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AAHA National Staff Meeting Web

Conference - The AAHA Nutritional

Assessment Guidelines - What They

Mean to You

September 2010

1

The AAHA Nutritional Assessment Guidelines – What They Mean to You

September 9 & 17, 2010By

C. A. Tony Buffington, DVM, PhD, DACVNProfessor of Veterinary Clinical Sciences

The Ohio State University Veterinary Medical Center

The AAHA Nutritional Assessment Guidelines for Dogs and Cats were sponsored by a generous educational grant from Hill’s Pet Nutrition. Educational events are presented in collaboration with Hill’s Pet Nutrition.

After participating in this web

conference, you will be able to:1. Explain the use of the Circle of

Nutrition for patient assessment

2. Perform BCS and MCS scoring

3. Conduct a basic assessment and

extended evaluation

4. Determine a nutrition action and

monitoring plan for each patient

Learning Objectives




Mean to You

September 2010

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IntroductionThe committee:

• Kimberly Baldwin, CVT, VTS, ECC

• Joe Bartges, D.V.M., Ph.D., DACVIM, DACVN

• Tony Buffington, D.V.M., Ph.D., DACVN, Chair

• Lisa M. Freeman, D.V.M., Ph.D., DACVN

• Mary Grabow, D.V.M.

• Julie Legred, CVT

• Donald Ostwald, Jr., D.V.M., DABVP (Canine & Feline)

Introduction

The charge - produce a document to:

• Increase awareness of the importance of nutritional

assessment in dogs and cats.

• Provide guidelines for nutritional evaluation of animals

to promote optimal health and response to disease.

• Present available evidence and tools to support

recommendations.




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September 2010

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Introduction

The process:

One (weekend) meeting in CO in 11/09, followed

by circulation and comment on nine (!) iterations

of the initial draft, all coordinated by an unbiased

facilitator.

Definitions & Acronyms




Mean to You

September 2010

4

The ACVN Circle of Nutrition

Reminds us to consider

• Animal factors

• Diet factors

• Feeding factors

• Environmental factors

• Interactions

™Used with permission of the American College of Veterinary Nutrition, www.acvn.org

Animal Factors

– Species

– Breed

– Lifestage (age)

– Neuter status

– Physical evaluation

http://www.acvn.org/




Mean to You

September 2010

5

Effect of Lifestage

on Energy Needs

0

0.5

1

1.5

2

2.5

3

0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180

Kcal/

day (X

M)

Time - Months

Neutering

Body Condition Score




Mean to You

September 2010

6

Muscle

Condition

Score

Diet Factors

1. What is fed

(exactly)

2. How much

(cups, cans)

3. How often




Mean to You

September 2010

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Feeding Factors

1. What is fed (exactly)

2. How much

3. How often

4. When

5. Where

6. How

Environmental Factors

What’s

going on

here?




Mean to You

September 2010

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EnvironmentHealth

Barren Chaotic

Good

Poor

Where Are We?

15

The ACVN Circle of Nutrition

Reminds us to consider

• Animal factors

• Diet factors

• Feeding factors


• Interactions™

Used with permission of the American College of Veterinary Nutrition, www.acvn.org





Mean to You

September 2010

9

Basic Assessment

Nutritional Screening Risk Factor Check ()

if presentHistory

Altered gastrointestinal function (e.g., vomiting, diarrhea, nausea,

flatulence, constipation)

Previous or ongoing medical conditions / disease

Currently receiving medications and/or dietary supplements

Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar)

Snacks, treats, table food > 10% of total calories

Inadequate information about or inappropriate feeding management

Inadequate or inappropriate housing

Physical Examination

Body condition score

5-pt scale: any score other than a 3

9-pt scale: any score less than 4 or greater than 5

Muscle condition score: Mild, moderate, or marked muscle wasting

Unintended weight loss of > 10%

Dental abnormalities or disease

Poor skin or hair coat

New medical conditions / disease

Basic AssessmentNutritional Screening Risk Factor Check ()

if presentHistory

Altered gastrointestinal function (e.g., vomiting, diarrhea, nausea,

flatulence, constipation)

Previous or ongoing medical conditions / disease

Currently receiving medications and/or dietary supplements

Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar)

Snacks, treats, table food > 10% of total calories

Inadequate information about or inappropriate feeding

management

Inadequate or inappropriate housing


Body condition score

5-pt scale: any score other than a 3

9-pt scale: any score less than 4 or greater than 5

Muscle condition score: Mild, moderate, or marked muscle wasting

Unintended weight loss of > 10%

Dental abnormalities or disease

Poor skin or hair coat

New medical conditions / disease




Mean to You

September 2010

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Index of Suspicion Low

Signalment Adult

History

Environment Enriched

Diet Satisfactory commercial

Food Intake Appropriate to conditions

Owner Commitment

Physical

Weight Appropriate

BCS Moderate (3/5)

MCS Normal

Coat Quality Good

Lab Evaluation Normal

Index of Suspicion Moderate

Signalment Gest, lact, growth, athlete, old

History

Environment ?

Diet Commercial, good home-made

Food Intake Unknown

Owner →Commitment

Physical

Weight 20% < or > Normal

BCS 2/5, 4/5

MCS Mild wasting

Coat Quality Poor

Lab Evaluation Few abnormalities




Mean to You

September 2010

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Index of Suspicion High

Signalment Orphan, hospitalized

History

Environment Unknown

Diet Unknown

Food Intake Unknown

Owner Commitment

Physical

Weight 40% < or > Normal

BCS 1/5, 5/5

MCS More than mild wasting

Coat Quality Very poor

Lab Evaluation Many abnormalities

Index of Suspicion Low Moderate High

Signalment Adult Gest, lact, growth,

athlete, old

Orphan,

Hospitalized

History

Environment Enriched ? ?

Diet Satisfactory ? Commercial

good home-made

?

Food Intake Appropriate Unknown ?

Owner Committed OK ?

Physical

Weight Appropriate 20% < or > N 40% < or > N

BCS 3/5 2/5, 4/5 1/5, 5/5

MCS N ↓ ↓↓ or

overcoat

Coat Quality Good Poor Very poor

Lab Evaluation No AN Few AN Many AN




Mean to You

September 2010

12

Extended EvaluationThe Circle of Nutrition

• Animal factors

• Diet factors

• Feeding factors


• Interactions


Extended EvaluationScreening Animal Diet Feeding Environment

History

Altered GI Function

Effect on FI?

Food intolerance

Spoiled foodOvereating, gorging

Barren or chaotic

environment

medical

conditions/disease

Correct diet for

disease?Effect on FI?

Effect on access or

compet. for food?

Meds ± diet suppl. Affecting diet

adequacy?

Effect on FI? Total

calorie intake?

Who is doing this? Are

others affected?

Unconventional diet

How is the pet

affected?

Is the diet

satisfactory?

Effect on FI?

Other

“unconventional”?

features

Snacks, treats, table

food > 10% Effect on diet

adequacy?

Other features

affected?

Inadequate or

inappropriate housing

Barren or chaotic;

competition


BCS

Many diseases

Quality, suitability for

the situation

identified

Amount, frequency

Effect on access or

compet. for food?MCS

BW > 10%

Others with similar

problems?

dental dz or disorder

Effect on appetite or

food intake?Poor skin or hair coat

New disease





Mean to You

September 2010

13

Interpretation, Analysis & Action

Another iteration

• Animal factors

• Diet factors

• Feeding factors



• Healthy

– Food intake & appetite

– BCS, MCS, BW

– GIT, CQ

– Overall wellness

• Hospitalized

– Weight

– Food intake & appetite

– Clinical progress

Monitoring







Mean to You

September 2010

14

Client

Education

Importance & Effects of the

Guidelines for Practice

• Evidence-based

• Practical (we hope)

• Actionable

• Updatable




Mean to You

September 2010

15

Summary and Perspective

QUESTIONS?




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September 2010

16

1. To complete the evaluation, please go to the following website:

2. After completing the evaluation, you will automatically be linked to the Continuing Education Certificate. The CE certificate can only be accessed after the evaluation is completed.

3. Download the CE Certificate (in pdf format) to your computer and print enough copies for those persons viewing the web conference with you.

Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible.

If you have any questions about completing the evaluation or accessing your CE certificate, please email us at [email protected] or call 800/252-2242.

http://www.keysurvey.com/survey/326688/e8be/

Questions to the Speaker

Please email your questions to [email protected] by Friday, September 24, 2010.

Dr. Buffington will provide written responses to all of the questions and they will be posted on AAHA’s website by Wednesday, October 6, 2010.


http://www.keysurvey.com/survey/326688/e8be/




Mean to You

September 2010

17

Taking Action with the AAHA Nutritional Assessment Guidelines web conference, Thursday, September 23, 2010.

Nutrifluent: Speak the Clients’ Language workshops, beginning October 2010.

Please visit www.aahanet.org/nutrition


http://www.aahanet.org/nutrition

The AAHA Nutritional Assessment Guidelines What …eoplugin.commpartners.com/AAHA/2010/100909...

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