Disease Management in Pets: Obesity, Nutrition, and Feeding

Disease Management Clinical Nutrition - Makeup of a balanced diet will vary based on animals needs - Most threatening life condition takes priority - Life stage must also be considered - Any disease affects homeostasis and ultimately the whole body - Diseases are classified according...

Disease Management Clinical Nutrition - Makeup of a balanced diet will vary based on animals needs - Most threatening life condition takes priority - Life stage must also be considered - Any disease affects homeostasis and ultimately the whole body - Diseases are classified according to body system origin - Structural - Skeletal - muscular - integument - cardiovascular - visceral - digestive - respiratory - urinary - reproductive - coordinating - nervous - endocrine Two major forms of malnutrition - Obesity - Almost always recognized - Most common nutritional disease seen in dogs and cats - Affects all organs - Is preventable - 10-19% over normal wt= overweight - Over 20% of normal weight = obese - Starvation - Much rarer - Serious Obesity - Epidemic amoungst cats and dogs - Leading preventanle - 35-40% of adult pets and 50% of pets over 7 yrs are overweight or obese - Factors - Excessive caloric intake - Decreased activity - Genetics - Neutering - Breed - Age - Type of food and feeding method - Main causes - \#1 cause -- overfeeding during growth phase - \#2 cause -- eating more then expenditure during maintenance phase - \#3 cause -- genetics - Health risks - Diabetes - Cardiovascular - Cancer - Respiratory - Skin issues - Lower urinary tract issue - Hepatic lipidosis - Difficult to manage in a hospital setting - Iv catheter placements - Cystocentesis - Intubation - Slower to recover - Delayed wound healing - Decreased life expectancy - New fat cells are laid down during growth - Excessive calories in the growth stage from extra fat cells that are present for life - Adipose tissue is more then a storage site for energy - Plays a role in homeostatic and pathologic processes - Release cytokines that affect immune functions and inflammatory processes - Predisposed breeds - Sheltie - Golden - Dachshund - Cocker - Lab - Dalmation - Rottweilers - Mixed breeds - Genetic factors - Not well understood - Rule- out - Underlying conditions that may cause obesity - Hypothyrodisim - Cushings Weight management program - Consistent and accurate weight measurement/ patient monitoring - Effective client communication - Utilization of tools to reinforce compliance - Client and patient support - Program restructure as needed - Steps - Determine pets ideal body weight - Determine \# of daily calories that will result in weight loss while providing proper nutrition to meet DER - Use basic formulas for RER - Determine DER - DER - Dogs - Obese prone 1.4 x rer - Weight loss 1.0 x rer - Cats - Obese prone 1.0 - Weight loss/0.8 - Total weight loss program - Target weight or weight loss goal - Maximum daily caloric intake - Specific food, amount of food and method of feeding Exercise - Only way to increase energy expenditures - Benefit to obese patients - Lessening the loss of lean body mass and maintaining or improving RER - May improve metabolic abnormalities - Start gradually if sedentary - 15-30 min/day for at least 5 days/week is a good start - Increase duration and intensity over time - Cats - Treat balls - Harness walks - Placing food where they must climb - Toys - Laser pointer Weight management guidelines - Emphasizing feeding consistency including the pet from its designated dish only - Be sure client is using an 8 oz measuring cup - Recommend the appropriate weight loss food and calculate the initial feeding amount - Discuss the importance of Total energy intake (do not feed anything other than the recommended food at the designated amount) - If client wants to treat the pet, make appropriate recommendations and adjust the caloric intake accordingly - Encourage clients to feed their pets separately if possible - Recommend appropriate excersise for the pet - Offer your clients suggestions on ways other than food to reward or bond with their pets - Evaluate, adjust, communicate and encourage on a consistent basis - Celebrate success - Ideal rate of weight loss - 1-2%/ week in dogs - 1-1.5% / week in cats Refeeding syndrome - Metabolic alterations that occur after nutritional support is started in a severely malnourished, underweight or starved patient - Hypokalemia - Most commonly detected electrolyte disturbance - Glucose is absorbed , insulin is secreted and potassium is taken up by cells along with glucose - Clinical signs - Glucose intolerance - Muscle weakness - Ileus - Respiratory depression - Cardiac arrhythmias - ECG changes - Hypomagnesemia - Common with prolonged starvation, diabetes mellitus or renal disease - Clinical signs - Neurological abnormalities - Cardiac arrhythmias - ECG changes - Secondary effects on homeostasis - Can be supplemented parenterally with magnesium sulfate in sever cases - Hypophosphatemia - Hemolysis, cardiac and neurological complications - Often consequence of enteral nutrition in veterinary patients and of insulin administration of diabetic patients - Uncommon in dogs and cats - Most significant disturbance in refeeding syndrome - Additional supplementation in their IVF - Possible thiamine deficiency - What happens - Food reintroduced = blood glucose rises and body releases insulin - Pumps glucose and potassium intracellularly - Occurs in disease conditions such as starvation from - Feline hepatic lipidosis - Overall malnutrition - Prolonged diuresis - Greatest risk in patients that are severly malnourished and experience significant loss of lean body mass - Cats are more susceptible then dogs - Signs - Anorexia - Weight loss - Lethargy - Weakness - Nausea and or vomiting - Diarrhea - Restlessness - Seizures - Coma - Initially during the period of starvation (24-72 hrs) - The liver uses glycogen stores for energy and skeletal muscle to provide amino acids as a source of new glucose production - After 72 hours metabolic pathways shift and take energy from ketone production as a result of free fatty acid oxidation while sparing protein utilization from skeletal muscle - Prevention - Begin feeding equal to patients estimated RER - Do not use any stress/ illness factors in your initial energy calculation - Adjust based on response is safest course of action - Begin feeding very slowly - Portion of RER increasing amounts as tolerated over 3-5 days - 25-30% of RER for the first 24 hours working up to 100% after 5 days - Body weight and BCS should be recorded at least once a day Cancer - Signs - Weight loss - Many more in humans but in animals the only criteria is cancer - Patients may lose weight due to - Location of the tumor - Complications due to cancer treatment - Cancer cachexia - Wasting syndrome - Often occurs with anorexia - Some patients exhibit progressive weight loss in spite of apparent adequate caloric intake - Physical wasting with loss of weight and muscle mass caused by disease - Patients with advanced cancer and some other major chronic progressive diseases may appear cachectic - Equal loss of muscle and fat characterized bt increased catabolism of skeletal muscle - Starvation fat is used first - Some tumors can use glucose for energy producing lactic acid as an end product - Host must expend energy to convert lactic acid to glucose - Results in a net energy gain by the tumor and net loss by the animal - Therefore avoid giving fluids that contain glucose or lactate - Some tumors don't use fat well and so the animal may benefit form a high fat diet - Nutrition - Improve quality of life - Enhance the effectiveness of treatment - Increase survival time - Nutritional factors - Soluble carbohydrates - Low as it can feed the tumor - Fiber - Maintain stool consistency - Protein - Due to cachexia, feed highly digestible and high levels - Arginine - Essential AA that may help improve immune function, promote wound healing and inhibits tumor growth - Fat and omega-3 fatty acids - Omega- 3 may have a preventative and therapeutic role in cancer therapy - Reduced tumor growth and metastasis - Show to influence - Clinical signs - Increase survival time - Provide longer remission time - Improve quality of life