Session 5 therapeutic nutrition obesity diabetes

1. Therapeutic Nutrition
and
Small Animal Nutritional Diseases I

2. Therapeutic FoodsTherapeutic Foods
Formulated for nutritional
management of diagnosed disease
conditions in dogs and cats
NOT intended to cure disease
conditions but to help managing
them

3. Terminology & DefinitionsTerminology & Definitions
 Disease: any bodily abnormality or failure to
function properly, except that resulting
directly from physical injury
 Acute: having a sudden onset, sharp rise, and
short course
 Chronic: marked by long duration or
frequent recurrence

4. Terminology & DefinitionsTerminology & Definitions
Clinical: diagnosable by or based
on clinical observations.
Sub-clinical: not detectable by the
usual clinical observations.

5. Key Nutritional FactorsKey Nutritional Factors (KNF)(KNF)
Nutrients of concern and other food
characteristics that make them useful as
a nutritional aid to specific disease
management or prevention goals
KNFs are either increased or decreased in
therapeutic nutritional formulas based on
research

6. Key Nutritional FactorsKey Nutritional Factors
Adjusted to help bring about desired
outcome:
 Improve or maintain nutritional status
 Correct deficiency
 Gain or lose weight
 Rest an organ
 Avoid specific food ingredient
 Preventive for predisposition

7. Therapeutic ProductsTherapeutic Products
Prescription Diet®
(Hill’s Pet Nutrition, Inc.)
Iams Veterinary Diets®
(The Iams Company)
Purina Veterinary Diets™
(Nestlè Purina Petcare Company)
Royal Canin™ Veterinary Diets

8. Therapeutic NutritionTherapeutic Nutrition
1. Disease
2. Goals
3. KNF key nutritional factors
4. Products

9. Disease ConditionsDisease Conditions
Therapeutic Nutrition I
Obesity
Diabetes
Mellitus/hyperthyroidism
Periodontal Disease
Therapeutic Nutrition II
Acute Care/Recovery
Food Allergies
Canine Osteoarthritis
Therapeutic Nutrition III
GI Disease
Lower Urinary Tract Disease
Liver Disease
Therapeutic Nutrition IV
Renal Disease
Cancer/Neoplasia
Cognitive Dysfunction Syndrome

10. ObesityObesity ( number 1 nutritional disease)( number 1 nutritional disease)
Clinical Definition:
20% or more over ideal body
weight
“Rocky” 7 years, M(N) DSH 20# BCS 5/5
(enjoys yoga )

11. Obesity FactsObesity Facts
54% of cats are overweight
56% of dogs are overweight
Most owners do not understand how to
feed their pets to prevent obesity
Owners need to understand how to use
body condition scoring

12. Body Condition scoring for dogsBody Condition scoring for dogs

13. Body Condition Scoring for CatsBody Condition Scoring for Cats

14. What diseaese processes are associatedWhat diseaese processes are associated
with obesity in animals?with obesity in animals?
osteoarthritis
diabetes mellitus
dermatitis
cardiorespiratory disease
urinary and reproductive disorders,
neoplasia (mammary tumors, transitional cell carcinoma),
dermatological diseases,
anesthetic complications
The main therapeutic options for obesity in companion animals
include dietary management and increasing physical activity. There
are no easy answers.

15. Weight management for every petWeight management for every pet
Get a full history of every patients diet
Always use open ended questions ( not
yes or no questions) to get the full story
Make sure you find out if pet is getting
supplements, treats, chews, medications
etc that can add calories to the diet
In general you need to reduce current
calorie intake by 10-12 % to reduce
weight

16. Some general guidelinesSome general guidelines
Dry dog food can contain 217 to 440
calories per cup with 300 calories being
the average
Canned dog foods 189-398 calories per
can with 310 being the average
Dry cat food averages 237-480 calories
per cup with 342 being average
Canned cat food averages 78-172
calories per can with 146 being the
average

17. Weight management includesWeight management includes
Recheck weight every 1-2 weeks and
eventually once a month
Most pets only lose about 1% a week
Follow up with the client, keep in touch,
encourage them

18. Nutritional management of diseaseNutritional management of disease
process rulesprocess rules
Don’t start the new diet in the hospital
Ex: kidney disease, diabetes, surgery,
trauma
Get these patients home and happy
before starting the new diet
Treat the patient as a whole
A sick patient may refuse a new diet

19. Should I recommend the expensiveShould I recommend the expensive
therapeutic diet only available fromtherapeutic diet only available from
the hospital?the hospital?
Only with severe obesity, marked
caloric restriction like an orthopedic
patient or the patient has a very low
energy requirement
Use over the counter when possible to
reduce client cost and increase
compliance. Make sure you calculate the
amount to be fed

20. Obesity GoalsObesity Goals
Reduce weight
(slowly, be
careful of
hepatic lipidosis
in cats)
Increase satiety
(feels full)
Increase lean
body tissue Jesse James 40lbs

21. Obesity KNFsObesity KNFs
Increased fiber
Decreased
energy
density/fat
Added
carnitine
Jesse James 40lbs

22. Diabetes dogs vs catsDiabetes dogs vs cats
Dogs get type 1 and cats get type 2
Dogs tend to be thin and cats overweight
Dogs are omnivores and cats are
carnivores
Nutritional management is not the same
in the dog as the cat

23. Diabetes Mellitus in the DogDiabetes Mellitus in the Dog
Type 1- insulin deficient
You need to keep glucose levels stable
REQUIRES insulin, regardless of diet
A link has not been established between
obesity in dogs and diabetes mellitus
Some dogs may have insulin resistance
because of obesity or other endocrine
diseases

24. What nutrients should we monitorWhat nutrients should we monitor
in dogs with Diabetes Mellitus?in dogs with Diabetes Mellitus?
Fiber
Fat
Protein
carbohydrates

25. FiberFiber
Slows glucose absorption, effects vary,
commonly recommend in diet. Different
types, like soluble or insoluble can have
different effects
Soluble: oatbran, barley, nuts, seeds,
beans, lentils, fruits like citrus and apples,
strawberries and many veggie
Insoluble: whole wheat and whole grain,
veggies and wheat bran

26. More Fiber FactsMore Fiber Facts
Higher fiber diets are often lower in fat
Higher fibers diets are often lower in
calories
Low energy dogs do well with lower
calories
Underweight dogs will not do well with
lower calorie diets

27. FatFat
Low fat diets are often recommended
Naturally lower in calories
Can help prevent other common diseases
associated with diabetes like
hyperlipidemia and chronic pancreatitis

28. ProteinProtein
Diabetic dogs do not require more
protein in the diet vs non diabetics
No contraindications to higher protein
diet if no other disease process prohibits
it
If obese patient, higher protein is
recommended for weight loss to
compensate for the restricted calories

29. CarbohydratesCarbohydrates
Be consistant !!!! Most important factor
Avoid simple sugars, low carb diet will
not eliminate the need for insulin
Low carb diets in dogs have not been
shown to benefit the patient or eliminate
the need for insulin

30. Diabetic Dog diet optionsDiabetic Dog diet options
Veterinary diets: high fiber, low to
moderate calories
Any commercial diet that the dog will eat
on a consistent basis so glucose levels
can be controlled with insulin
Feed every 12 hours, same size meals,
immediately before administering insulin
Can use non starchy veggies or lean
meats for treats

31. Obese DiabeticObese Diabetic
Weight loss will cause the patient to be
more sensitive to insulin so watch
glucose levels
Use a weight loss diet
ADJUST INSULIN AS WEIGHT LOSS
PROGRESSES

32. Diabetes Mellitus in CatsDiabetes Mellitus in Cats
Insulin resistant type 2 diabetes
Most of these cats were or are obese
Up to 70% of these cats can go into
diabetic remission
Weight loss increases insulin sensitivity
IMPORTANT: try to get cat back to ideal
weight and in remission.

33. Nutrients of InterestNutrients of Interest
Carbohydrates
Fiber
protein

34. CarbohydratesCarbohydrates
High fat diets cause more weight gain
than high carb diets
Calories in the diet is the most important
factor
Dry diets commonly lead to overfeeding
and obesity because the owners just
“keep the bowl full”

35. Did you know?Did you know?
Higher carbohydrate diets ( greater than
20% of the ME) and dry diets are not
associated with the development of
Diabetes Mellitus
Indoor, inactive and obese cats get
Diabetes Mellitus

36. Managing Carbohydrates in theManaging Carbohydrates in the
Diabetic CatDiabetic Cat
Low carb diets decrease the amount of
insulin required and improves glycemic
control
Low carb diets are recommended but
not the only option for these patients

37. FiberFiber
May improve glycemic control and
promote diabetic remission
May be helpful for weight loss
41% of cats in one study on a high fiber
diet no longer required insulin

38. ProteinProtein
Cats are obligate carnivores and require
more protein than other species
Many lower carb diets are also higher in
protein
Weight loss diets are higher in protein
Do not use higher protein diets in renal
disease or hepatic encephalopathy

39. Should you recommend canned orShould you recommend canned or
dry?dry?
Dry
-Usually higher carbs than canned, low
carbohydrate diets are often very high in
calories Ex. Purina DM 590 kcal /cup
Canned
- Can be lower in carbs and is harder to
overfeed since owners do not leave it out
all day. Controlled portions.

40. Don’t make these mistakesDon’t make these mistakes
Recommend a kitten diet: high calories
and will not lead to weight loss
Recommend any canned food will do:
many won’t lead to weight loss, some
cats won’t eat canned, caloric content
varies widely

41. Diabetic Cat diet optionsDiabetic Cat diet options
Moderate carbs and higher fiber ex Hills
prescription w/d canned or dry
Low carb diets with less than 20% of ME
from carbohydrates ex Purina DM canned
or dry

42. Diabetic Cat FactsDiabetic Cat Facts
Low carb diets may be beneficial but are
not good for the obese cat
High fiber may help
Weight loss WILL help, all obese
diabetics should be on a weight loss plan
Remission is possible with insulin, weight
loss and possibly diet

43. HyperthyroidismHyperthyroidism
Cats with hyperthyroidism produce too
much thyroxin
Hill’s y/d can reduce T4 levels but are
low in iodine
y/d should not be eaten by other cats in
the household, long term effects are not
known and cannot be eaten by cats iwht
moderate or severe chronic kidney
disease

44. Image Source: Dr. Geneva Acor, DVM
Periodontal DiseasePeriodontal Disease

45. What is Periodontal Disease?What is Periodontal Disease?
““any pathologic process thatany pathologic process that
affects the periodontium, i.e.affects the periodontium, i.e.
structures that surround andstructures that surround and
support the tooth gingivae,support the tooth gingivae,
cementum, periodontal ligament,cementum, periodontal ligament,
alveolar bonealveolar bone””

46. What’s Wrong With This Picture?What’s Wrong With This Picture?

47. Periodontal DiseasePeriodontal Disease
PlaquePlaque
 Clear, sticky deposit on tooth surface,Clear, sticky deposit on tooth surface,
composed of bacteria and salivarycomposed of bacteria and salivary
glycoproteins.glycoproteins.
GingivitisGingivitis
 Inflammation of the gingiva (gum tissue)

48. Periodontal DiseasePeriodontal Disease
Stain
 discoloration of the tooth or of toothdiscoloration of the tooth or of tooth
accumulated materialsaccumulated materials
Tartar (Calculus)Tartar (Calculus)
 mineralized plaque that forms a hard
shell on tooth surfaces

49. Development of Periodontal DiseaseDevelopment of Periodontal Disease
Tartar is visible to pet owners, but…
Bacterial plaque is the most
important substrate in the
development of periodontal
disease.
It is a major precursor!
*Nutrients, In: Hand, Thatcher, Remillard, Roudebush, ed. Small Animal Clinical Nutrition, 4th Ed. Mark Morris Institute, 2000;483.
www.technicianadvances.com

50. HOW DO YOU PREVENTHOW DO YOU PREVENT
PERIODONTAL DISEASE INPERIODONTAL DISEASE IN
YOUR PETS?YOUR PETS?

51. Periodontal Disease GoalsPeriodontal Disease Goals
o Reduce precursors to plaque
buildup
o Provide regular (daily) removal of
plaque
o Dental Prophylaxis when needed

52. Periodontal Disease KNFPeriodontal Disease KNF
Daily tooth brushing is the most
effective method of home dental
care
Mechanical removal of plaque
and tartar via food like D/D. The
food is designed to abrade plaque
off the teeth

53. Dental Care ProductsDental Care Products
3 Categories of Dental Care Products
Method Properties
Examples of
Products
Mechanical
fiber enhanced
foods/treats;
special texture
Prescription Diet t/d;
Purina DH Dental
Health; Greenies;
Nylabone
Antibacterial
use Chlorhexidine as
bacteriostatic or
bacteriocidal agent
CET Chews &
Toothpaste;
Nolvosan
Chelating
Use Hexametaphosphate
to bind calcium in saliva
to prevent tartar
Iam’s Daily Dental
Care

54. Next Week…Next Week…
Therapeutic Nutrition II:
Acute Care/Recovery
Food Allergies
Canine Osteoarthritis