Nutritional Support of Dermatological Patients (University of Surrey PDF)

Nutritional support of Dermatological patients Dr Jon Lewis PhD MSc BSc VBM COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE LEARNING OBJECTIVES Explain the role...

Nutritional support of Dermatological patients Dr Jon Lewis PhD MSc BSc VBM COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE LEARNING OBJECTIVES Explain the role of nutrition in dermatological disease with specific reference to atopic dermatitis and food allergic dermatitis Describe the approach to dietary modification in relation to dermatological disease including the integration of a diet trial as part of a therapeutic regime Discuss the different options for dietary modification in dogs and cat COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE QUESTION TIME! What are the main functions of the skin? COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE 3  FUNCTIONS OF THE SKIN Secretion and Barrier: excretion: Internal and Indicator: external Health status Natural skin ‘oils’, waste products Temperature Storage: Regulation: Fats, proteins, Insulation, blood flow electrolytes etc. Sensation: Heat, cold, pain, Production: pressure, itch Immuno- Vitamin D regulation COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE STRUCTURE OF THE SKIN Epidermis Composed of 5 layers of cells Thickest on the footpads Contains keratin and melanin Dermis Accounts for skin elasticity Composed of connective tissue fibres and cells Significant amount of blood and lymphatic vessels and nerves Hypodermis Storage of fat and blood vessels Contains nerve endings Attaches to tissues and underlying organs COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE FOCUS ON THE SKIN BARRIER Skin Barrier is made up of corneocytes and a lamellar lipid layer “Bricks and mortar” What happens if your mortar isn’t very strong? Let’s find out! COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE  SKIN AND COAT FACTS Skin accounts for: 24% body weight of new-born puppy and 12% body weight of an adult dog Multiples rapidly and requires many nutrients in times of intense cell renewal A 22–30-day complete cycle Hair: ~ 90% protein High amounts of specific amino acids (methionine, cysteine) Skin & coat 30-35% daily protein requirements1 COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE 1Mundt et al (1987) NUTRITIONAL CONSIDERATIONS High content of a good quality, highly digestible protein Inclusion of other nutrients to support skin and coat health: Omega-3 and Omega-6 fatty acids Alpha Linolenic Acid (Ω3) Linoleic Acid (Ω6) Specific amino acids (methionine, cysteine) Vitamins and minerals Feed the diet ideally for two skin cycles COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE CANINE SKIN CARE COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE WHAT COULD BE CAUSING BENJI’S PRURITIS? External parasites and infectious causes (fleas, demodex, etc.) Environmental atopic dermatitis Nutrient intolerance, food allergy or adverse food reaction (AFR) Endocrine or auto-immune diseases COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE ATOPIC DERMATITIS (ATOPY) Atopy An inflammatory and pruritic skin condition Genetically predisposed to certain inhaled or cutaneously absorbed environmental allergens Grass, pollen, dust, feathers, mould etc Primary target organ is the SKIN Rhinitis and asthma may also occur Alteration of the skin barrier function commonly seen Long-term support Medications Nutritional recommendation COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE  ADVERSE FOOD REACTION Adverse food reactions (AFR) include poisoning, nutrient intolerance or severe allergic reaction. Can lead to cutaneous signs: pruritic dermatitis (skin “irritation” with scratching associated), in dogs and cats and/or gastrointestinal signs: mostly diarrhoea and vomiting. The prevalence of cutaneous AFR in dogs reaches nearly 20% in cases of pruritic disease or allergic skin issues.1 COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE 1Olivry and Mueller (2017)  ALLERGENS Allergies develop due to prior exposure of an allergen Produce antibodies Allergens that cause a reaction are usually proteins of a specific size More commonly 15-40 kDa1 Too large and the protein won't cross the gut barrier and be digested at all Too small and the protein won’t be recognised and sufficient to trigger a reaction COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE 1 Lesponne et al (2018)  TOP ALLERGENIC PROTEIN SOURCES COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE Mueller, Olivry & Prelaud (2016)  HOW DO YOU IDENTIFY A NUTRIENT INTOLERANCE? Tests such as serology (IgG and IgE), intra-dermal, saliva or hair tests are considered unreliable for the diagnosis of a food allergy, in cats and dogs, to date.1,2 Did you know that elimination trial is the ONLY RELIABLE METHOD to help identify a nutrient intolerance in cats and dogs?1 Feed an appropriate exclusion diet for 6-8 weeks Two types of exclusion diets available Novel protein Feeding a protein source the pet has not been exposed to Challenging to find a suitable protein source Hydrolysed diets 1Mueller and Olivry (2017) COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE 2Coyner et al (2019)  HYDROLYSED DIETS VS NOVEL PROTEIN DIET Novel protein Hydrolysed diet Advantages Advantages The diets are cheaper Shorter trial less likely for compliance to drop. Less processing involved Easier to run the trial Reduced likelihood for and adverse food Disadvantages reaction to the diet Need to acquire a detailed history Difficult to find a suitable diet Longer trials so client compliance will diminish over Disadvantages time Potential of AFR developing to this protein source More expensive overtime Very few wet options Palatability COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE WHAT ARE HYDROLYSED PROTEINS? Let’s do an activity to help explain this! COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE WHAT ARE HYDROLYSED PROTEINS? Protein Partially hydrolysed protein Extensively hydrolysed protein COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE ELIMINATION DIET TRIAL PROTOCOL Start 8 week End challenge 4 week Challenge (max 2 8-week elimination diet Min 2 weeks (re-stabilisation) weeks) Monitor for improvements in Monitor for Monitor for improvements in clinical signs, SCOREFAD and take deterioration in clinical clinical signs, SCOREFAD photos signs, SCOREFAD COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE QUESTION TIME! In order to run an elimination diet trial you need to exclude all other sources of protein in the pet’s diet. What needs to go into the “lockbox”? COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE 20 THE LOCKBOX! Prescription medications (heartworm, fleas, NSAIDs, antibiotics and all capsules) Supplements (vitamins, nutraceuticals, fish oil, flavoured probiotics)​ Dental products and toothpaste​ Treats​ Human foods​ The world outside COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE PRACTICAL ADVICE Wash all items used in feeding the patient (bowls, scales etc) with soap and thoroughly rinse after every meal Have separate feeding equipment reserved for the cat/dog undergoing the elimination diet trial Feed the pet separately to eliminate the risk of access to other food COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE RESULTS OF A HYDROLYSED DIET Meet Henri! Before After 30 days COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE SUMMARY Specific nutrients in the Diet can really help the skin and coat recover, These include; A good quality protein, zinc, Omega 3 and omega 6. The most common form of dermatological issue is parasite For an animal to develop an AFR they must have had prior exposure to the diet. Thank you any Protein is the main nutrient that causes AFR with the most common being beef in both dogs and cats questions The two food elimination trial methods for determining an adverse food reaction are Novel protein Hydrolysed diet Food elimination trial is best ran over an 8 week period (2 skin cycles) The best protocol for determine and adverse food reaction is an 8 week diet elimination trial with a hydrolysed diet. COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE REFERENCES Connolly, E.D., Wu, G. (2024). Functions and Metabolism of Amino Acids in the Hair and Skin of Dogs and Cats. In: Wu, G. (eds) Nutrition and Metabolism of Dogs and Cats. Advances in Experimental Medicine and Biology, vol 1446. Springer, Cham. https://doi.org/10.1007/978-3-031-54192-6_6 Kirby, N. A., Hester, S. L., Bauer, J. E. (2007). Dietary fats and the skin and coat of dogs. Journal of the American Veterinary Medical Association, 230(11), 1641-1644. Olivry T, Mueller RS. Critically appraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats. BMC Vet Res. 2017 Feb 15;13(1):51. Watson, A. L., Fray, T. R., Bailey, J., Baker, C. B., Beyer, S. A., & Markwell, P. J. (2006). Dietary constituents are able to play a beneficial role in canine epidermal barrier function. Experimental dermatology, 15(1), 74-81. Kirby, N. A., Hester, S. L., Bauer, J. E. (2007). Dietary fats and the skin and coat of dogs. Journal of the American Veterinary Medical Association, 230(11), 1641-1644 Mueller RS, Olivry T, Prélaud P. Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats. BMC Vet Res. 2016 Jan 12;12:9. Lesponne, I., Naar, J., Planchon, S., Serchi, T., Montano, M. (2018). DNA and protein analyses to confirm the absence of cross-contamination and support the clinical reliability of extensively hydrolysed diets for adverse food ration- pets. Veterinary Sciences, 5(63) COPYRIGHT MARS, INC. CONFIDENTIAL – INTERNAL USE ONLY. EUKANUBA IS A TRADEMARK OF MARS, INC. EXCEPT IN EUROPE