session 3 san ecalcs & ls ls

The Iterative ProcessTwo step clinical

nutrition process

Step 1: Assess the patient, food and feeding method

Step 2: Develop feeding plan including food choice and feeding method

Animal

Food

FeedingMethod

ASSESSMENT

Food

FeedingMethod

FEEDING PLAN

Iterative ProcessFactors in Patient Assessment

Signalment: species, breed, age, gender, neuter status, activity level, environment

Medical History: medical conditions, vaccines,

surgeries, medications

Diagnostics: blood chemistry, radiographs

Physical Exam: abnormalities, BCS

Body Condition ScoringSubjective method of assessing an animal’s fat

stores

Fat cover is evaluated over the ribs, down the topline, around the tail base and along the abdomen

1 2 4 5

EMACIATED THIN

3

IDEAL OVERWEIGHT OBESE

PALPATION IS KEY!

© Hill’s Pet Nutrition, Inc.

Body Condition Scoring

© Hill’s Pet Nutrition, Inc.

Body Condition Scoring

Iterative Process: Dietary History

What Do You Need to Know About the Animal’s Dietary

History?

Brand of Food Form of Food Feeding Method & Frequency Treats?

Table food?…

Review of Nutrients Water Carbohydrates Protein Fat Minerals Vitamins Antioxidants*

EnergyProducingNutrients

Review of Basic Nutrients:Water

As fed Nutrients are

calculated as a percentage of the product including

water

Dry matter basis

Nutrients are calculated as a

percentage of the product without

the water

Vs.

Nutrients in food…

Which Has More Protein?Moist Product75% moisture10% protein 8% fat 9% CHO

Dry Product10% moisture18% protein 12% fat 32% CHO

Review of Basic Nutrients:Water

Moist Product – as fed75% moisture10% protein 8% fat 9% CHO

For Moist Products the percentage of nutrients on a Dry Matter Basis (DMB)

equals approximately 4x the percent on an as fed basis

This product contains ~40% protein DMB

Review of Basic Nutrients:Water

Dry Product – as fed 10% moisture 18% protein 12% fat 32% CHO

For Dry Products the percentage of nutrients on a Dry Matter Basis equals

approximately 10% more than the percent on an as fed

basisThis product contains ~20% protein DMB

Review of Basic Nutrients:CarbohydratesEnergy source

Conditionally essential23% for gestation and lactation in

dogsCats are different

Provides form to dry and canned foodIncreases food volumeReduces cost

Benefits of Insoluble Carbohydrates

“Normalize” bowel transit time Increase satiety Provide probiotics for intestinal

health

Review of Basic Nutrients - Carbohydrates

SolubleInsoluble “Fiber”

SugarsStarches …etc.

Beet pulpCelluloseSoybean hulls …etc.

Review of Basic Nutrients - Proteins

Tissue BuildingGrowthHormonesEnzymesBlood CellsAntibodiesEnergy source

Comprised of Amino Acids

Amino Acids of Special ConcernArginine

(Essential)Immune system stimulant; key in management of dogs with cancer

Taurine(Essential in cats)

Critical for retinal and cardiac muscle development in cats; Conditionally essential in Newfoundlands

Carnitine(Conditiona

lly essential)

Improves fat metabolism, builds lean body tissue, make mitochondria more efficient

AAFCOAssociation of Association of American Feed American Feed Control OfficialsControl Officials

Nutrient Profiles forNutrient Profiles for dogs and cats dogs and cats

minimum nutrient minimum nutrient values values

required at different required at different lifelife

stagesstages

some maximumsome maximum valuesvalues

Review of Basic Nutrients - Proteins

Adult Dog – 18%Puppy – 22%

Adult Cat – 26%Kitten – 30%

AAFCO PROTEIN minimums - DMB

Review of Basic Nutrients - Fat

Adult Dog – 5%Puppy – 8%

Adult Cat – 9%Kitten – 9%

AAFCO FAT minimums - DMB

Review of Basic Nutrients – Minerals Minerals of Special Concern in Dogs & Cats

Mineral Mineral Diseases ExacerbatedDiseases ExacerbatedSodium Heart failure

HypertensionKidney disease

Calcium Skeletal disease (pups)Bladder stones

Phosphorus Kidney failureSkeletal diseaseBladder stones

Magnesium Struvite bladder stones

What Determines How Much an Animal Eats?

Energy Needs +

• Palatability • Competition• Reward• Attention• …

Energy NeedsGrowth

Reproduction/lactation

Activity level

Breed

Temperament

Environmental conditions

Intact or neutered

Calculating Energy RequirementsRER – Resting Energy RequirementMeasure of the amount of energy needed

based on animal’s metabolic body size

Formula:

Expressed in kilocalories

RER = 30 x BW(kg) +70

STEP 1

Calculating Energy Requirements

DER = Daily Energy RequirementAn animal’s RER multiplied by a factor that

accounts for the animal’s life stage or life style

DER Factor = Numeric value that accounts for life stage, neuter status, life style, body condition, gestation or lactation

STEP 2

DER = RER x DER factor

Calculating Energy NeedsWhat You Need to Know About the

Animal Before You Calculate:

Age Neuter Status Current Weight Target Weight

(if not at ideal weight)

How Much Will We Feed Gracie Whitesox?

“Gracie Whitesox”3yrs; Female(N) Maine Coon; Wt. 11lbs; BCS 3/5

Calculating Gracie’s Energy Needs1. Calculate RER: 30 x (BW in kg) +70

Calculating Gracie’s Energy Needs1. Calculate RER: 30 x (BW in kg) +70

30 x (11 2.2) + 70

Calculating Gracie’s Energy Needs1. Calculate RER: 30 x (BW in kg) +70

30 x (11 2.2) + 70 30 x (5)+70 = 220 kcals

Calculating Gracie’s Energy Needs1. Calculate RER: 30 x (BW in kg) +70

30 x (11 2.2) + 70 30 x 5+70 = 220 kcal

2. Calculate DER: Average, neutered feline

adult =

(Use DER factors provided in notes)

Calculating Gracie’s Energy Needs1. Calculate RER: 30 x (BW in kg) +70

30 x (11 2.2) + 70 30 x 5+70 = 220 kcal

2. Calculate DER: (Use DER factors provided in notes)

Average, neutered feline adult =

1.2 x RER

Calculating Gracie’s Energy Needs1. Calculate RER: 30 x (BW in kg) +70

30 x (11 2.2) + 70 30 x 5+70 = 220 kcal

2. Calculate DER: (Use DER factors provided in notes)

Average, neutered feline adult =

1.2 x RER 1.2 x 220 = 264 kcals per

dayGracie should have 264 kcals per day

Calculating Gracie’s Energy Needs

3. Find the food’s metabolizable energy: ex: Purina® Cat Chow® Indoor Formula

= 379 kcal per cup

4. Divide Gracie’s DER by the #kcal per cup/can of food

DER = 264 379 = ~3/4 cup per day

Gracie should eat ~3/4 cup of cat food per day

Gracie’s DER is 264 kcal per day

How much food should she eat per day?

How Much Should

Breeze Eat?

11-years old M(N)Shetland Sheepdog, 21# BCS 3/5

Source: Geneva Acor

Life Stage FeedingThe practice of feeding animals foods designed to meet their optimal nutritional needs at a specific age or physiologic state

Feeding an animal above

or below their optimal nutritional level can negatively affect their health.

“Cowboy” 5 mos.

Different Life Stages = Different Nutritional Requirements

Growth, Reproduction & LactationSmall & Medium Breeds vs. Large Breeds

Adult

Senior

Small Animal Clinical NutritionNutrient Profiles Published

For

Dogs and Cats

Recommended Nutrient Ranges (OPTIMAL LEVELS)

All Life StagesOn reserve in Library

Life Stage: Adult

Recommended

3500Kcal/kg

AAFCO Minimum

Calories/Energy

Fat Calcium PhosphorusProtein

2.5% 1.6%

0.5% 0.6% 5% 18%

.4%-.9%.5%-1.0%

10-20%

15-30%

3500 - 4500Kcal/kg

Life Stage: Adult – Canine

Image Source: Dr. Geneva Acor, Hill’s Pet Nutrition, Inc.

What Defines a Large Breed Dog?

ANY DOG WHOSE

IDEAL ADULT WEIGHT IS 55# OR MORE

Life Stage: Large Breed Adult Carnitine

Increases & improves fat metabolism

Supports healthy heart

Glucosamine & Chondroitin Helps maintain healthy joints

Life Stage: Adult - Feline

Recommended

4000Kcal/kg

AAFCO Minimum

Calories/Energy

Fat Calcium PhosphorusProtein

0.5% 0.04%

9% 26%

0.5%-0.8%

0.04-0.1%10-30%30-45%

4000 - 5000Kcal/kg

Source: Hill’s Pet Nutrition, Inc.

Life Stage: Adult - FelineTaurine

Essential Amino Acid; Helps maintain normal heart function, retinal structure, and reproduction and development

MagnesiumAvoid excesses

How Much Food Does Bevo Need?

RERRER = 30 x (BWkg) +70

DER Factor Pg. 15

DER

# cups to be fed/day

“Bevo” 2yrs old;•M(N) 40# BCS 3/5

•Average activity level

•Eats Purina ONE™ Beef & Rice Formula 441 kcals/cup

616 kcals

1.6

1.6 x 616 kcals = 986 kcals

986 kcals per day441 kcals/cup = 2¼ cups

Life Stage: GrowthCarly, 5 months

Amanda Adels

“Maisey” 8 months

Stephanie Caviglia

Life Stage: Puppies & KittensAs Compared with Adult Nutritional Needs

PROTEIN

PHOSPHORUSCALCIUMFATCarbohydrates

Life Stage: Large Breed Puppy

Life Stage: Large Breed PuppyAs Compared with Small/Medium Breed Puppies

PROTEIN

PHOSPHORUSCALCIUMFATCHO

Ben, 8-year old, mixed breed

Pre-surgical radiographPre-surgical radiograph

Ben, 8-year old, mixed breed

Post-surgical radiographPost-surgical radiograph

Ben, 8-year old, mixed breed

What Purina Learned…The Purina Life Span Study

14 year study (1987 – 2001)

Purpose: “Evaluate the effects of food intake on body condition…and life span.”

www.purinavets.comUser name: purinavets

Password: nutritionSearch: Life Span Study

JAVMA, Vol. 220, No. 9, May 1, 2002

Life Span Study Parameters

48 Labrador Retrievers

Paired by sex and weight and assigned at random to control or limit-fed group

Followed for 14 years

Evaluated radiographs for osteoarthritis

Obesity & Skeletal Disease

Control Group

Limit-fed

Group

Hip joint lesions 15/22 3/21

Shoulder joint lesions 19/22 12/21

Clinical Findings

JAVMA, Vol. 220, No. 9, May 1, 2002

Clinical Findings

Feeding dogs to a leaner body condition increases their life

span and reduces incidences of osteopathies

Excess Fat/Energy Density

Beware Excessive Calcium in Large Breed Dog Diets

11 Great Dane pups (5 - 10 weeks old)

Fed free choice for 1 hour twice daily

5 fed food with 1.1% Calcium

6 fed food with 3.3% Calcium

JAAHA, 21:377 1985JAAHA, 21:377 1985Excess Calcium

1.18% Ca 3.3% Ca

Excessive Calcium

Hazewinkle, Thesis, Utrecht 1985

Life Stage: Reproduction/Lactation

Baby & PupsBaby & Pups

Life Stage: Canine Reproduction/Lactation

Canine Gestation

First 42 days: Feed as average adult

Last 21 days: Feed 3 x RER

Canine Lactation

Varies with number of puppies

Range is from 3 x RER to ≥ 6 x RER

Feed ad libitum Energy needs peak at 4th

week of lactation

Life Stage: Feline Reproduction/Lactation

Thepetcenter.com

Wikipedia.com

Life Stage: Feline Reproduction/Lactation

Feline Gestation

Consumption increases linearly during gestation

Increase to 1.6 x RER at breeding

Feline Lactation

Greatest nutritional need peaks at 6th week

2 to 6 x RER, ad libitum

FEEDING ANNIE

•“Annie” F(I); 4 yrs old Dalmatian•62# BCS 3/5•Whelped 7 pups 2 wks ago

RERRER = 30 x BWkg +70

DER Factor

DER

# cups to be fed/day

910 kcals

5.5

5.5 x 910 kcals = 5005 kcals

5005 kcals per day372 kcals/cup = 13½ c.

Which Type of Food Will You Feed Annie

While She’s Pregnant And Lactating?

REGULAR PUPPY FOODSD Puppy Lamb Meal and Rice Formula

Life Stage: Senior

“Ginger” 14 yrs, F(N) Scottish Terrier

Stephanie’s Cat 18 yrs, M(N) DSH

Crystal Branch

Stephanie Caviglia

Life Stage: Senior Dogs & CatsAs Compared with Adult Life Stage

PROTEIN

PHOSPHORUSSODIUMFATCHO

Life Stage: Senior

“Minky” 15 years

Glucosamine & Chondroitin• Helps maintain healthy joints

Controlled Sodium• Helps protect heart health

Controlled Phosphorus• Helps protect kidneys in old

age

Life Style FeedingFeeding animals foods formulated to support optimal health and meet their nutritional needs based on their life style and activity level.

Life Style Terminology Active Obesity Prone

Life Style: Active Adult

High Energy

Density

What is the most What is the most important important

nutritional factor for annutritional factor for an active lifestyle? active lifestyle?

Life Style: Active CanineAs Compared with Adult Life Stage

PROTEIN

PHOSPHORUSCALCIUMFATCHO

Flickr

Life Style: Obesity & Obese Prone

“Light” or “Lite” or “Low Calorie”

AAFCO Guidelines

Less than 3100 kcal/kg dry dog food

Less than 3250 kcal/kg dry cat food

Life Style: Obesity & Obese ProneAs Compared with Adult Life Stage

PROTEIN

PHOSPHORUSCALCIUMFATFIBER

Source: Funny-cats.com

No visible waistline

Fat pools aroundtailbase

“Missy”English Pointer

F(N); 92# BCS 5/5

Karen Pogmore

“Rocky” 7years, M(N) DSH 20# BCS 5/5(enjoys yoga )

Nicole Polizzi

Managing Obese & Obese Prone Animals

FOOD

FEEDING METHOD

EXERCISE

OWNER

Managing Obese & Obese Prone Animals

Beware of Marketing Claims

FOOD EXERCISE FEEDING METHOD OWNER

Amadeus, 26lbs

FOOD FEEDING METHOD EXERCISE OWNER

Feeding Methods

Ad libitum

Time limited

Portion limited

FOOD FEEDING METHOD EXERCISE OWNER

Exercise is Important Too!

What Are Some Ways To Get Your Cat to Exercise?

FOOD FEEDING METHOD EXERCISE OWNER

Rocky’s Energy Needs

“Rocky” 7yrs; M(N), DSH

20lbs, BCS 5/5

RULE FOR OVERWEIGHT ANIMALS

Calculate RER based on TARGET WEIGHT,

NOT Current Weight

WHERE WOULD YOU FIND ROCKY’S

TARGET WEIGHT?

Rocky’s Energy Needs

RERRER = 30 x BW(kg) +70

DER Factor

DER

# cups to be fed/day

315 kcals

0.8

0.8 x 315 kcals = 252 kcals

252 kcals per day

283 kcals/cup = ~4/5 cup

INTERIMTarget Weight: 18 lbs

Science Diet® Feline Hairball Control Light

Adult – Dry283 kcals/cup

“Rocky” 7yrs; M(N), DSH

20lbs, BCS 5/5