(T3) Lecture 11b - Nutritional disorders and wellness diets Flashcards
What are 2 food sensitivities (aka adverse rxns to food)?
- Food allergy (hypersensitivity)
- adverse rxns to food that have an immunologic basis - Food intolerance
- adverse rxns to food due to nonimmunologic mechanisms
*Adverse food rxns mimic other diseases
What are the symptoms of a food sensitivity? When do clinical signs appear?
- Skin
- pruritus, self-inflicted alopecia, eosinophilic plaques, indolent ulcers on the lips in some cats - Digestive tract
- vomiting, small bowel diarrhea, large bowel diarrhea
Clinical signs appear 4-24hr after consumption of food with offending antigen
What are food allergens generally?
- Large proteins: beef, dairy products, fish and gluten intolerance
- Lactose intolerance
What is the traditional way to diagnosis/ identify allergens?
First of all: ruling out of other causes of allergic disease
- Feeding an elimination diet and demonstrating a decrease or elimination of clinical signs
- “Challenging” the animal with the original diet and observing a return of clinical signs
- Feeding select ingredients to identify the specific dietary component to which the animal is allergic
How would you formulate an elimination diet?
Take allergens out and feed a different protein or hydrolyzed protein
Diagnosis and management of dietary hypersensitivity
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
How can food allergens be identified with an elimination diet?
Food allergens can be identified by adding a small amount of a SINGLE suspected allergen to the elimination diet
- observe for return of signs
How are dietary hypersensitivities managed?
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
4 Non-allergen Diet Considerations
- 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 - Avoid protein excesses
- Avoid additives and vasoactive amines
- ex. histamine - Be nutritionally adequate for animal’s life stage & conditiion
Homemade elimination foods: recommended ingredients
- 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
What is the most common form of malnutrition in companion animals?
Obesity
- due to changes in lifestyle to sedentary companions
What is obesity?
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
Why is obesity “bad”?
Excessive body fat has detrimental effects on health and longevity
How do we assess obesity in companion animals?
Body condition score
Other important info?
- body weight
- how much of body weight is fat mass
Definition of overweight
- Above optimal: animals 1-9% above optimal wt
- Overweight: animals 10-19% above optimal wt
- Obese: animals >20% above optimal wt
What is normal or optimal wt?
Breed specific! Need the range of the breed to know what to aim fo
- certainly a bit of variation, so use BCS to finetune
5 main categories of risk factors for obesity
- Breed
- high incidence in dogs - 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 - Age
- decrease in energy requirement
- older dogs and horses
- middle-aged cats have highest incidence - Physical activity
- daily energy expenditure
- playful/outdoor cat vs sedentary cat
- working vs sedentary dog
- exercising horse vs pasture pet
- individual temperament - Type of diet fed
- caloric comp of foods and feeding
- highly palatable diet
- overall, sedentary animals have higher BCS when fed free choice
Why is less energy-dense food important?
For weight loss
What will you take out/add in for less energy dense diets?
- less fat, more fiber
- to stimulate satiety
- if the fiber is fermentable you help even more with achieving a satiety response
Weight loss diets for cats
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
How do commercial foods for wt loss in cats provide fewer calories?
- Decrease fat content to 8-12% DM basis
- reduces calories, but food still palatable - Increase amount of complex CHOs
- highly digestible with lower energy than fat
- only slightly increased amounts in wt loss diets - Increase indigestible fiber
- increase bulk but decrease digestibility of diet
- increased defecation
- may not reduce voluntary energy consumption!
How are weight loss diets for dogs formulated?
- 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 - 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
How are weight loss diets for horses formulated?
- 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 - 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
Health risks of obesity: diseases associated with or exacerbated by obesity
- Metabolic alterations
- Endocrinopathies
- Functional alterations
- Other diseases
What is diabetes mellitus?
Chronic endocrine disorder caused by altered glucose metabolism, usually as result of either relative or absolute deficiency of insulin
Diabetes mellitus: Type I
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
Diabetes mellitus: Type II
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
5 clinical symptoms of diabetes mellitus
- Related to short- or long-term hyperglycemia
- results in glucose toxicity - Increased water consumption (polydipsia)
- Increased urination (polyuria)
- Occasionally: weight loss
- If uncorrected, diabetes can lead to renal disease, neurological disorders, and development of cataracts
Diabetes mellitus - CATS
- 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
Why do 70% of diabetic cats need insulin therapy for survival?
Amyloid deposition in islet cells
- impairment of insulin production
- insufficient insulin secretion
- need for exogenous insulin
Dietary management of cats with diabetes mellitus
- Lifelong treatment
- Most cats need insulin injections, only few diabetic cats can be treated with diet alone
- Weight reduction and control
- Minimize postprandial blood glucose fluctuations
- feeding times should be strictly regulated - 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 - Portion-controlled meal feeding
- multiple small meals fed each day - Meal should be always offered prior to administering insulin
- Periodic monitoring of blood glucose levels can assess the cat’s response to treatment and dietary management
Diabetes mellitus - DOGS
- 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
Dietary management of dogs with diabetes mellitus
- Lifelong treatment
- 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) - Food should contain a fermentable fiber blend (FOS, beet pulp) to aid with glycemic control and a moderately increased level of chromium
- Fat should be moderately restricted
- Feeding of high-quality dog food that has a fixed formulation
- consistent caloric distribution of CHO, fat and protein - Portion-controlled meal feeding
- Feeding times should be consistent each dday
- If applicable, feeding times should be strictly regulated to coincide with peak insulin action
- If applicable, meal should always be offered before insulin
What tricks would you use to reduce the dietary glycemic index?
- Take out any sugar
- Change the starch profile; think amylose and amylopectin; add more amylose (slowly digestible) and less amylopectin (rapidly digestible)
Diabetes mellitus - Horses
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
In horses insulin resistance is common with obesity but rarely do they develop diabetes mellitus. What does insulin resistance lead to instead?
- Laminitis
- Pituitary pars intermedia dysfunction
- Osteochondrosis
Dietary management - Horses
- 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
What is hepatic lipidosis in cats?
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
Dietary management of hepatic lipidosis in cats
- Requires early diagnosis and immediate nutritional therapy
- Most effective treatment includes a high-protein, energy dense formulated diet
- Anorexia may persist for several months
- needs tube feeding until cat voluntarily eats normal intake for 1 week - For long-term treatment, provide feed that prevents obesity or promotes wt loss
What is V. laminitis in horses?
Systemic disease resulting from failure of attachments btw dermal and epidermal laminae jxn in foot
What are the 4 phases of V. Laminitis in horses?
- Developmental
- period btw initial causative insult and first appearance of lameness - Acute
- follows developmental phase and can manifest in no physical damage or result in rotation of distal phalanx - Subacute
- follows acute phase with absence of physical damage and considered recovery period - Chronic
- follows acute phase with rotation and results in horse having mechanical collapse of foot
Dietary management of laminitis in horses
- Obesity and insulin resistance results in metabolic changes that activate metallic matrix metalloproteinases
- lead to breakdown and separation of laminae - 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 - Above all, feed diets that do not disturb the microbial enviro in the cecum
