ABSTRACT: The World Small Animal Veterinary Association (WSAVA) is starting a project to standardise the nutritional assessment of small animals as the fifth (V) vital sign, following temperature, pulse, respiration and pain assessment. Guidelines have been developed by a panel which includes several American diplomats in nutrition, and these guidelines have been recommended by the American Animal Hospital Association.

Good nutrition improves animal health, may prevent nutritional diseases – including obesity and those disorders related to obesity – may treat or provide adjunctive support in disease treatment, improves performance and improves longevity. It also requires little additional time and little to no cost.

Feeding pets is an important part of the companion animal:owner bond, and many clients will ask their veterinary surgeons about nutrition. In the USA, it has been stated that 90 per cent of owners want a nutritional recommendation from their vet and only 15 per cent perceive they have been given one! Furthermore, only seven per cent of pets that could benefit from a therapeutic food are receiving it.

What makes up a nutritional assessment?

included in routine history taking and the physical examination. A dietary history should include the amount, type, storage of food, frequency of feeding, amount of treats, snacks and table food.

Further questions should be asked to determine life factors, such as exercise, number of household pets, gestation or lactation and growth (less than one year old) or geriatric status (probably greater than seven years of age, depending upon the individual) (Figure 1).

Figure 1: Geriatric patients, such as this thin 15-year-old Burmese cat, need an extended nutritional assessment and special dietary considerations

A body condition score should also be performed on every pet at every visit, using either a 5- or 9- point scale (Figures 2 & 3). Muscle mass scoring systems are currently being developed because some clinical conditions result in more loss of muscle mass relative to the changes in body fat.

Figure 2: The Pet Food Manufacturer's 5-Point Body Condition Score Model for Dogs

Figure 3: The Pet Food Manufacturer's 5-Point Body Condition Score Model for Cats

Special considerations

If an animal is considered to be at risk for a nutrition-related problem – or a disorder for which nutrition may form part of the therapy – a more extended evaluation is recommended. Factors which may prompt an extended evaluation include gastrointestinal or other medical disorders, the use of medications or dietary supplements, unconventional diet, snacks, treats or table food making up greater than 10 per cent of the diet, a fat or thin body condition score, unintended weight loss, dental or dermatological problems.

Further evaluation of the diet includes reviewing the caloric density – especially if the animal is too fat or thin – and the completeness and quality of the diet (Figures 4 & 5). Note that caloric density is not usually printed on packaging and it will likely be necessary to check with the manufacturers or read their printed product support information.

Figure 4: Overweight body condition or obesity, as in this case, merits an extended nutritional assessment and dietary plan

Figure 5: This setter's loss of body fat (poor body condition score) and muscle mass is extreme and an extended nutritional evaluation and dietary plan are recommended

Note too that some diets are higher in caloric density than maintenance diets – for example, diets for kidney disease and performance diets. Some diets, such as low fat or high fibre diets, are likely to be lower in calories than maintenance diets. And don’t forget to evaluate the use of treats, including dental chews, as some of these can be quite high in calories.

Home-made diets with care

If a home-made diet is being fed, it should be thoroughly evaluated as even many published recipes are not complete and balanced. Problems with home-made diets may include deficiencies – in calcium, other vitamins and micro¬minerals, essential fatty acids, and excesses in protein, and in the phosphorus:calcium ratio.

Raw food diets pose a risk for the same reasons – with similar deficiencies, excesses, imbalance and incompleteness to other home-made diets; but with the additional risks of contamination with Salmonella spp. and other food poisoning organisms and Toxoplasmosis. Ingestion of bones can lead to obstruction of the oesophagus or gastrointestinal tract.

Tell-tale signs and stressful situations

Any changes in food intake and eating behaviour should be explored, and information about feeding and exercise practices should be discussed. Feeding management includes who feeds the pet, where it is fed, and if there are any problems with the other pets in the household.

Exercise and the presence of any environmental stresses (for instance, a stray cat looking in the window!) should be discussed. An extended evaluation may involve diagnostic tests – including haematology, serum chemistry, urinalysis, and imaging – as appropriate for the pet’s problems.

If a pet is hospitalised for illness or injury, the determination of food intake and type of food can be critical, as changes may be necessary on account of the animal’s disorder. Abrupt changes from the diet fed at home to a standard hospital diet may also cause gastrointestinal upset or a decreased intake of food.

The amount of food eaten should be determined carefully to assess that the animal is ingesting its resting energy requirement, and supplementation provided as needed if it is not.

Make a plan

Finally, a plan should be made with the owner regarding the type and daily intake of diet, and any changes in lifestyle management, such as more exercise or feeding animals separately. Care should be used to enlist the owner’s co-operation in the changes in diet and lifestyle, and the changes should be monitored by follow-up visits and telephone calls.

Author

Marge Chandler

DVM
MS MACVS DACVN DACVIM DECVIM-CA MRCVS

Marge Chandler qualified from Colorado State University in the USA and also completed a Master of Science in Animal Nutrition. After six years in private practice, she returned to university for a dual residency programme at Colorado State University and Massey University in New Zealand. She is presently a senior lecturer in small animal internal medicine and clinical nutrition at the Royal 'Dick' School of Veterinary Studies, Edinburgh.
 

Veterinary Nursing Journal • VOL 25 • No12 • December 2010 •