(T3) Lecture 11b - Nutritional disorders and wellness diets

Question 1

What are 2 food sensitivities (aka adverse rxns to food)?

Answer 1

1. Food allergy (hypersensitivity)
   - adverse rxns to food that have an immunologic basis
2. Food intolerance
   - adverse rxns to food due to nonimmunologic mechanisms

*Adverse food rxns mimic other diseases

Question 2

What are the symptoms of a food sensitivity? When do clinical signs appear?

Answer 2

1. Skin
   - pruritus, self-inflicted alopecia, eosinophilic plaques, indolent ulcers on the lips in some cats
2. Digestive tract
   - vomiting, small bowel diarrhea, large bowel diarrhea

Clinical signs appear 4-24hr after consumption of food with offending antigen

Question 3

What are food allergens generally?

Answer 3

1. Large proteins: beef, dairy products, fish and gluten intolerance
2. Lactose intolerance

Question 4

What is the traditional way to diagnosis/ identify allergens?

Answer 4

First of all: ruling out of other causes of allergic disease

1. Feeding an elimination diet and demonstrating a decrease or elimination of clinical signs
2. “Challenging” the animal with the original diet and observing a return of clinical signs
3. Feeding select ingredients to identify the specific dietary component to which the animal is allergic

Question 5

How would you formulate an elimination diet?

Answer 5

Take allergens out and feed a different protein or hydrolyzed protein

Question 6

Diagnosis and management of dietary hypersensitivity

Answer 6

Select an elimination diet containing novel protein and CHO sources
- e.g. Cat: lamb and barley; Dog: fish and potato; Horse: timothy hay
- feed the elimination diet for 8-10 wks
- observe for diminishing clinical signs of hypersensitivity

If the elimination diet decreases clinical signs, re-feed the original diet
- observe for return of signs
- if signs reappear, is definitive diagnosis of food hypersensitivity

Question 7

How can food allergens be identified with an elimination diet?

Answer 7

Food allergens can be identified by adding a small amount of a SINGLE suspected allergen to the elimination diet
- observe for return of signs

Question 8

How are dietary hypersensitivities managed?

Answer 8

For lifelong management, a diet that is nutritionally complete and balanced and does not contain the food allergens to which the animal reacts must be fed exclusively
- additional treats and human foods should not be fed unless they are known to be free of the allergen

Question 9

4 Non-allergen Diet Considerations

Answer 9

1. Reduced number of novel, highly digestible protein source (> 87%) or contain a protein hydrolysate
   - usually 1 animal protein source and 1 veg protein source
   - free AA and small peptides are poor antigens
2. Avoid protein excesses
3. Avoid additives and vasoactive amines
   - ex. histamine
4. Be nutritionally adequate for animal’s life stage & conditiion

Question 9

Homemade elimination foods: recommended ingredients

Answer 9

• 1 CHO and 1 protein source
• Feline foods: lamb baby food, lamb, rice, rabbit
• Canine foods: rice, potato, lamb, fish, rabbit, venison, and tofu
• Not relevant for equine nutrition

Question 10

What is the most common form of malnutrition in companion animals?

Answer 10

Obesity
- due to changes in lifestyle to sedentary companions

Question 11

What is obesity?

Answer 11

Overconsumption of calories
- excess body fat deposition
- increased ratio of fat to lean tissue

Animals in positive energy balance for extended period of time
- energy intake increases
- energy expenditure decreases

Question 12

Why is obesity “bad”?

Answer 12

Excessive body fat has detrimental effects on health and longevity

Question 13

How do we assess obesity in companion animals?

Answer 13

Body condition score

Other important info?
- body weight
- how much of body weight is fat mass

Question 14

Definition of overweight

Answer 14

1. Above optimal: animals 1-9% above optimal wt
2. Overweight: animals 10-19% above optimal wt
3. Obese: animals >20% above optimal wt

Question 15

What is normal or optimal wt?

Answer 15

Breed specific! Need the range of the breed to know what to aim fo
- certainly a bit of variation, so use BCS to finetune

Question 16

5 main categories of risk factors for obesity

Answer 16

1. Breed
   - high incidence in dogs
2. Gender and gonadectonomy
   - females more at risk
   - neutering of dogs and cats lowers basal metabolic rates; increased efficiency of energy utilization & increases appetite; decreased voluntary activity
3. Age
   - decrease in energy requirement
   - older dogs and horses
   - middle-aged cats have highest incidence
4. Physical activity
   - daily energy expenditure
   - playful/outdoor cat vs sedentary cat
   - working vs sedentary dog
   - exercising horse vs pasture pet
   - individual temperament
5. Type of diet fed
   - caloric comp of foods and feeding
   - highly palatable diet
   - overall, sedentary animals have higher BCS when fed free choice

Question 17

Why is less energy-dense food important?

Answer 17

For weight loss

Question 18

What will you take out/add in for less energy dense diets?

Answer 18

• less fat, more fiber
• to stimulate satiety
• if the fiber is fermentable you help even more with achieving a satiety response

Question 19

Weight loss diets for cats

Answer 19

Obese cats should be fed a commercial cat food formulated for wt loss
- contain adequate amounts of protein, fat, vitamins, and minerals
- restricting normal maintenance diets may result in nutrient deficiencies

Question 20

How do commercial foods for wt loss in cats provide fewer calories?

Answer 20

1. Decrease fat content to 8-12% DM basis
   - reduces calories, but food still palatable
2. Increase amount of complex CHOs
   - highly digestible with lower energy than fat
   - only slightly increased amounts in wt loss diets
3. Increase indigestible fiber
   - increase bulk but decrease digestibility of diet
   - increased defecation
   - may not reduce voluntary energy consumption!

Question 21

How are weight loss diets for dogs formulated?

Answer 21

1. Complex CHOs as source of energy for dogs
   - lower in energy than fat and highly digestible
   - maintenance diets: 30-50% of calories from CHOs
   - wt loss diets: 50-60% of calories from CHOs (more fiber); fewer calories but same digestibility; no increased defecation as with high fiber diets
2. Fiber diets create bulk to decrease appetite; but have adverse side effects:
   - reduce nutrient digestibility
   - poor skin and hair coat quality
   - poor diet palatability and acceptance

Question 22

How are weight loss diets for horses formulated?

Answer 22

1. Wt loss management dependent to individual horse status
   - lower the amount of ration for high-calorie diets
   - consume diet containing lower energy concentration
   - increase energy expenditure through exercise
2. Dietary changes are the easiest to implement
   - reduce level of nonfibrous CHO and fat and feed more fiber
   - feed bulkier feedstuffs, such as grass hay
   - restrict grazing of lush pastures

*as always, adjust diet to ensure adequate intake of other associated nutrients

Question 23

Health risks of obesity: diseases associated with or exacerbated by obesity

Answer 23

1. Metabolic alterations
2. Endocrinopathies
3. Functional alterations
4. Other diseases

Question 24

What is diabetes mellitus?

Answer 24

Chronic endocrine disorder caused by altered glucose metabolism, usually as result of either relative or absolute deficiency of insulin

Question 25

Diabetes mellitus: Type I

Answer 25

Abrupt onset
- Absolute lack of endogenous insulin production by the pancreas
- Result of an immune-mediated destruction of the pancreatic islet beta-cells
- Need for regular administration of exogenous insulin for survival

Question 26

Diabetes mellitus: Type II

Answer 26

Slow onset
- Impaired insulin secretion and cellular resistance to circulating insulin
- insulin resistance: elevated concentration of circulating insulin is needed to maintain blood glucose adequately
- over time resistance to insulin worsens, persistent hyperglycemia develops
- deposition of amyloid in islet cells of pancreas; precipitation product of pancreatic peptide amylin that is co-secreted with insulin

Question 27

5 clinical symptoms of diabetes mellitus

Answer 27

1. Related to short- or long-term hyperglycemia
   - results in glucose toxicity
2. Increased water consumption (polydipsia)
3. Increased urination (polyuria)
4. Occasionally: weight loss
5. If uncorrected, diabetes can lead to renal disease, neurological disorders, and development of cataracts

Question 28

Diabetes mellitus - CATS

Answer 28

• Risk factors: age, obesity, inactivity
• Neutered males at greater risk than intact females and males
• Breeds at higher risk: Siamese, Burmese cats
• MOST COMMON FORM IS TYPE ii

Question 29

Why do 70% of diabetic cats need insulin therapy for survival?

Answer 29

Amyloid deposition in islet cells
- impairment of insulin production
- insufficient insulin secretion
- need for exogenous insulin

Question 30

Dietary management of cats with diabetes mellitus

Answer 30

1. Lifelong treatment
2. Most cats need insulin injections, only few diabetic cats can be treated with diet alone
3. Weight reduction and control
4. Minimize postprandial blood glucose fluctuations
   - feeding times should be strictly regulated
5. Feed a premium cat food with a fixed formulation, with high-quality ingredients and consistent caloric distribution of CHO, fat and protein
   - complex CHO source: corn and sorghum better than rice
6. Portion-controlled meal feeding
   - multiple small meals fed each day
7. Meal should be always offered prior to administering insulin
8. Periodic monitoring of blood glucose levels can assess the cat’s response to treatment and dietary management

Question 31

Diabetes mellitus - DOGS

Answer 31

• Diabetes related to obesity; glucose intolerance, hyperinsulinemia
• Other factors: age, sex, presence of hormonal abnormalities (ex. hypothyroidism)
• Female dogs more prone to diabetes than male dogs
• Some breeds at higher risks
• MOST COMMON FORM IS TYPE I; req daily insulin

Question 32

Dietary management of dogs with diabetes mellitus

Answer 32

1. Lifelong treatment
2. Complex CHO (starch and fiber) should make up 40-50% of the calories
   - barley, sorghum and corn are good starch sources
   - avoid rice (quickly digestible = steep spike in blood glucose)
3. Food should contain a fermentable fiber blend (FOS, beet pulp) to aid with glycemic control and a moderately increased level of chromium
4. Fat should be moderately restricted
5. Feeding of high-quality dog food that has a fixed formulation
   - consistent caloric distribution of CHO, fat and protein
6. Portion-controlled meal feeding
7. Feeding times should be consistent each dday
8. If applicable, feeding times should be strictly regulated to coincide with peak insulin action
9. If applicable, meal should always be offered before insulin

Question 33

What tricks would you use to reduce the dietary glycemic index?

Answer 33

• Take out any sugar
• Change the starch profile; think amylose and amylopectin; add more amylose (slowly digestible) and less amylopectin (rapidly digestible)

Question 34

Diabetes mellitus - Horses

Answer 34

Rarely develops in horses, even though insulin resistance is quite common with obesity
- pancreatic secretion of insulin rarely fails during lifespan of horse
- possibly due to little fat consumption

Most common in older horses and ponies

Insulin resistance leads to other disorders in horses
- Laminitis
- Pituitary pars intermedia dysfxn
- Osteochondrosis

Question 35

In horses insulin resistance is common with obesity but rarely do they develop diabetes mellitus. What does insulin resistance lead to instead?

Answer 35

• Laminitis
• Pituitary pars intermedia dysfunction
• Osteochondrosis

Question 36

Dietary management - Horses

Answer 36

• Lifelong treatment required
• Provide meals at intervals that avoid large glucose response
• Avoidance of high starch diets is key to nutritional management: avoid highly digestible concentrates (corn), opt for lower quality forages (ex. 1st cutting grass hay)
• Some insulin-sensitizing drugs available

Question 37

What is hepatic lipidosis in cats?

Answer 37

Excessive accumulation of triglycerides in hepatic cells; interferes with liver fxn

Common liver disorder of cats
- very high mortality rate
- affects female cats more readily than males
- associated with obesity and diabetes mellitus

Reversible, but requires aggressive treatment

Clinical signs:
- anorexia
- depression
- jaundice
- wt loss
- muscular wasting
- occasional vomiting and diarrhea

Question 38

Dietary management of hepatic lipidosis in cats

Answer 38

1. Requires early diagnosis and immediate nutritional therapy
2. Most effective treatment includes a high-protein, energy dense formulated diet
3. Anorexia may persist for several months
   - needs tube feeding until cat voluntarily eats normal intake for 1 week
4. For long-term treatment, provide feed that prevents obesity or promotes wt loss

Question 39

What is V. laminitis in horses?

Answer 39

Systemic disease resulting from failure of attachments btw dermal and epidermal laminae jxn in foot

Question 40

What are the 4 phases of V. Laminitis in horses?

Answer 40

1. Developmental
   - period btw initial causative insult and first appearance of lameness
2. Acute
   - follows developmental phase and can manifest in no physical damage or result in rotation of distal phalanx
3. Subacute
   - follows acute phase with absence of physical damage and considered recovery period
4. Chronic
   - follows acute phase with rotation and results in horse having mechanical collapse of foot

Question 41

Dietary management of laminitis in horses

Answer 41

1. Obesity and insulin resistance results in metabolic changes that activate metallic matrix metalloproteinases
   - lead to breakdown and separation of laminae
2. Start wt loss program to minimize stress on foot
   - use of rapidly digestible starches should be avoided
   - avoid forages rich in water-soluble CHOs (glucose, fructose, sucrose)
   - feed rations with low-caloric density; must ensure ADEQUATE nutrients are supplemented
3. Above all, feed diets that do not disturb the microbial enviro in the cecum