Specific diseases

Question 1

What are the considerations for feeding for CKD

Answer 1

Poor appetite
Poor BCS
Lyte and acid base derangements
Polyuria can lead to loss of water soluble nutrients

Question 2

What is the evidence for renal diets?

Answer 2

Dogs - improved survival and reduced uraemic crises stages 3-4
Cats - improved survival stages 2-4

Question 3

What are the properties of renal diets?

Answer 3

Energy dense to balance reduced intake
Phos restricted to prevent renal secondary hyperparathyroidism
Protein restricted to minimise uraemia
Low Na to counteract hypertension
K+ and vitamin supplementation
Alkalinising

Question 4

What are the features needed of a diet for a PLN?

Answer 4

Moderate protein restriction
Low Na to minimise hypertension
Omega 3 FAs - decrease the degree of proteinuria

Question 5

What are the benefits of omega 3 FAs

must be fish oil to supply EPA and DHA

Answer 5

Lead to a decrease in the production of inflammatory mediators
Used in cardiac disease -reduce arrythmias in cardiac disease
Good in PLN
also used for neoplasia and OA

reduces inflammation, lowers systemic arterial pressure, alters plasma lipid concentrations, and preserves renal function

Question 6

What are the main components of a urolith diet?

Answer 6

Increase water consumption either by increasing moisture or adding Na to increase thirst
Decrease in the dietary precursors to the stone (e.g. Mg and phos in struvite)
alter the pH

Question 7

What are the types of diet trial?

Answer 7

Novel protein (Hx essential, may need to do home cooked)
Hydrolysed (minimises immunogenicity, can still get reactions)

Question 8

Outline soluble fibre

Answer 8

Mostly from fruit
Increases bacteral fermentations
Adds moisture - get decrease faecal bulk
Decreases small intestinal transit time
Adds water, moistens the f+

Question 9

Outline insoluble fibre

Answer 9

e.g brans, woody things
Adds bulk
Increases SI transit time
Normalises LI transit time
Decreases f+ water content

Question 10

What are the dietary risk factors of pancreatitis?

Answer 10

Ingestion of unusual food items
Table scraps
Eating from a bit
Obesity/ neutered

Question 11

When is a low fat diet helpful in pancreatitis?

Answer 11

In chronic pancreatitis
When the patient is obese
When there is hypertryglyceridaemia

Question 12

how much should you feed in critical illness?

Answer 12

RER only - and gradually introduce this
Complications with feeding more:
High BG, azotaemia, hypertryglyceridaemia, lyte disturbances
V+ or regurge or tube feeds
Re-feeding syndrome

Question 13

What sort of diet should be given in critical illness?

Answer 13

Balanced
high quality, quantity and digestibility of protein - want to minimise negative nitrogen balance, need to ensure all the conditionally essential amino acids ae available
Moderate fat content to increase energy density
Supply with necessary micronutrients and antioxidants

Question 14

Why is important to limit hypertension in renal disease?

Answer 14

BPs over 180 shown to increase the likelihood of uraemic crisis and death in dogs
No real evidence for reducing sodium for now as evidence is mixed on the benefits and cons of restricting sodium

Question 15

Why avoid metabolic acidosis in renal disease?

Answer 15

Increases renal ammoniagenesis which contributes to renal failure
Increases catabolism and degradation of skeletal muscle protein
disrupts intracellular metabolism, and promotes dissolution of bone mineral, exacerbating azotemia, loss of lean body mass, and renal osteodystrophy

Question 16

What alkanising agents can be used for reduced renal metabolic acidosis?

Answer 16

sodium bicarbonate, calcium carbonate, or potassium citrate

Question 17

Why are omega 6 FAs avoided in renal disease?

Answer 17

Cause an acute increase in GFR

Question 18

What nutrients are antioxidants that trap free radicals?

Answer 18

vitamin E, vitamin C, taurine, carotenoids, and flavonols

Question 19

What are the main recommendations for feeding hyperthyroid cats?

Answer 19

large amount of dietary protein
a small amount of carbohydrate
and a moderate amount of phosphate

Question 20

How should diabetic cats be fed?

Answer 20

Because cats are obligate carnivores, diabetic cats are carbohydrate intolerant and respond best to a low-carbohydrate diet
Because diabetes is a catabolic state, weight loss, muscle wasting, and poor muscle condition scores are common in diabetic cats; therefore, feeding high-protein diet helps maintain muscle mass

Question 21

How does hyperthyroidism affect insulin

Answer 21

moderate to severe endogenous insulin resistance,
This insulin resistance is associated with a decreased glucose clearance (impaired glucose tolerance), which indicates a prediabetic state
Some cats may become overt diabetics - this may not resolve, and may get worse, with hyperthyroid treatment

Question 22

How does hyperthyroidism affect the kidney

Answer 22

increases GFR which can lead to damage

Lots develop hyperphosphataemia and high PTH which can lead to renal secondary hyperparathyroidism

Question 23

How do maintenance energy levels change with age in cats?

Answer 23

3% per year until the age of 11 years, and then start to increase again

Question 24

What are the key goals in a hyperthyroid diet?

Answer 24

allows weight gain (back to optimal body weight) and helps restore loss of muscle mass;
lessens postprandial hyperglycemia, improves insulin sensitivity, and helps stabilize glucose metabolism;
helps control hyperphosphatemia and secondary hyperparathyroidism and slows the progression of any underlying kidney disease.

Question 25

How are food needs different in dogs and cats with diabetes?

Answer 25

Diabetic cats are carbohydrate intolerant and respond best to a low-carbohydrate diet; this again differs from dogs, which are omnivores and are more tolerant of a meal that is moderate to high in carbohydrates, even when diabetic

Question 26

Why is carbohydrate restriction good with diabetics?

Answer 26

One of the main advantages of carbohydrate restriction is that it allows control of hyperglycemia with lower doses of insulin, thus lessening the risk of hypoglycemia

Question 27

What is glucose toxicity and how does it affect prognosis?

Answer 27

suppression of insulin secretion from beta cells secondary to prolonged hyperglycemia.
Glucose toxicity is dose dependent, with greater suppression occurring with more severe hyperglycemia.
Suppression of insulin secretion by glucose toxicity is initially reversible but eventually results in the irreversible loss of beta cells.
Therefore cats with poorly controlled diabetes for longer than 6 months have a reduced probability of remission, even after good glycemic control is achieved.

Question 28

What are the nutritional goals of a diabetic diet?

Answer 28

lessens postprandial hyperglycemia
reduces marked fluctuations of blood glucose concentrations
minimizes the demand on beta cells to produce insulin
and improves insulin sensitivity