Clinical Nutrition Flashcards
what are the 6 basic classes of nutrients?
protein fat carbohydrate minerals vitamins water
why may dry food be prefurrable?
aids dental health
what is the most important nutrient?
water
how much water intake is required per day?
20-70 ml/kg/day
what is the correct urine output for animals?
1-2 ml/kg/hr
what must be available at all times?
water
what are vitamins?
organic compounds
what are the lipid soluble vitamins?
A, D, E, K
what are the non-lipid soluble vitamins?
B and C
what are vitamins used for?
energy metabolism
biochemical reactions
what can happen if an animal is receiving an inadequate number of vitamins?
deficiency syndromes
what are the macrominerals?
calcium phosphorus magnesium sodium potassium chloride sulpher
what are the most important microminerals?
iron copper zinc manganese iodine selenium
what is protein formed from?
chains of amino acids
how many amino acids to animals need?
all 23
what is formed from amino acids?
hair skin muscle hormones antibodies (etc)
where can many amino acids be synthesised?
in the body
what are the essential amino acids?
those that cannot be synthesised within the body and so must be gained through the diet
why are cats obligate carnivores?
require taurine in their diet as they are unable to synthesise it
what are the functions of protein?
regulation of metabolism
tissue growth and repair
cell and muscle fibre structure
energy source
what are the essential amino acids?
phenylalanine valine tryptophan threonine isoleucine methionine arginine leucine lysine taurine (cats only)
what will deficiency in taurine cause?
blindness and heart problems
what is the biological value of protein?
a measure of the proportion of absorbed protein from a food which becomes incorporated into the proteins of the organism’s body - higher value is easier for the body to utilise
what are the issues caused by excess dietary protein?
liver and kidney problems
why must care be taken to to ensure dietary protein is at the right level at different life stages?
care that there is not excess in ageing animals as their kidney function is likely reduced
ensure high protein diet in growing young
what is caused by protein deficiency?
poor growth, muscle and weight loss dull hair reduced immunity oedema (due to hypoalbuminemia) death
what are fats made up of?
triglycerides (glycerol and fatty acids)
what is the role of fats in the body?
provide energy aid absorption of fat soluble vitamins enhance palatability source of essential fatty acids neural development (DHA)
what are the essential fatty acids?
linoleic
linolenic
arachidonic
what is DHA essential for?
neural development
what is the effect of inadequate intake of fats?
energy deficiency
EFA deficiency
what are the effects of EFA deficiency?
impaired reproduction impaired wound healing dry coat flaky skin eczema hot spots
what are the 3 main groups of carbohydrates?
monosaccharides
disaccharides
polysaccharides
what group do complex carbohydrates fall into?
polysaccharides
what are carbohydrates used for?
energy
metabolic requirement for glucose
what will happen to excess carbohydrates?
converted to fat
what is fibre?
indigestible polysaccharide
what are the main sources of fibre?
cellulose
lignin
pectin
where is fibre most commonly found?
plant cell walls
is fibre digestible in the intestine of dogs and cats?
no
what is the function of fibre?
bulk out faeces
prevent constipation and diarrhoea
role in correction of obesity (satiety)
role in regulating blood glucose levels in diabetes
when should animals be body condition scored?
at all clinical exams
describe a BCS of 4 in a dog
Ribs easily palpable, with minimal fat covering. Waist easily noted, viewed from above. Abdominal tuck evident
describe BCS of 5 in a dog
Ribs palpable without excess fat covering. Waist observed behind ribs when viewed from above. Abdomen tucked up when viewed from side
describe BCS of 5 in a cat
Well-proportioned body. Ribs are not visible but easily felt. Waist obvious/ slight abdominal tuck. Small amount of abdominal fat.
describe BCS of 4 in a cat
Ribs not visible but are easily felt. Waist is obvious/ slight abdominal tuck. Minimal amount of abdominal fat.
what is metabolisable energy (ME)?
kcal per 100g of a diet - most accurate way to see what calories the animal will take in
why is gross energy a less reliable measure of energy intake?
not all available to the animal so less reliable
what is basal energy requirement (BER)?
amount of energy expended during sleep, 12-18 hours after food in a thermoneutral enviroment
what is resting energy requirement (RER)?
BER with energy expended for recovery from physical activity and feeding
what energy requirement is used to calculate food needs in hospitalised patients?
RER
what is maintenance energy requirement (MER)?
energy required by a moderately active animal
what is not included within MER?
energy for growth, lactation and work
what factors must be considered when calculating MER?
lifestage
what is the calculation for RER for animals under 2kg and above 45kg?
RER= 70 x (BWT/kg)0.75
what is the calculation for animals between 2 and 45kg?
RER = 30x BWT/kg + 70
how can calorie intake be calculated?
calculate RER
choose most beneficial diet
divide energy content of diet by RER to achieve daily food required
divide total for the day by total number of feeding times /max volume of each meal
what should be used to calculate calorie needs in the clinical environment?
RER
what should be used to calculate calorie needs in the healthy patient?
MER
what makes up the MER calculation?
RER x lifestage factor
what factors are now no longer considered appropriate to factor into calorie needs?
illness factors
what is obesity?
excess accumulation of body fat
what can cause obesity?
modern lifestyle
neutering
overfeeding
poor owner understanding
what can be used to give an indication of obesity?
BCS
what are the possible consequences of obesity in dogs and cats?
hepatic lipidosis joint disease exercise intolerance DM skin disease cardiorespiratory disease impacts on surgery FLUTD
what is a safe amount of weight loss per week?
1-2%
what is required in order to achieve safe weight loss?
diet changes
exercise plan
behavioural changes
what should the MER of an obese dog be calculated based on?
ideal weight not current weight
what should weight loss programmes be tailored to?
individual animal and owner
what are the key issues with starvation for weight loss?
ethically questionable
excessive loss of lean body mass (LBM)
body function problems
risks hepatic lipidosis in cats
what are the main features of obesity diets?
nutritionally balanced
high protein
joint health often supported
L- carnitine included
what is the benefit of a nutritionally balanced obesity diet?
pet receives correct levels of vitamins and minerals
what is the benefit of a high protein obesity diet?
preserves lean body mass
reduced net energy
satiety
palatability
why are joint health supplements often included in obesity diets?
obesity and joint issues linked
what is the benefit of joint supplements within an obesity diet?
helps maintain joint health in overweight pets
reduces the need to supplement
what are the main components of joint supplements?
glucosamine and chondroitin
what is L-carnitine?
non essential amino acid
what does L- carnitine do?
transports long chain fatty acids into the mitochondria for use in beta oxidation
what are the benefits of including L- carnitine into obesity diets?
helps encourage use of fat for energy and reduce fat storage
reduces risk of hepatic lipidosis in cats
what is one of the key areas where owners can make a significant difference to their pet’s health?
diet
what are the key GI issues that may be managed through nutrition?
acute and chronic GI issues
EPI and uncderweight
what acute and chronic GI issues may be managed with diet?
diarrhoea gastritis/enteritis IBD maldigestion/malabsorption bacterial overgrowth cholangiohepatitis (cats)
what is cholangiohepatitis?
inflammation of liver and bile duct
what are the ingredients found in diets for GI disease?
highly digestible proteins and starch mannon oligosaccharrides FOs EPA/DHA Psyllium high or low fat supplementation for EPI or absorption syndromes
what do highly digestible proteins have?
high bioavailablity (easy to break down)
what does MOS stand for?
mannan oligasaccharide
what does FOS stand for?
fructose oligasaccharides
where do MOS come from?
cell wall of yeast
where does FOS come from?
beet pulp, grains, barley and wheat
what is the role of MOS and FOS?
enhances good gut bacteria
what does EPA stand for?
eicosapentaenoic acid
what does DHA stand for?
docosahexeanoic acid
what are EPA and DHA?
omega 3 essential fatty acids (unsaturated)
what is the role of EPA and DHA?
increase digestion
what is the role of psyllium in GI diets?
aids toxin and waste removal
bulks faeces and absorbs water
relieves constipation
aids peristalsis
where does psyllium come from?
plant husk
what will the decision to feed high or low fat diets depend on?
individual patient
what my be included in GI diets to support EPI or malabsorption syndromes?
supplementation e.g. Lypex
how does Lypex deliver pancreatic enzymes to the small intestine?
coated so that they are unaffected by the gastric environment
what does Lypex provide?
artificial pancreatic enzymes for patients with EPI
why may a patient need a hypoallergenic diet?
allergic to a component or ingredient of normal diets
what can food allergy lead to?
skin and GI diseases
what is the role of hypoallergenic diets?
nutritional management of dogs and cats with food allergy/hypersensitivity/intolerance
what may be involved in diagnosis food allergy/hypersensitivity?
food elimination
what other conditions aside from allergy are hypoallergenic diets useful for?
inflammatory bowel disease
EPI
as it increases the digestibility of food
what are some common protein allergies?
chicken
beef
what can be done to prevent food allergy but still be able to feed protein?
hydrolysed proteins
how does hydrolysation of proteins prevent allergic reaction?
change the protein surface so that immunoglobulins in the body no longer recognise and bind to the protein. This means mast cells no longer degranulate and histamine is not released (no symptoms)
how are proteins hydrolysed to prevent allergic reaction?
using enzymatic hydrolysis by hydrolysates
what immunoglobulin is involved in hypersensitivity reactions?
IgE
what happens during a hypersensitivity reaction that causes symptoms?
IgE binds, mast cells are stimulated to degranulate
histamine released
how long can a hypersensitivity diet take to have effect?
several weeks - up to 6
what are hypoallergenic diets made from?
hydrolysed proteins
novel source of protein (e.g. duck)
what is included within hypoallergenic diets to improve the skin barrier?
B vitamins
amino acids
zinc
linolenic acid
what fatty acids are found in hypoallergenic diets?
EPA and DHA
why are the essential fatty acids EPA and DHA needed in hypoallergenic diets?
support skin and GI mucosal integrity so the animal is less prone to upset
what is included in hypoallergenic diets to improve digestive security?
beet pulp
FOS and MOS
zeolite
what is the role of beet pulp in a hypoallergenic diet?
promote motility
what is the role of FOS, MOS and zeolite in hypoallergenic diets?
support a healthy intestinal environment
what is zeolite?
mineral that removes toxic elements
who are convalescent required for?
hospitalised patients / those with anorexia
how much of total energy provision in convalescent diets is from protein sources?
30-50%
why must care be taken when feeding high protein convalescent diets?
if patient is in renal failure or has hepatic encephalopathy as these animals are less able to manage protein safely in the body
what should happen before feeding a convalescent diet to patients?
check with vet
what are the most widely available forms of convalescent diets?
liquid diets
powdered diets
solid wet diets
can all convalescent diets be given via feeding tube?
yes but care must be taken to ensure correct calories if diluting and that they will not get stuck in the tube
what are critically ill patients at risk of?
malnutrition
why are critically ill patients at risk of malnutrition?
energy is not conserved as normal due to catabolism and rapid breakdown of energy stores that occurs in the stress state of metabolism
what is one of the most marked features of critically ill patients?
catabolic depletion
what will be improved by proper nutrition of the critically ill patient?
tissue repair
wound healing
immune function
what should be encouraged in all sick patients as soon as is safe?
oral nutrition considering possible complications (e.g. aspiration)
what should not be introduced in a hospital setting?
new diet (if long term use planned) as there is risk of food aversion
what is the first option when feeding animals?
voluntary eating
how can an animal be encouraged to eat?
calm environment warm food strong smelling palatable remove any physical barriers ensure fresh offer one food type at a time leave patients without food
what are the physical barriers that may prevent a patient from eating?
buster collars
injury to face
too small bowl (esp. cats)
what can be used if voluntary feeding is not achieving adequate calorie intake?
enteral feeding tubes
what type of diet is judged to be better for dental health in dogs and cats?
hard kibble
what 3 things can be included in the diet to improve dental health?
phosphate salts - anti calculus properties
Igy-GP - blocks bacterial formation
omega 3 - controls inflammation caused by periodontal disease
what is the exocrine function of the pancreas?
synthesis and excrete digestive enzymes
what causes pancreatitis?
premature activation of digestive enzymes within acinar cells - leads to pancreas autodigestion
what does the inflammatory cycle of pancreatitis begin with?
addition of neutrophils
what are the clinical signs of pancreatitis?
vomiting
abdominal pain
anorexia
lethargy
what can severe pancreatitis lead to?
renal failure acute lung injury DIC chronic pancreatitis EPI
how is pancreatitis treated?
IVFT antiemetics analgesia gastro-protectants nutrition
what is involved in nutritional support of pancreatitis patients?
no fasting
eat as early as possible once nausea and vomiting are under control
what are the benefits of early nutrition for pancreatitis patients?
reduced villi damage and so less bacterial translocation
reduced villus atrophy
reduced pancreatic inflammation
is enteral or parenteral nutrition more beneficial for pancreatitis patients?
enteral
what type of diet should be avoided in pancreatitis patients?
high fat
why should a high fat diet be avoided in pancreatitis patients?
concurrent hyperlipidaemia which is a risk factor for pancreatitis
what enteral feeding methods can be used in pancreatitis patients?
oral
pre-pyloric (NG, NO)
when feeding an anorexic patient what must be considered?
introducing food slowly over a number of days to prevent refeeding syndrome
what elements of the diet need to be carefully managed to ensure normal skeletal development/maintenance?
calcium
phosporus
vitamin D
what is the benefit of regulating calcium, phosphorus and vitamin D in growing animals?
reduction in orthopoedic issues in later life
when is diet management of orthopedic issues particularity important?
large breeds while they’re growing
what is osteoarthritis?
articular cartilage degradation
what animals is osteoarthritis seen in?
ageing cats and dogs
some rabbits
in what breeds is joint dysplasia most commonly seen?
medium to large
what makes joint dysplasia more likely?
genetic predisposition
what are the main orthopedic issues that can be supported by diet?
osteoarthritis
joint dysplasia
cranial cruciate ligament rupture/luxating patella
what must be managed in young dogs (especially large and medium)?
growth rate through diet
exercise
what is the key area of nutrition for dogs with arthritis?
weight management
how can reducing weight lead to improved arthritis?
reduces pain as weight and so force through joints is reduced
what are the key ingredients in arthritis diets?
omega 3 fatty acids (EPA/DHA)
green lipped mussel
glucosamine and chondroitin sulphate
what is the role of omega 3 fatty acids in arthritis management?
reduces inflammation
what is the required amount of omega 3 needed to have an effect on arthritis?
230-370 mg/kg
what is the role of glucosamine and chondroitin sulphate?
cartilage formation and repair
reduce inflammation
slow cartilage degeneration
what are the aims of diabetic diets?
support in achieving normal glucose levels
decrease postprandial glucose peaks
achieve normal metabolism of carbs, fats and proteins
normalise body weight
what is the effect of high fibre on DM?
regulation of glucose spikes
what % DMB of a diabetic diet should be made up of protein in dogs?
15-25%
what % DMB of a diabetic diet should be made up of protein in cats?
28-50%
why should fat be controlled in diabetic diets?
high fat will increase insulin resistance
what % DMB of a diabetic diet should be made up of fat?
<20%
what is an important dietary factor in DM management?
insoluble carbohydrate (fibre)
what blood parameter is moderated by diabetic diets?
fructosamine
what must be avoided when feeding diets in cats while hospitalised?
food aversion - do not feed new diet while in hospital
what is often seen alongside hyperthyroidism?
chronic renal failure
why may kidney disease only become apparent after treatment of hyperthyroidism?
renal perfusion is increased in hyperthyroidism
as thyroid resolves this will drop and so CKD will become obvious
what is required in the diet for the production of thyroid hormones?
iodine
what level of iodine should be seen in a diet for hyperthyroid cats?
0.2ppm DMB
what is the issue with hyperthyroid diets (e.g. Hills y/d)?
must be exclusively fed
poisonous to euthyroid cats
is there a single diet appropriate for all cardia cases?
no - holistic approach and discussion with vets
what are the main considerations for nutrition of the cardiac patient?
mild sodium restriction to maintian BP
maintain optimal BCS
monitor muscle mass in severe cases (cardiac cachexia)
what are the main things that can be added to the diet to support cardiac health?
amino acids
what amino acids can support cardiac function?
taurine
lysine and methionine to synthesise L-carnitine
arginine
what is taurine deficiency linked to?
dilated cardiomyopathy
cats especially needed as they cannot synthesise
what is the role of L-carnitine in cardiac health?
myocardial energy production
what is the role of arginine in cardiac health?
normal vasular tone
what is the role of omega 3 fatty acids in cardiac health?
reduces muscle loss - cardia cachexia
anti-arrhythmatic effects
what should never be restricted in pet diets unless specifically required by condition?
protein - especially in older animals
