac Diseases; American College of Veterinary Internal Medicine [ACVIM] Stage B) 467 Mild to Moderate Congestive Heart Failure (ACVIM Stage C) 468 Cardiac Cachexia 468 n-3 Fatty Acids 471 Sodium 472 Potassium and Magnesium 472 Antioxidants 472 Arginine 473 Advanced Congestive Heart Failure (ACVIM Stage D) 473 Additional Supplements for Dogs with Cardiac Disease 474 Taurine 474 l-Carnitine 475 Coenzyme Q 10 475 Vitamin d 475 Hypertension 476 General Nutritional Issues for Dogs and Cats with Cardiac Disease 476 Summary 477 References 478 19 Nutritional Management of Oncologic Diseases 484 Glenna E. Mauldin Cancer-Associated Malnutrition 484 Weight Loss and Cachexia in Humans with Cancer 484 Weight Loss and Cachexia in Cats and Dogs with Cancer 486 Obesity in Humans with Cancer 487 Obesity in Cats and Dogs with Cancer 489 Canine Mammary Tumors and Obesity 489 Nutritional Management of Cats and Dogs with Cancer 490 Energy 490 Calorie Sources 492 Protein and Amino Acids 493 Assisted Feeding 495 Other Nutrients for Cats and Dogs with Cancer 497 Omega-3 (n-3) Fatty Acids 497 Vitamin d 498 Antioxidants 500 Nutritional Fads 502 Supplements and Nutraceuticals 502 Feeding Raw Foods to Cats and Dogs with Cancer 503 Summary 503 References 504 20 Enteral Nutrition and Tube Feeding 515 Jennifer A. Larsen The Case for Enteral Feeding 515 Nutritional Support of Veterinary Patients 515 When to Intervene 516 General Contraindications 518 Enteral Feeding Devices 519 Nasoenteral Feeding Tubes 519 Pharyngostomy Feeding Tubes 520 Esophagostomy Feeding Tubes 520 Gastrostomy Feeding Tubes 522 Jejunal Feeding Tubes 523 Beginning Enteral Feeding 525 Diet Choices 526 Immunomodulating Nutrients 527 Glutamine 529 Arginine 530 Other Nutrients 530 Calculation of Energy Requirements 531 Complications 531 Mechanical Complications 532 Metabolic Complications 534 Gastrointestinal Complications 535 Transitioning Patients to Voluntary Intake 537 Summary 537 References 537 21 Parenteral Nutrition 546 Sally C. Perea History 546 Assessment of Nutritional Status and Patient Selection 547 Nomenclature 551 Determination of Administration Route 551 Catheter Selection and Placement 552 Parenteral Nutrition Components 553 Protein 553 Fat 555 Carbohydrate 556 Electrolytes and Trace Minerals 557 Vitamins 558 Energy Requirements 559 Formulation Calculations 560 Compounding 561 Initiating Parenteral Nutrition 562 Monitoring Guidelines 563 Complications 563 Metabolic Complications 563 Mechanical Complications 566 Septic Complications 567 Discontinuing ParenteralNutrition 568 Summary 568 References 569 22 Abridged Clinical Nutrition Topics for Companion Avian Species 574 Elizabeth Koutsos and Brian Speer Water 574 Clinical and Welfare Considerations Associated with Water 575 Energy 575 Sources of Energy 576 Clinical Issues Associated with Energy Imbalance: Obesity 576 Food-Based Enrichment 577 Amino Acids and Protein 578 Clinical Issues with Protein/Amino Acids 578 Essential Fatty Acids and Lipids 579 Clinical Issues Associated with Lipid Nutrition: Atherosclerosis 579 Vitamins 581 Clinical Issues Associated with Vitamin Nutrition 581 Minerals 582 Clinical Issues Associated with Mineral Nutrition 582 Other Clinical Nutrition Issues 583 Nutrition and Feather-Damaging Behaviors 583 Appropriate Diets for Birds and Their Role in Animal Well-Being 584 Conclusions 585 References 585 23 Nutrition for Small Mammalian Companion Herbivores and Carnivores 590 Jonathan Stockman and Olivia A. Petritz General Nutrition for Small Mammalian Companion Herbivores 590 Lagomorphs (Rabbits) and Caviomorphs (Chinchillas and Guinea Pigs) 590 Gastrointestinal Physiology and Anatomic Features 591 Rabbit, Chinchilla, and Guinea Pig Normal Diet 592 Protein 592 Carbohydrate and Fiber 593 Hay and Other Plant Considerations 594 Fat 595 Vitamins and Minerals 595 Water 596 General Warning about Energy-Dense Foods and Treats 596 Nutrition-Related Diseases of Small Mammalian Companion Herbivores 597 Lagomorphs (Rabbits) and Caviomorphs (Chinchillas and Guinea Pigs) 597 Dental Disease and Malocclusion 597 Obesity 598 Gastrointestinal Stasis or Ileus 599 Urolithiasis 599 Critical Care Nutrition for Small Mammalian Companion Herbivores 600 Energy Calculations for Rabbits, Chinchillas, and Guinea Pigs 601 General Nutrition for Small Mammalian Carnivores 602 Ferrets 602 Digestive Physiology 602 Nutrition-Related Diseases of Small Mammalian Companion Carnivores 602 Ferrets and Considerations for Mink 602 Marine Food Sources: Hypovitaminosis E/Nutritional Steatitis, Thiamine Deficiency, and Salt Toxicity 602 Considerations for Mink 602 Nutrition-Related Diseases of Small Mammalian Carnivores 603 Ferrets 603 Obesity 603 Urolithiasis 603 Ferret Pancreatic Islet Beta-Cell Tumor (Insulinoma) 605 Inflammatory Bowel Disease 605 Critical Care Nutrition for Small Mammalian Companion Carnivores 606 Ferrets 606 References 606 Index 610