Nutrition is one of the most important considerations in the maintenance of health and plays a critical role in the management of diseases, patient recovery and hospital outcome; a reflection of its acknowledgment as the fifth vital assessment (after temperature, pulse, respiration and pain). The veterinary healthcare team (veterinarians, veterinary nurses/technicians and patient care assistants) play an instrumental role in implementing nutritional support to hospitalised animals and educating pet owners about nutrition. Yet, findings suggest that, while 90% of pet owners would like a nutritional recommendation from the veterinary healthcare team, only 15% of pet owners identify receiving one (AAHA 2003). An understanding of basic nutritional principles and the application of nutrition in optimising the health and wellbeing of both fit and clinically affected companion animals is therefore essential.
As with any medical intervention, there are always risks of complications and this is no different with nutritional interventions. Minimising such risks depends on careful patient selection and assessment. Nutritional assessment identifies malnourished patients requiring immediate nutritional support as well as those at risk of developing malnutrition.
In 2011, the WSAVA Global Nutrition Committee (GNC) launched Nutritional Assessment Guidelines for Dogs and Cats to help the veterinary healthcare team and pet owners ensure that dogs and cats receive optimal nutrition, tailored to their needs (Freeman et al. 2011). They have been endorsed by the BSAVA, together with numerous other global veterinary organisations, published in a variety of journals and translated into many languages since. They are available for free download from the WSAVA website (www.wsava.org) and have become one of its most frequently accessed WSAVA resources.
These guidelines provide a framework for the veterinary healthcare team to assist them in making a nutritional assessment, and specific nutritional recommendations, for every patient at every visit (Figure 1).
|Figure 1. The nutritional assessment process using the WSAVA Nutritional Assessment Guidelines for Dogs and Cats (modified from Freeman et al. 2011)|
The first stage of this process involves making a systematic screening evaluation of the animal as well as identification of the diet fed and any feeding management and environmental factors. This includes information obtained from the history and a physical examination and should include measurement and/or consideration of these additional factors:
- Current and previous bodyweight
- Body condition score (BCS)
- Muscle condition score (MCS)
- Diet (including type and brand, frequency of feeding and amount being fed)
- History of vomiting, diarrhoea or other
- Temperature, pulse, respiration, pain
- Any abnormal physical findings
The identification of any abnormalities in the history, diet, or physical exam and nutrition•related risk factors should prompt a more in-depth extended evaluation of each of these factors and will impact on how, and when, the nutritional plan can be implemented (Table 1). If no risk factors are identified, owners should be advised accordingly and given an appropriate recommendation, for example, to continue with the existing diet.
Table 1. Examples of factors to consider when completing a nutritional assessment
Feeding and environmental factors
Initial screening evaluation
• Physiological status?
• Activity levels and daily exercise?
• Body condition?
• Body weight?
• Existing medical conditions?
• Conventional or unconventional?
• Suitability for the species and life-stage?
• Complete versus complementary?
• Composition (including ingredients)?
• Feeding guidelines?
• Frequency, timing, location and method of feeding?
• Food container and material e.g., metal bowl, food dispensing toy
• Multipet household?
• Quality of surroundings and husbandry?
• Pet’s access to space?
• Changes in food intake or behaviour?
• Alterations in gastrointestinal function and faecal production?
• Condition of the skin?
• Presence and effect of any medical conditions and/or medications?
• Laboratory abnormalities?
• Other sources of nutrients, e.g., access to treats, snacks and table food?
• Type, formulation, energy density, texture and flavour of diet?
• Storage of the diet?
• Primary feeder of pet?
• Other providers and sources of food?
• Extent of enrichment?
• Environmental stressors?
• Presence of conditions and/or circumstances causing fear and anxiety?
Nutritional assessment identifies risk factors influencing how, and when, the nutritional plan can be implemented. In some situations, focus must be placed on resuscitation and stabilisation with the possibility of feeding being delayed until the patient is haemodynamically stable and any major electrolyte, fluid, and acid-base abnormalities have been corrected. Appropriate laboratory analysis may be performed and any concurrent conditions such as renal or hepatic disease may require dietary adjustments. A nutritional plan should prevent (or correct) overt nutritional deficiencies and imbalances. Further to this, a detailed dietary history, including information about the pet. The provision of supportive care to address problems involving hydration and electrolyte status, pain, body temperature, vitamin B deficiencies and nausea can result in appetite being reestablished in many anorexic patients (Delaney 2006).
In addition to the nutritional assessment guidelines, the GNC has prepared a non-branded Global Nutrition Toolkit, again available for free download and containing a number of resources including:
- A body condition scoring chart
- A muscle condition scoring chart
- ‘How to’ videos for performing a feline and canine body condition score
- A diet history form
- A nutritional assessment checklist
- Calorie guidelines for healthy adult dogs and cats
- A hospitalised patient feeding guide and nutrition monitoring chart
- An advice sheet for pet owners on selecting the right diet
- A pet owner’s guide to nutrition on the internet
Additional resources are added to the toolkit on a regular basis to reflect the latest thinking on nutrition.
The vision of the GNC is to help the veterinary healthcare team and the public understand the importance of nutrition in companion animal health by providing an expert source of accurate nutritional information and recommendations. Its campaign aims to ensure that a nutritional assessment and recommendation is made on every patient during every visit to the vet. All members of the veterinary healthcare and reception team are integral to promoting the value and importance of nutrition in their practice. As acknowledged by the American Animal Hospital Association (AAHA 2009, p. 4).
1. American Animal Hospital Association. The Path to High-Quality Care: Practical Tips for Improving Compliance. Lakewood, CO: American Animal Hospital Association; 2003.
2. American Animal Hospital Association. Compliance: Taking Quality Care to the Next Level - Executive Summary. AAHA Compliance Study Executive Report. https://www.aaha.org/public_documents/professional/resources/complianceexecutivesummary.pdf. 2009. Accessed February 11, 2019.
3. Delaney SJ. Management of anorexia in dogs and cats. Vet Clin North Am Small Anim Pract. 2006;36:1243–1249.
4. Freeman L, Becvarova I, Cave N, MacKay C, Nguyen P, Rama B, Takashima G, Tiffin R, Tsjimoto H, van Beukelen P. WSAVA nutritional assessment guidelines. J Small Anim Pract. 2011;52(7):385–396.