GI Nutritional Treatments Flashcards
describe adverse food reactions
- immunologic/hypersensitivity
-food allergies
-food anaphylaxis - non-immunologic
-food intolerance: abnormal clinical response following ingestion of food (ex. lactose intolerance)
-dietary indiscretion: ingestion of both food and non-food items
–pica: compulsive behavior; ingesting items without nutritional value
describe atopic dermatitis
- immune system abnormality that increases susceptibility to sensitization to allergens
- includes both food and environmental allergens
- if due to a food allergy/hypersensitivity, must avoid triggering food
what is the gold standard approach to diagnose a food allergy/insensitivity?
- elimination diet: 8-10 weeks
-signs must resolve or improve - challenge with original diet: 2 weeks or less if signs reoccur
- elimination diet: signs must resolve or improve again
what is the most common/silver standard approach to diagnosing a food allergy/insensitivity?
- elimination diet: 8 weeks
-signs must resolve or improve - challenge: 2 weeks or less if signs reoccur
- elimination diet: signs must resolve or improve again
- challenge again: 2 weeks or less if signs reoccur
- elimination diet: signs must resolve or improve again
describe how to avoid cross contact and accidental exposures during an elimination trial
cross-contact:
1. replace plastic items: food bowl, scoops/cups, puzzles/toys, storage containers
2. replace or sanitize fabrics: plush toys, bedding/blankets
accidental exposures:
1. hand washing before feeding
2. feed pets separately
3. consider changing all pets in home to elimination diet (esp with social grooming)
4. no litter box access
5. signage and reminders for guests and pet sitters
what can result in inconclusive elimination diet trial results?
- protocol:
-compliance, confounders, accidental exposures, cross-contact - diet:
-not novel
-cross contact (OTC) - disease:
-NOT food allergic
-other diseases present
describe the novel protein diet
- avoid the protein(s) that trigger the hypersensitivity reaction
- challenges:
-obtaining an accurate nutritional history to ensure ingredients are novel (esp if adopted pet)
-developing sensitivities to previously tolerated ingredients over time
describe the hydrolyzed protein diet
- proteins have been broken down into smaller peptides and/or amino acids to avoid triggering the hypersensitivity reaction!!!
- challenges:
-typically dry foods only with few canned options and treats
-misinformation regarding palatability and daily cost is rampant
describe protein sizes
- novel proteins:
-whole proteins (commercial or homemade)
-relies on accurate nutritional history - hydrolyzed proteins:
-typically 2-15kDa (smaller = better)
-typically soy, chicken, or salmon based - extensively hydrolyzed proteins:
-less than 1 dKa (small peptides)
-feather protein hydrosylate dry food - elemental (amino acids)
-individual amino acids only
-only dry available for dogs
describe feather protein hydrosylate
feather protein hydrosylate is DIFFERENT than feather protein meal (which is ground up feathers)
feather protein hydrosylate:
-amino acids
-excludes fibrous component
-high digestibility
-original use: infant formula for food allergic infants
feather meal
-mainly fibrous material
-low digestibility
when would you choose to feed a hydrolyzed protein diet?
- elimination diet trials
- chronic gastroenteritis including IBD and PLE
- exocrine pancreatic insufficiency
- paroxysmal gluten sensitive dyskinesia (border terriers: avoiding wheat, barley, rye, and triticale
when would you choose to feed a homemade cooked novel protein diet?
- patient and/or owner preference
- multiple medical conditions for which NO commercial diet is available to meet all needs
when would you choose to feed a commercial, veterinary, novel protein diet?
- patient an/or owner preference
- multiple medical conditions for which NO hydrolyzed protein commercial diet is available to meet all needs
describe the fiber content and uses of a highly digestible diet
fiber: aim for <5g of fiber/1000kcal
use for:
1. acute gastroenteritis
2. small bowel disease
3. exocrine pancreatic insufficiency
4. pancreatitis
5. obstipation/megacolon
don’t forget: weight gain plans for under-conditioned patients and assisted enteral feeding options!
contrast rapidly fermentable to slowly fermentable fibers
rapidly fermentable/prebiotic fibers:
1. affects composition of microbiota
2. short chain fatty acids produced, yielding energy for GIT
3. as fermentation increases, GI transit and fecal bulk decrease
4. potential side effects: gas and/or soft stools/diarrhea
slowly fermentable/bulking fibers/roughage
1. low energy density
2. low digestibility
3. causes colonic distension which stimulates motility
4. potential side effects: fecal impaction/obstipation if patient becomes dehydrated
describe a fiber enhanced diet
per 1000kcal aim for:
>10 grams of crude fiber
>25g of total dietary fiber
use for:
1. acite enteritis, including dietary indiscretion
2. stress colitis
3. chronic colitis
4. constipation: still able to pass stools just infrequent
CONTRAINDICATED:
1. megecolon/obstipation (loss of motility)
what is the importance of dietary fat?
- energy source
- source of essential fatty acids
- vehicle for fat soluble vitamin absorption
- palatability
describe a low fat diet in dogs
per 1000kcal aim for
<20grams = ultra low fat
25-35g = low fat
use ultra-low fat for:
1. persistent fasting hyperlipidemia
2. lymphangiectasia
3. severe pancreatitis: esp if recurring and/or hospitalized
4. chylothorax
5. ileus: esp post op
6. weight loss
use low fat for:
1. mild pancreatitis managing as outpatient, feed multiple meals to spread out daily dose of fat
2. weight loss
describe a low fat diet for cats
<30grams/1000kcal
use for:
1. persistent fasting lipidemia
2. chylothorax
3. ileus: post op
4. weight loss
describe how the GI diets categories relate to each other
NOT mutually exclusive!
EXCEPT: cannot be high AND low fiber
but can have hydrolyzed highly digestible, low fat hydrolyzed, etc.
describe the benefits of small, frequent meals
- decrease gastric distension
- decrease gastric secretion
- decrease nausea, vomiting, GE reflux
- more effective nutrient assimilation
at home: 3-4 meals/day
in hospital: 4-6 meals/day or CRI
