Veterinary Therapeutic Diets - 2024-2025 Exam Notes PDF

Theoretical-practical class Veterinary therapeutic diets 20th december and 6th january 2024 - 2025 Nuno Coelho Summary for today Introduction to the therapeutic role of the diet Veterinar...

Theoretical-practical class Veterinary therapeutic diets 20th december and 6th january 2024 - 2025 Nuno Coelho Summary for today Introduction to the therapeutic role of the diet Veterinary therapeutic diets (prescription diets) - what is this? Examples of vet therapeutic diets Working time – in groups 1) Therapeutic role of the diet 3 1) Therapeutic role of the diet Proper nutrition plays a vital role in maintaining the health and well-being of animals, and it can also be used as a therapeutic tools to manage various medical conditions animals have specific nutritional requirements requirements vary based on factors such as species, age, size, and health status 4 1) Therapeutic role of the diet are products derived from food sources that provide additional health benefits beyond their basic nutraceuticals nutritional value. They are often used to promote general health, prevent chronic diseases, and support specific body functions. Role of food, ingredients and diet in prevention, treatment and overall management of clinical conditions veterinary therapeutic diets (aka prescription diets) 5 2) Veterinary therapeutic diets Veterinary therapeutic diets Conventional Commercial diets 2) Veterinary therapeutic diets 2) Veterinary therapeutic diets Conventional Commercial diets are most commonly fed common commercial foods are made with chicken, beef, lamb, or fish products and by products, grains such as corn, wheat, rice, barley and/or oats, and added vitamins and minerals to ensure that the final diet is satisfactory and relatively balanced These foods may be formulated for specific life stages such as puppy/kitten, adult, or for “all life stages – one size fits all” Conventional Commercial diets designed to meet the general nutritional needs of pets 2) Veterinary therapeutic diets Veterinary therapeutic diets Veterinary therapeutic diets Therapeutic Diets A therapeutic diet or prescription diet is a meal plan that controls the intake of certain nutrients It is included in the correct treatment, to manage a particular medical condition; help mitigate; or prevent diseases common to animals, particularly cat and dogs prescribed by vet or under vet supervision – available through veterinarians and they should be administered under their supervision Veterinary therapeutic diets Therapeutic Diets A therapeutic diet is a meal plan that controls the intake of certain nutrients prescribed by vet/under vet supervision – available through veterinarians and they should be administered under their supervision but are not medications! not regulated as medicinal products Veterinary therapeutic diets Why is it based on vet prescription/supervision? 1) These diets are part of a medical treatment to accomplish that purpose sometimes the nutrientes are not always “complete and balanced” for that lifestage “Complete” means the product contains all the nutrients required “Balanced” means the nutrients are present in the correct ratios (AAFCO, 2023) prescription diets are not required to be complete and balanced (AAFCO and FEDIAF guidelines) not formulated for a life stage instead, it contains specific nutrients in very different ratios when compared with a regular pet food Veterinary therapeutic diets complete and balanced for the lifestage with specific nutrients in different relative quantities/different ratios (↑ or ↓) from regular pet food key nutritional factors: induce certain states may not be suitable for that can help modulating the disease/condition certain clinical conditions they are targeted for Veterinary therapeutic diets Why is it based on vet prescription? 2) Some are not to be fed on a long term only in short term to promote an healthy state, then can return to normal pet food only the vet can know Also, as some prescription diets are for a long-term, the vet should be consulted periodically so he/she can make the proper test to confirm that the prescrition (therapeutic) diet is being effective or Not seldom used as a standalone treatment for any condition Veterinary therapeutic diets Why is it based on vet prescription? e) diets vs medication some diets can not be given with some certain medication only the vet can know contain formulas that may not be appropriate for otherwise healthy animals which are why they must be prescribed by our veterinary experts Veterinary therapeutic diets Therapeutic Diets a therapeutic diet is usually a modification of a regular diet - modified or tailored to fit the nutrition needs of an animal with a specific pathology these diets are modified for: formulated to target a specific type of nutrients (quantitatively and qualitatively) metabolic process of animals and modified to effect certain changes food allergies (reduced presence of food allergens), to an animal’s immune responses, particularly the type of proteins digestions, blood pressure, renal function, blood sugar levels, or texture metabolism, etc. Veterinary therapeutic diets Therapeutic Diets in addition to manage treating clinical conditions: these prescription diets also have some other nutrients (such as added vitamins and anti-inflammatory omega-3 fatty acids) more easily digested or help in the weight management – obesity or cachexia Veterinary therapeutic diets Therapeutic Diets In Europe, these diets are regulated with different legislation they must meet specific characteristics, depending on the intended particular nutritional purpose Commission Regulation (EU) 2020/354 of 4 March 2020 establishing a list of intended uses of feed intended for particular nutritional purposes, https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32020R0354 Veterinary therapeutic diets Therapeutic Diets Used for nutrient- sensitive diseases those that respond to a dietary management Villaverde, 2022 Veterinary therapeutic diets Therapeutic Diets More expensive more costs involved with the manufacturing process Raditic, 2017 Veterinary therapeutic diets Hills Prescription Diets Purina Veterinary Diets Royal Canin Veterinary Diets Other less known as Blue buffalo (USA), Dechra, Virban, Eukanuba Working time! Group 4 – Diet for skin Group 1 – Diet for chronic diseases/food allergies kidney disease (e.g. cat) Group 5 – Diet for Group 2 – Diet for joint cardiac disease diseases (e.g. osteoarthritis) Group 3 - Gastrointestinal Group 6 – Diet (chronic enteropathies) Obesity Working time! pamphlet with the use of the therapeutic diet in the clinical condition of your group work to be done “role play” of a medical consultation, in which you have an animal with a specific clinical condition, and you explain the owners the “what”, the “when” and the “how” about the diet you are to prescribe and its benefits  Specification for the pamphlet Introduce slightly the disease Then describe the therapeutic diet you chose o Brands: check and analyze several brands – compare the similarities and the differences between brands (for instance with a comparative table) – choose one to prescribe to your animal o which brand to use? can you use different brands for the same condition? o Feeding regimen: quantities, frequency, with some special conditions o Benefits of the diet o components of the diet o impact that diet will have on the clinical condition o you have to check in the internet/pubmed if there is scientific validation for the use of that diet (the components presents in the diet) – cite that research (if exists) in the pamphlet Be rigorous with the information – there will be questions about this in the test  Specification for role play You “invent” a clinical case in which you should include the therapeutic diet studied by your group to manage the clinical condition The main focus is the therapeutic diet: benefits, components, how to give it to the animal and the “therapeutic/preventive effect” of that diet in the clinical condition of the animal 10-15 minutes (+/-): presented on the 7th of january each group should send 2 questions – KAHOOT in the end to help solidify the knowledge  Diet for skin diseases/food allergies This part is just to illustrate the concept Petersen, Blue Natural Veterinary Diet  Diet for skin diseases/food allergies Adverse Food Reactions (AFR): Includes both food allergies (immunologic response) and food intolerances (non-immunologic response) https://prime100.com.au/blogs/blog/novel-protein-diets-for-dogs  Diet for skin diseases/food allergies Adverse Food Reactions (AFR): Includes both food allergies (immunologic response) and food intolerances (non-immunologic response) AFR manifests commonly through the skin (Cutaneous Adverse Food Reactions - CAFR) and gastrointestinal system Common Food Allergens Dogs: Beef, dairy products, chicken, wheat nly proteins and carbohydrates that the pet has not been exposed to before Cats: Beef, chicken, fish Elimination Diet Trial (EDT): gold standard for diagnosing CAFR An EDT should be considered for those allergic patients with non- seasonal clinical signs, those where the clinical pattern is atypical for atopic dermatitis (AD), those with GI signs and/or those who are not responsive to typical AD treatments. How to diagnose? Restrictive Period: Pet ingests only the elimination diet for a minimum of 8 weeks Provocation Phase: Original diet is reintroduced to confirm relapse of clinical signs.  Diet for skin diseases/food allergies Selecting an Elimination Diet Factors to Consider: Pet's dietary history, life stage, comorbidities Owner's budget, dietary preferences, willingness to home cook Diet Options: Hydrolyzed Diets: Protein structure is disrupted to avoid immune response; ideal for cases of unknown dietary history; hypoallergenic diet; the most restrictive diet + these diets may be more bitter and lead to osmotic diarrhea Novel Protein Diets: Uses protein sources the pet has not been exposed to → challenging to find a suitable alternative; e.g. kangaroo, venison, alligator, black soldier fly larvae, quinoa + avoid normal commercial diets (cross contamination and mislabeling) Synthetic Amino Acid-Based Diets: Avoids large protein molecules to prevent immune response: ideal for cases of unknown dietary history and removes animal protein; not common Home-Cooked Diets: Formulated under veterinary guidance to avoid nutritional deficiencies + A balanced limited ingredient, single protein diet is designed to provide all necessary nutrients while minimizing the risk of allergic reactions + time and effort consuming – only for highly motivated tutors Blue Buffalo Company, 2023 Petersen, Blue Natural Veterinary Diet Diet for skin diseases/food allergies  Gastrointestinal Diet (chronic enteropathies) Chronic Enteropathies (CE) Chronic enteropathies are characterized by gastrointestinal clinical signs that persist for at least two weeks – ex: Inflammatory Bowel Disease (IBD), Protein-Losing Enteropathy, Colitis CE can be managed through nutritional management, gut bacterial modulation, pharmacologic therapy, and stress reduction Diagnosis involves ruling out systemic disorders and non-dietary responsive gastrointestinal diseases Almost ½ of cats with CE will respond to nutritional management alone → importance of prescription diets No specific first-line diet; choice should be guided by patient factors and clinical signs  Gastrointestinal Diet (chronic enteropathies) Chronic Enteropathies (CE) in Cats and dogs - Types of Diets for Managing CE 1) Hydrolyzed Diets: Processed to alter macronutrient structure, reducing antigenic or allergenic potential Typically made with a single protein (of small polypeptides ) and highly digestible, but low fiber content hydrolyzed soy, poultry, poultry feather and fish protein sources and various carbohydrate sources, including rice, wheat, and starch 2) Limited Ingredient Diets: Provide limited protein and carbohydrate sources (ideally provide a single carbohydrate and a single protein source); often novel ingredients (not previously exposed before), useful for suspected food allergies some owners believe “novel protein diets” are more natural than hydrolyzed A myriad of ingredients are found in commercially available diets (may contain other ingredients than those listed on the label) → challenging to identify a novel ingredient  Gastrointestinal Diet (chronic enteropathies) 3) Highly Digestible Diets: Over 90% digestibility of major macronutrients and over 80% total digestibility, being more calorically dense and variable in digestibility. help in reduction of intestinal absorptive disorders Dietary fat is highly digestible; however, fat content should not be the primary focus of dietary management of CE, particularly in cats. 4) Modified Fiber Diets: Fiber is a complex, nondigestible carbohydrate from plants that resists normal digestion but undergoes fermentation by intestinal microbiota Modified fiber content to improve clinical response through solubility and fermentability. Fiber sources are soluble and insoluble. Soluble fibers produce volatile fatty acids beneficial for enterocytes and microbiota; insoluble fibers (less fermentable) aid gut motility and content passage fiber can serve as prebiotic (i.e. a nondigestible food ingredient that selectively stimulates bacteria to improve host health) probiotics (live microorganism, as bacteria or yeast, with health benefits by improving or restoring the gut microbiota) as Fortiflora (a strain of Enterococcus faecium, a “friendly” lactic acid bacterium) can also have a role in CE of cat and dog low fibre formulations for compensation for maldigestion and in exocrine pancreatic insufficiency Blue Buffalo Company, 2023 Gastrointestinal Diet (chronic enteropathies) Rudinsky  Diet for chronic kidney disease Chronic kidney disease (CKD) in cats and dogs is a progressive condition characterized by the gradual loss of kidney function, with increased levels of renal markers (azotemia, creatinine) and characteristics symptoms (polyuria, polydipsia, anorexia, weight loss), requiring careful management to improve quality of life and slow disease progression. Nutritional management is an important aspect: Therapeutic Kidney Diets: These diets are the cornerstone of CKD management and are modified to varying levels in phosphorus, protein, potassium, and sodium. They may also include increased levels of omega-3 fatty acids, antioxidants, and water-soluble vitamins Phosphorus and Protein Restriction: Lowering phosphorus and protein intake helps reduce plasma phosphate, blood urea nitrogen, and parathyroid hormone concentrations, improving survival times diets with normal phosphorus: renal mineralization and fibrosis, and inflammatory cell infiltrates kidney diets may have chitosan – phosphorus binder Omega-3 Fatty Acids and Antioxidants: These components help manage inflammation and oxidative stress L-Carnitine and Enhanced Protein Levels: Some diets include these to help maintain body condition and muscle health  Diet for chronic kidney disease Diet Transition: Slow transition to kidney diets is crucial to improve acceptance and minimize risk of food aversion. Appetite stimulants may be used to manage unintended weight loss and increase diet acceptance – CKD diets enhance appetite (aroma) CKD therapeutic diets also help to control: acidosis secondary to CKD hypokalemia (K+ supplementation in the CKD diets) GI disturbance: therapeutic kidney diet may help lessen GI signs in some cats by managing hydration, hypokalemia, and acidosis Adapted energy content to reduce meal volume and help compensate for a decreased appetite Diet for chronic kidney disease 1/7/2025  Diet for joint diseases With aging, cats and dogs may develop osteoarthritis (OA) or other joint diseases, impacting their mobility and quality of life - OA is a prevalent form of arthritis, progressive and degenerative – around 25% of dogs are diagnosed Management of OA: optimization of body condition, exercise modification, anti-inflammatory therapy and the use of protectant agents (chondroprotector) Nutritional management weight control: obesity is a risk factor for OA. Weight reduction help reducing load in the joints and decrease inflammation but is more that weight control: therapeutic diets can help reducing inflammation, promoting cartilage health and reduce free-radicals damage Blue Buffalo Company, 2023 Diet for joint diseases Therapeutic diets for joint diseases/AO Omega-3 Fatty Acids: diets rich in long-chain omega-3 fatty acids (EPA and DHA) from fish oil can help reduce inflammation, pain and improve joint health These fatty acids decrease the production of pro-inflammatory eicosanoids and cytokines Antioxidants: Vitamins C and E, and other antioxidants, can help reduce oxidative stress in joints, potentially slowing the progression of OA Glucosamine and Chondroitin sulfate: these supplements are often included in therapeutic diets to support the structure of cartilage and repair Fiber content May have other antioxidants and anti-inflammatory components as polyphenols Diet for joint diseases Diet for joint diseases  Diet for cardiac disease Cardiac diseases are commonly found conditions in dogs (e.g. myxomatous mitral valve disease) and cats (e.g. hypertrophic cardiomyopathy) - Nutrition is an important adjunct to medical therapy in cardiac disease and even hypertension Characteristics of a therapeutic diet for cardiac diseases: should address the loss of lean body mass (“cardiac cachexia”), which is common in patients with cardiac heart failure and may be linked to inflammatory cytokines – supplementation/inclusion of fish oil, high in omega-3 fatty acids (EPA and DHA) reduces cachexia Energy requirements should be provided by the vet diets  Diet for cardiac disease Sodium restriction – moderate to severe restriction, to help manage fluid retention and reduce cardiac load → attention with high-sodium treats Potassium: several drugs (ACEi and spironolactone) may increase K concentrations, so therapeutic diets should have low K+ levels to prevent hyperkalemia Taurine and carnitine: important for maintaining heart muscle function and energy metabolism + deficiency in these nutrients can lead to cardiomyopathy dilated (cats) Protein: Ensure adequate protein intake (at least 5.1 gm/100 kcal) unless concurrent severe CKD Magnesium can be reduced with some drugs – cardiac diseases should have ↑ levels of Mg Antioxidants as coenzyme Q10 may be important in canine heart diseases + vitamin E and C may have also beneficial effects reducing oxidative stress 1/7/2025 SAMPLE FOOTER TEXT 65 Diet for cardiac disease  Therapeutic Diet for obesity Obesity in cats and dogs: over 50% of dogs and cats in the USA are overweight or obese Health Risks: Associated with osteoarthritis, diabetes mellitus, neoplasia, and other conditions. Obesity drives inflammation and has endocrine functions that are pathological. Among several tools to manage obesity, therapeutic diets are a good example Recognition and Communication (before “prescribing” the diet) 1. Accurately assess body condition with scores (body condition scores), that will also help monitor the efficacy of the obesity management (where diet is included) 2. Obtain a thorough diet history and discuss the severity of the pet's weight problem with the owner Implementing a Weight Loss Plan - when caloric excess is present using therapeutic Weight Loss (obesity) Diets: These diets have several advantages: Consistent Calorie Density and Macronutrient Profiles: Ensures consistency across batches High Protein Content: Maintains adequate dietary protein intake during caloric restriction and maintain muscle mass Nutrient Profiles: Ensure proper vitamin and mineral intake Satiety Features: Improve compliance by promoting satiety (e.g. with increased mixed dietary fiber) Additional Nutritional Factors: Some diets include ingredients like L-carnitine to help promote weight loss Clinical Trials: Research supports the benefits of these diets Therapeutic Diet for obesity Other considerations with weight loss diets: Macronutrient Profiles: High protein, low fat, and low carbohydrate content (moderate levels of calories) Mobility Features: Inclusion of omega-3 fatty acids for joint health Encourage Water Consumption: Particularly important for cats Canned diets may help with satiety; the water content improves gastric fill Treats should be about 10% of total calories: use low-calorie options like green beans for dogs and zucchini or winter squash for cats betaine may support oxidation of fat and help protect against hepatic lipidosis during weight loss Prescription weight loss diets are formulated to provide higher levels of nutrients per calorie, to prevent deficiencies in pets consuming a low number of calories, contrarily to the over-the-counter weight loss diets Therapeutic Diet for obesity Therapeutic Diet for obesity  Diet for urolithiasis Urolithiasis is a common disorder of the urinary tract in dogs and cats. The most common uroliths are calcium oxalate and struvite (magnesium ammonium phosphate). In general, struvite uroliths are associated with more alkaline urinary pH values and calcium oxalate with lower urinary pH values Urinary therapeutic diets can be a therapeutic tool: Urine Acidification: These diets often include ingredients that help maintain an acidic urine pH (calcium sulphate, phosphoric acid), which can dissolve and don’t allow the precipitation of certain crystals, as struvite Reduced Protein and Minerals: They typically have reduced levels of protein, magnesium, and phosphorus to minimize the precursors of uroliths Increased Moisture Content: Many of these diets are available in canned or wet forms to increase water intake, which helps dilute the urine and reduce the risk of uroliths formation These diets also provide balanced nutrition - overall health urinary diets are less effective in preventing calcium oxalate uroliths. Current diets focus on reducing relative supersaturation by lowering calciuresis and oxalate, increasing urinary citrate ad volume and diluting lithogenic elements. NaCL or KCl may help Diet for urolithiasis References Villaverde, C. (2022). Therapeutic pet foods: benefits and nutritional innovations. vet times cpd, consulted in https://cpd-dev.vettimes.co.uk/cpd- plus/article/250547/therapeutic-pet-foods-benefits-and-nutritional- innovations?utm_source=CPD%20listings&utm_medium=Widget&utm_campaign=CPDlaunch#ref1 Raditic, D., & Bartges, J. (2017). Nutritionist’s view: Over-the-counter versus therapeutic veterinary diets. Today’s Veterinary Practice, 79-83. Nutrition RVN (2023). Prescription diets – how they work, consulted in https://nutritionrvn.com/2021/05/02/prescription-diets-how-they-work/ Rudinsky, A. J., Rowe, J. C., & Parker, V. J. (2018). Nutritional management of chronic enteropathies in dogs and cats. Journal of the American Veterinary Medical Association, 253(5), 570-578. Rudinsky, A. J. (2020). Nutritional management of chronic enteropathies in cats. Blue Veterinary Company– Advertorial Barnette, C. (2020). Prescription Veterinary Diets: An Overview for Vet Techs. Consulted in https://blog.vettechprep.com/prescription-veterinary-diets-an- overview-for-vet-techs Thomas, S., Browne, H., Mobasheri, A., & Rayman, M. P. (2018). What is the evidence for a role for diet and nutrition in osteoarthritis?. Rheumatology, 57(suppl_4), iv61-iv74. Freeman, L. M. (2013). Nutritional Management of Cardiac Disease, World Small Animal Veterinary Association World Congress Proceedings, consulted in https://www.vin.com/apputil/content/defaultadv1.aspx?id=5709919&pid=11372&print=1 Atkins, C. (2014). Medical and Nutritional Management of Cardiac Disease, World Small Animal Veterinary Association World Congress Proceedings, consulted in https://www.vin.com/apputil/content/defaultadv1.aspx?pId=12886&catId=57108&id=7054753 Blue Veterinary Company (2024), consulted in https://www.bluevetconnect.com/see-the-science/ and https://www.bluevetconnect.com/resources/