An Organized Approach to Clinical Nutrition
World Small Animal Veterinary Association World Congress Proceedings, 2004
C.A. Tony Buffington, DVM, PhD, DACVN
The Ohio State University Veterinary Hospital
Columbus, OH, USA

INTRODUCTION

The goal of the clinical nutritionist is to sustain the nutritional health of the pets we care for without adversely affecting the quality of the bond between our clients and their pets. To do this we need to consider the signalment of the animal, the most suitable diet to recommend given the pets physiological state and (or) disease, and the most appropriate feeding strategy for both the pet and her owner. An associated issue, at least in our practice, is that many urban clients do not have extensive experience as pet owners, and appreciate advice that may seem elementary to veterinarians.

Animal

As we approach the animal, we need to consider its age, physiological state, and the amount of activity it has the opportunity for. If we're lucky, we will be presented with a puppy or kitten so we can get owners off to the right start. This is the time to recommend a diet you trust, and to discuss any information, or misinformation, the client may have received about feeding their new pet. We should become concerned when a client reveals that a bizarre diet is fed, a variety of supplements provided, or when a well-meaning breeder has recommended an overly strict feeding regimen. Listening to the client's concerns, and explaining that pet food quality has improved so much that supplementation no longer is necessary and may be hazardous usually will convince them of the wisdom of feeding a prepared pet food. If not, I recommend that the patient be returned more frequently to ensure that all continues to go well.

The initial visit also is the time to explain that urban pets, like urban people, are at risk of obesity due to ready availability of highly palatable foods, and the lack of readily available opportunities for calorie-burning activities. To prevent future problems with obesity and begging for food, the client may need help learning to feed to a moderate body condition and to establish a tradition of non food-related interactions with their pet. Owners should be taught to feed whatever amount of food is necessary to maintain a moderate (3/5 or 5/9) body condition. If they have limited experience with animals, they should be shown the elements of moderate body condition by having them palpate the ribs and waist under your supervision, so you can advise them if the animal needs more, less or the same amount of food. Another advantage of teaching owners to feed according to body condition is that it is the same method they use (or should use) for themselves. Few people know how many cups or calories of food they need to eat to maintain moderate body condition. We usually decrease our intake when we notice that our clothes are becoming a little snug, and we can teach our clients to do essentially the same thing with their pets.

We also can help clients maintain their pet's body condition by recommending non food-related interactions. Teaching tricks, playing with the pet, and walking regularly instead of feeding the pet when it wants attention all help maintain a bond that is not held together with food. Owners sometimes confuse begging for attention with begging for food. They can differentiate the two by throwing a favorite toy for the pet to fetch when it looks longingly at them. If it fetches the toy, it was more interested in attention than food.

Diet

One of the most common nutrition-related client questions is, "what should I feed my pet?" Veterinarians can learn to answer this question confidently by obtaining diet histories on all patients, and creating a list of diets that seem to perform well for these animals.

Criteria to consider include

For animals at maintenance:

1.  Do animals have an appetite for the food? Will they eat enough to maintain themselves?

2.  Is the quality and volume of the feces acceptable to you and the owner? Loose and/or voluminous feces suggest poor digestibility and/or low energy density.

3.  Is the coat quality acceptable to you and the owner? Poor coat quality can be caused by a number of nutritional inadequacies, and suggests low diet quality.

4.  Is the diet economical to feed? Cost per day rather than cost per container should be determined, because of the differences in diet quality and energy density.

5.  Is the animal's weight and body condition acceptable?

a.  If overweight, is too much food offered? Too little exercise provided?

b.  If underweight, is enough food being offered?

For pregnant and lactating animals--In addition to the above criteria:

1.  Is the dam's weight gain during gestation acceptable?

2.  Is the dam's weight and body condition maintained during lactation?

3.  Is the physical condition of the offspring normal?

4.  Is the weight gain of the offspring appropriate for the breed, number of pups and parity of the dam?

For veterinary foods--In addition to 1,3,4, and 5 above:

1.  Are the nutrient modifications appropriate for the disease the diet is intended for?

2.  Is there supporting evidence, based on testing in a relevant patient population of the suitability of the diet? N.B. the FDA requires drugs, but not foods to demonstrate safety and efficacy.

Clinicians have a daily opportunity to evaluate the quality of diets. One should recommend those with which one has had positive experiences and against diets when a pattern of inadequacy is discerned. Moreover, absence of a product from one's list does not mean that it is unacceptable, only that insufficient experience with it has been obtained. This method of choosing diets to use and recommend is analogous to the decision making process for many pharmaceutical preparations; it is based on personal experience and judgment rather than marketing claims that may be irrelevant to one's own circumstances. When clients ask about a food one is unfamiliar with, the following general parameters (see also attached Label handout) may be considered if one is uncomfortable with saying, "I don't know.":

1.  Manufacturer's reputation--have you ever heard of them before? Are you familiar with other products from this manufacturer?

2.  Does the nutrition guarantee ("Complete and balanced for ___ stages of a ____'s life...) contain the words "feeding studies"? If so, it means that the manufacturer was sufficiently concerned with the quality of their product to feed it to animals before offering it for sale.

The majority of urban pets are inactive, neutered adults. The nutrient needs of these animals are not great, but may need to be provided in the small volume of food needed to maintain moderate body condition. This volume may be much less than label suggestions. Clients often misunderstand that manufacturer's feeding directions are only initial guidelines, often established based on the intakes of quite active animals. These owners should be informed that individual animals may need to eat twice, or half, as much as label recommendations to maintain moderate body condition, depending on its temperament and activity. I've had my students measure the food intake their pets need to maintain moderate body condition for many years. Most find that their pets consume enough to meet resting energy needs (20 kcal/lb. body weight/day), probably due to inactivity. Clinicians may ask if the small volume of food needed to maintain their pet's condition concerns an owner, and be ready to recommend a lower energy density food that one has experience with. There are many high-quality, reduced calorie foods currently available for treatment of obesity. I think we should be recommending these foods sooner, to prevent development of obesity rather than to treat it.

Lowering the fat content of the diet, and diluting the diet with water, air or fiber can reduce calories in food, or some combination of these can be used. Regardless of the method used, however, the amount fed still must be controlled. In humans, the explosion in availability of reduced fat foods during the past ten years has not been able to stop a nearly 50% increase in the prevalence of obesity among Americans. Our pets can also become fat on low-fat foods unless the amount they eat is restricted. If increased fiber foods are recommended, the client should be warned about the increased feces volume that results. Some owners are surprised and dismayed by this effect, whereas others view it as a sign of a "good constitution".

When small amounts of food are fed, one must be attentive to ensure that the needed amount of each nutrient is consumed. This is particularly a concern with protein. Dogs need at least a gram per pound body weight per day to maintain protein reserves, cats at least two. The smaller the amount of food consumed, the higher the % protein in the diet must be to ensure that needs are met. This can be estimated from the pet food label, which always states the minimum protein percentage, and the weight per unit of food. A dry food that reports 24% protein and weighs 100 gm. per 8oz measuring cup contains 24 grams of protein per cup food. If this food contains 360 calories per cup and dogs eat 30 calories per pound, as is commonly recommended, one cup would be appropriate for a 12 pound dog. The dog would get 24 gm/12 pound or 2 grams per pound per day. If the dog consumed only 15 calories per pound to maintain a moderate body condition, however, it would only receive 1 gram of protein per pound per day. This might not be enough to sustain its protein reserves, and could put the pet at greater risk for complications if it suffers an infection, requires surgery, or for any other reason needs to call upon these reserves.

Feeding

Once owners understand how to feed their pet to maintain a moderate body condition, the frequency and timing of feeding can be adjusted to their convenience to maintain this condition, and to facilitate toilet habits. The number of feedings necessary to maintain the desired condition ranges from continuous availability of food to one small meal per day. I generally recommend that owners feed dogs when they can be walked shortly afterward, usually after work. A small meal in the morning before they leave for work is all right, but the majority of the food should be fed when the owner is at home to reduce begging if only small amounts can be fed.

Owners who spend large amounts of time at home with the pet are especially likely to want to provide their pet with treats. We can help them do this without sacrificing the pet's body condition by teaching them the difference between replacing calories and supplementing them. If they want to feed treats, they need to understand that these should replace some the pet's regular food, not be added to it. Some clients are willing to set part of the daily ration of dry food apart to provide as treats, or to reduce the daily ration so they can provide treats. As long as the treats don't account for more than about 20% of the daily calories, this practice is not dangerous to the pet, and may bring great enjoyment to the owner.

More information is available at: http://www.nssvet.org/

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Tony C.A. Buffinton, DVM, PhD, DACVN
The Ohio State University Veterinary Hospital
Columbus, OH


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