Optimal Nutrition

Do you ever think about why we eat? Decisions may be predicated on the basis of concerns about maintaining or correcting health, fitness, fashion or self-image. Current trends would suggest that, unless under duress, many of us seem to have lost sight of thinking about why we need to eat. We need fuel on an autonomic basis but when conscious will is involved, the issues surrounding the interface between food and the individual are many and complex.

We need fuel for energy, to provide structural components for growth and repair, for fight or flight - all the factors concerning survival. At a conscious level, the emotional overlay may be highly influential; most people's food preferences or eating habits have been laid down during childhood and will be based on the cultural norm or other influential factors such as institutional feeding, relative poverty or wealth and other dietary norms.

Yet we are still faced with geographical malnutrition on the one hand and an epidemic of obesity in the western world on the other. All this as we enter a new period of awareness that, on a global basis with burgeoning populations in the emerging countries, we face the new and seemingly impossible challenge of trying to feed the world.

Once we believed that education might be the answer but it is clear that motivating people to change their entrenched habits takes more than education.

What has gone wrong? We know that calorie consumption has risen dramatically in the last 50 years, while energy expenditure has fallen. More food - less exercise, is it that simple? Normal patterns of human behaviour have changed over this period and the same pattern of obesity is happening in pets.

As in humans, pet obesity is not a new problem. This problem has been recognised in the US and in Europe for more than 25 years but there are even more complex human behavioural patterns behind this issue. Around the world, animals and humans co-exist in different ways from the intense human-animal bond that has become the basis for small animal veterinary practice as we know it. In India, cats and dogs may be overseen by a community but may, largely, be left to fend for themselves. In eastern Europe it is not uncommon for people to tip canned pet food out on to the pavement to feed unowned cats that have become part of their community; nearer to home, a grocery brand of cat food appears in TV advertising, served on a silver plate with a sprig of herbs to confirm the anthropomorphic pleasure pet owners get from indulging their pets.

Optimum nutrition is what we may advocate but a balance may be hard to achieve.

Malnutrition

Obesity

What's going on in the western world? New data show that more than half of US dogs and cats are now overweight or clinically obese but owners are often unaware of the severity and cost of the health problems associated with obesity and what constitutes a fat pet differs enormously from clinical reality and between individuals and different cultures. Pet obesity rates in the UK largely mirror those in the US but this is not an isolated problem. A similar incidence of obesity has been recorded in countries as diverse as Germany, Austria, Australia and Brazil.

If pets are dependent on humans for their food, we should look first at human behaviour and, unsurprisingly, obesity in humans is the number one nutritional issue in the US and in much of the rest of the world today. More than two-thirds of US adults are overweight, putting these individuals at increased risk of a variety of adverse health outcomes. In the UK, arthritis affects 1 in 5 adults. Obesity is a major risk for osteoarthritis in the knee; the UK currently ranks eighth highest in the world for obesity and 1 in 6 people have reported having a limiting long-term illness in the UK. Yet, the US and the UK have among the world's highest levels of formal education, and coverage of dietary issues involved in the maintenance of health is a regular feature of entertainment broadcasts. An online survey of pet care professionals in the UK identified differences in perceptions of obesity between stakeholders, poor owner understanding of what to feed, how much to feed and how much to exercise their dog. Owner obesity and lifestyle are also important factors. We recognise that labelling of pet foods is unhelpful and that the influence of the veterinary professional has a limited reach within society.

Feline Advisory Bureau (FAB) data show that around 10% of cat owners will do whatever the veterinarian asks them, around 40% understand the issues and are committed to doing the right thing but haven't yet done so and the remaining 50% will not do it at all as they operate outside our current reach. To reach FAB's 40% of floating voters we don't need more education, we need to find ways to motivate them. To reach the remaining 50% we need to find ways to influence their gatekeepers and veterinary practice must learn to operate outside the confines of its buildings if it is to play any significant role in affecting future behavioural patterns.

Dietary Supplements

Supplementation is another cause of overnutrition and the use of supplements in dogs and cats appears to be increasing. While many supplements are not harmful, they do have potential for side effects and interactions with medications, and quality control of supplements often is questionable. Supplement use often results in excess nutrient intake.

Because the use of dietary supplements is becoming more common, it is important to specifically ask owners if they are giving them to their pets. Owners often do not consider dietary supplements to be either a part of the diet or a medication so may not offer the information unless specifically asked. Clinicians may then need to gather additional information on these supplements to determine potential side effects, interactions with medications or appropriate doses to avoid toxicities. Be aware that supplement use is more common in animals with medical conditions.

Undernutrition

In countries where the majority of pets are fed prepared pet foods, deficiencies have become uncommon. However, other countries still rely primarily on diets of table scraps or homecooked foods which are nutritionally unbalanced. In these situations, deficiencies continue to be a problem (in addition to overall insufficient intake of calories for animals in many developing countries).

In some countries (e.g., United States), there is increasing owner concern over prepared pet foods. As a result, more pets are eating unconventional diets, such as homemade, vegetarian, or raw meat diets. These animals require thorough investigation of the diet to determine whether or not the diet is nutritionally balanced and optimal for that animal.

 While homemade diets can be formulated to meet canine and feline nutritional requirements (when carefully formulated by a board-certified veterinary nutritionist), the vast majority of homemade diets are nutritionally unbalanced - some extremely so!

 Raw meat diets, whether homemade or commercially prepared, carry a number of inherent risks due to bacterial contamination. In addition, the homemade varieties are typically nutritionally unbalanced (as are many of the commercial varieties).

 Vegetarian diets cannot be safely fed to cats and, while they can theoretically be fed to dogs, they are unlikely to be optimal for their health. Homemade vegetarian diets are of particular concern for nutritional imbalances. However, even commercially prepared vegetarian diets may not provide adequate nutrition if they are not very carefully made by companies with a great deal of experience.

 As a result of consumers' concerns over pet foods, there are more foods being manufactured by very small companies and being marketed as 'human grade', 'natural', 'holistic', 'grain free' and the like. Many of these companies do not employ nutritionists or have sufficient quality control standards to provide confidence that their foods are nutritionally balanced.

 While a pet may be eating a good quality, nutritionally balanced commercial pet food, it may actually be getting the majority of its calories from treats, table scraps or other unbalanced foods. As a result, the animal's overall diet can be unbalanced.

The examples illustrate the importance of collecting basic nutritional information on every patient at every visit and making specific nutritional recommendations if the diet is not optimal. If animals are in good body condition, eating a nutritionally balanced diet and are healthy, no additional nutritional assessment is needed. However, animals in thin or overweight body condition require additional information to be collected to investigate underlying medical issues or inappropriate diet.

References

1.  WSAVA Nutritional Assessment Guidelines Task Force: Freeman L, Becvarova I, et al. WSAVA Nutritional Assessment Guidelines. World Small Animal Veterinary Medical Association Website, 2011. www.wsava.org/PDF/Misc/WSAVA_GlobalNutritionalAssessmentGuidelines_2011.pdf