VNA Level I Module 5: Nutritional Assessmentvna.hillsvet.com/pdf/en-us/Module_5.pdf · VNA Level 1...

Learning ObjectivesAfter completing this module, your basic understanding should include: •Anappreciationfortheimportanceofpropernutritionalassessment. •Yourability,alongwithyourteamtoconductathoroughnutritional assessment. •Realizinghowcriticalregularnutritionalassessmentsare,evenforsocalledhealthypets.

VNA Level I Module 5: Nutritional Assessment

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VNA Level 1 Module 5: Nutritional Assessment

IntroductionThegeneralpublicisbecomingincreasinglyawareofthegrowingassociationoffoodwithconditionssuchasheartdisease,highbloodpressure,obesity,diabetes,andcancer.Moreandmorepetownersarerealizingthatproperpetnutritionisextremelyimportantinmaximizinghealth,performance,longevity,anddiseaseprevention.Theyalsowantrecommendationsaboutwhatisbesttofeedtheirpetandwillappreciateyournutritionalassessment.

Hill’saspartofthePracticeHealthSMinitiative,surveyedover900“ideal”clientstodeterminetheirwants,needs,andexpectations.Thisstudyrevealedsomeveryinterestinginsightsabouthowtheseidealclientsviewnutritionfortheirpets.Oftheclientssurveyed,94%feltthatnutritionalcounselingfromtheirveterinarianisimportant;53%ofthisgroupsaidnutritionalcounselingwascriticallyimportant(Figure1).Sixtypercentoftheclientssurveyedalsobelievedtheirveterinarian’srecommendationofapetfoodwasimportant(Figure2).Withoutquestion,veterinariansandtheirhealthcareteamscanstronglyinfluencenutritionchoices.Andtheyshould,withconviction!

You need to (confidently and compe-tently) be an advocate for the pet’s best interest!


Client Insights: How Important Is Nutrition Counseling?

42%18%

31%6%

3%

How Important Is a Veterinarian’s Recommendation on the Choice of Pet Food?

Figure1 Figure2

SoMewhAt

CrItICALLy

IMportANt

Not At ALL

Not Very 53%

15%

27%4%

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the Two-Step Nutritional Assessment ProcessFigure3depictsthetwo-stepprocessofnutritionalassessment.Thetopcircledepictsthefirststep;itinvolvesassessmentofthepatient,thefood,andthefeedingmethod.Thebottomcircledepictsthesecondstep;itinvolvesdevelopmentofafeedingplanandincludesrecommendationsforfoodandfeedingmethods.

Periodically(thelengthofwhichdependsontheconditionofthepatient),thetwo-stepprocessisrepeatedtodeterminetheappropriatenessoreffectivenessofthenewfeedingplan.Thus,thepatientisreassessedand,ifitsstatushaschanged,anewfeedingplanisimplemented.Thetwo-stepprocesscanberepeatedanynumberoftimes,dependingontheneedsofeachpatient.Acriticallyillpatientmayneedtobereassessedeveryfewhours,whereasanormaladultdogorcatmaybereassessedonly2-4timesayear.


Figure 3. Cats are becoming a more important part of the family.

The arrows in Figure 3 indicate that nutritional assessment should continue for the life of the pet.

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Whenyouconsiderallthediseasesforwhichpropernutritionhelpsprevent,aidsinrecoveryorlong-termmanagementandallthenutritionalriskfactorsthatpetsencounter,it’sobviousthatallpetsneednutritionalassessmenteachtimetheyareseenatyourpractice.Forexample,acertainpercentageofpetsyouseeareatvaryingdegreesofriskforoneormoreoftheseconditions:Anemia,traumaorsurgery,cancer,lowerurinarytractdisease,kidneyfailure,heartdiseaseandfailure(includingheartwormdisease),poororalhealth,dermatologicalproblems,obesitypreventionandtreatment,skeletaldiseaseespeciallyinpuppies,andgastrointestinaldisease.Combined,theseconditionsandtheirpreventionmakeupmuchofsmallanimalpractice.Itisimportantnottooverlookso-called“well”petsthough.Justbecausetheyappear“healthy”doesn’tmeantheywouldn’tbenefitbeingonabetterplaneofnutrition.Remember,asveterinaryhealthcareteammembers,we’reworriedabouttheinsideofthepet,notjustoutwardappearances.

Remember, nutritional deficiencies and excesses usually take a period of time to manifest themselves.


the Two-Step Nutritional Assessment Process

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Figure 4. An obese dog and cat, each with a Body Condition Score of 5/5.


Inwellpets,thenutritionalassessmentprocessidentifiespetsatriskforconditionssuchasobesity,renaldiseaseandsomeformsoforaldisease,whichmaybeavoidedorminimizedwithpropernutrition.Puppies,forexample,shouldbeevaluatedforappropriatenutritioneverytwotothreeweeks.Theamountoffoodandthefeedingmethodandhowlongthefoodisleftwiththepuppyandmayneedtobechangedbasedonbodyconditionscore(seebelow).Asapetages,riskfactorsincrease.Ovariohysterectomy/castration(spaying/neutering),increasingage,decreasingactivitylevel,etc.areriskfactorsforobesity.Assessingthepet,assessingthefood,implementingaplaninwhichthenutrientsandenergyinthefoodarematchedtothepatient,andmonitoring(follow-up)canhelpavoidobesity,andperhapsotherconditions.ThecycledescribedinFigure3shouldbecompletedeachtimeawellpatientisseen.Nutritionalassessmentofpetswithmedicalconditionshelpsuncovermodificationsthatneedtobemade,theeffectsofmedicationsonnutrients,andviceversa.AsyousawinI.2FeedingDogsandI.3FeedingCats,itisimportanttotakesuchassessmentsseriously.

the Two-Step Nutritional Assessment Process

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Assess The PetThegoalofpatientnutritionalassessmentistoestablishthepet’snutrientneedsandfeedingprotocolinwellnessordisease.Theveterinaryhealthcareteamneedstoensurethatathoroughpethistoryisobtained,alongwiththeveterinarian’scompletephysicalexaminationemphasizingbodysystems.Properinterpretationofthesedataleadstoalogicaldiagnosticworkupbytheveterinarianandcorrecttherapeuticandnutritionalplans.Figure5describesscreeningprotocolsforallpatientsandmorein-depthassessmentprotocolsforpatientsthatneedamorethoroughworkup.Theelementsofassessingthepatientinclude:

•Reviewingthemedicalrecords. •Interviewingtheclient,includingobtainingadietaryhistory(“Whatare youcurrentlyfeeding?”“Whattreatsdoyoufeed?”Whointhefamily feedsthepet?”). •Examiningthepatient,emphasizingabodysystemsapproachandbody conditionscoring. •Obtaininganthropometric(zoometric)measurements(Seebelow). •Reviewinglaboratoryandotherdiagnosticdata. •Estimatingtargetlevelsforthekeynutritionalfactorsbasedonthe patient’smedicaldiagnosisorstateofwellness(Seebelow)

Involvement in nutritional assessment should be under the supervision of a veterinarian.


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Review of the medical recordprovidesobjectivehistoricalinformationanddocumentsthepet’sprevioushealthstatus,healthmaintenanceproceduresthatwereperformed,andmedicationsandfoodsthatwereprescribed.Thisinformationshouldbeevaluatedtodetermineifanyofthesefactorsarerelatedtothepet’scurrentnutritionalstatus.Thisreviewpermitsearlynutritionalinterventioninthetreatmentofestablishedmalnutrition(under-orovernutrition)andinthepreventionofmalnutritioninindividualsatrisk.

Medicalrecordsprovidevaluableinformationaboutthepet’sweightovertime.Ingeneral,dogsandcatsshouldweighnomoreinlateryearsthantheydidduringtheirfirstfullyearofmaturity.Medicalrecordsalsoprovidecluesaboutriskfactors,suchasage,breed,gender,neuterstatus,environment(exposuretootherpets,typeofshelter,etc.),andmedical/surgicalproblems(adversereactiontofood/drugreactions),etc.

Figure 6. Veterinary medical records provide valuable information about the chronology of a pet’s weight gain or loss.

Figure 5.

Assess The Pet

ReviewmedicalhistoryCurrenthistory/diethistoryPhysicalexamZoometricsDiagnosticsRiskfactors

AbnormalfindingsToomuch/toolittlefoodintakeClinicalsignsofdiseaseAbnormalbodyprotein/fatstoresAbnormaldiagnosticresults

InterventionChangenutritionalplan

NormalfindingsFewriskfactorsBodyconditionscore=3

NormalfindingsHighriskfornutritionaldisordersMorediagnosticsesp.withage

Discussoptimalnutritionalplan(petmaynotbeonproperdiet)

InterventionChangenutritionalplan

Re–evaluatefrequently



Screenings

Indepth workup ?

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Taking an accurate historyisamongthemostusefulandrewardingdatacollectionprocedures.Evenwhenthereisnoproblemorprimarycomplaint,clientsshouldbequestionedcarefullyusingabodysystemapproach.Acompletehistoryshouldalsoincludequestionsaboutthepet’sweightandmedical,surgicalandothertherapiesthatmayaffectappetite,nutrientmetabolism,orboth.Anaccuratedescriptionofthecurrentfeedingplan,includingthepet’sfood,eatinganddrinkinghabits,andfeedingmethods,shouldbeobtainedfromtheclient.Carefullydetailalldietaryfacts,includingthetypeandbrandoffood,snacks/treats/tablefood,nutritionalsupplements,amountsfedeachday,feedingmethod(e.g.,freechoice,mealfeeding,etc.).


Assess The Pet

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Assess The Pet

A thorough physical examinationbytheveterinariancanhelpdefineapet’snutritionalstatusaswellasidentifydiseasesthatmayhaveanutritionalcomponent.Thephysicalexaminationshouldtakethesameformasthehistorytaking:bodysystembybodysystem.Table1listssomeofthemorecommonfindingsthatmayindicateanutritionalproblem.

Body Area/System Good Nutrition Poor Nutrition

Table 1. Indicators of Good and poor Nutritional Status.*

Appearance

Coat

oral cavity

eyes

ears

Abdomen

Muscles

Skeleton

pink mucous membranes, no swelling or bleeding, no gum disease

Clear, pink membranes nodischarges, no prominent bloodvassels

Concave

Clean, no discharge Discharges, excessive scratching

Firm

No abnormalities

pale mucous membranes , red mucous membranes, gums that bleed easily , exposed tooth roots, loss of teeth

pale membranes, dry eyes, dis-charges, red membranes, prominent blood vessels

SwollenFlaccid, sore

Conformation problems, early arthritic changes, lameness

Shiny Dull, hair easily lost, greasy, scales

Alert, responsive to environment Listless, apathetic, cachexia

Gastrointestinal function Normal appetite, normal stools

*Other medical conditions that cause these changes should be ruled out first.

Anorexia, vomiting, diarrhea

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BodyconditioncanbesubjectivelyassessedbyaprocesscalledBodyConditionScoring(BCS).Ingeneral,thisprocessassessesapatient’sfatstoresand,toalesserextent,musclemass.Fatcoverisevaluatedovertheribs,downthetopline,aroundthetailheadandventrallyalongtheabdomen.


Figure 7. Canine Body Condition Scoring.

Figure 8. Feline Body Condition Scoring.

Assess The Pet

BCS 1: Very Thin

BCS 2: Underweight

BCS 3: Ideal

BCS 4: Overweight

BCS 5: Obese

BCS 1: Very Thin

BCS 2: Underweight

BCS 3: Ideal

BCS 4: Overweight

BCS 5: Obese

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Here’showtousebodycondition(BCS)scoring.Fordogsandcatsalwaysdeterminetheamountoffatcoveringtheribs.Feeltheareasbetweenribstogetthemostinformation.Palpatethetailbaseindogs(areainfrontandtothesidesofwherethetailattachestothebody)andtheareasoverthebackboneandhipbonesincatsformoreinformation.Then,reviewtheprofileoftheabdomenfromthesideandtop.Dogsandcats,whenviewedfromthesideshouldhaveaconcavewaist(alsocalledtuck).Dogsshouldhaveanhourglassfigurewhenviewedfromthetop.Assesstheamountoffatintheabdominalfatpad(alsocalledapron)alongthebottomofacat’sstomach.

Theribsofoverweightcatsanddogsaredifficulttofeelbecausetheyarecoveredwithfat.Overweightdogshaveasmooth-to-thickenedtailbaseandit’sdifficulttopalpatebones.Thebackofobesedogsmaybemarkedlywiderthanusualandthespinemayappearinadepression.Overweightdogsandcatshavelittleornoabdominalwaist.Catswithbodyscoresof4and5havemoderatetomarkedfatdepositsalongtheabdominalwall.

Bodyconditionscoringshouldbeincorporatedintothephysicalexaminationofeachpatienteachtimeitisseen.Thegoalistodetermineifapatientneedstogainorloseweightorifitisatidealweight.Afive-pointsystemcanbeusedfordogsandcats. Bodyconditionscoreof1=Verythin Bodyconditionscoreof2=Underweight Bodyconditionscoreof3=Ideal Bodyconditionscoreof4=Overweight Bodyconditionscoreof5=Obese. Yourprogressissaved. Slide 11 of 26

Body Condition Scoring is one of the most obvious and visible evaluations you can do on a pet in front of the client.

Assess The Pet

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Anthropometryisthesciencethatdealswithbodymeasurements,suchasheight,weight,andproportions.Itisusedtoassessbodyfatandproteinstores.Forexample,inpeople,tricepsskinfoldandarmcircumferencearemeasuredandrecorded.Zoometricsisanequivalentanimalterm.Bodyweightisthemostcommontechniqueusedinsmallanimalpractice.Weightovertimecoupledwithbodyscoringtechniques(palpation)isveryusefulforestimatingfatandproteinstoresinpets.

Youmayapplywhatyou’velearnedaboutbodyscoringandzoometricsinweight-lossprogramsforpets.Forexample,youmightuseatapemeasuretomeasurethecircumferenceofadog’sabdomen(pelviccircumference)immediatelyinfrontofitsbacklegs,intheflankarea.Becausedogsonaneffectiveweight-lossprogramwillloselumbar(back)fatastheyloseweightthecircumferenceshoulddecrease.Likedecreasingbodyweight,adecreasingabdominalcircumferencemeasurementhelpsconvinceclientstheyaredoingagoodjobwithaweight-lossprogramfortheirpet.

Figure 9. Measuring abdominal (pelvic) circumference.

Assess The Pet

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Laboratoryandotherdiagnostictestsmaybeusedaspartofthenutritionalassessmentprocess,ifthehistoryandphysicalexaminationsuggestamorein-depthworkup.Nosinglelaboratorytestorotherdiagnosticprocedurecanaccuratelyassessapatient’snutritionalstatus.Routinecompletebloodcounts,urinalysesandbiochemistryprofileshowever,canprovideinsightintothepresenceofmetabolicdisordersandotherdiseases.Lowserumproteinvalues(e.g.,liverandkidneydisease),elevatedglucosevalues(e.g.,diabetes),elevatedlipidlevels(e.g.,hyperlipidemia),decreasedpackedcellvolume(e.g.,anemia),inabilitytoconcentrateurine(e.g.,kidneydisease),andabnormalradiographs(e.g.,skeletaldiseasesofgrowingpuppiesandkittens)arejustafewofthedisordersforwhichdiagnosticassessmentisuseful.

Figure 10. Serum Chemistry Profile. Yourprogressissaved. Slide 13 of 26

Assess The Pet

Species Canine

Breed SexSF

Pet Age12Y

Reported07/23/2012

10:50 AM

Test Requested Results Reference Range UnitsOCCULT HEARTWORM ANTIGENOccultHeartwormAntigenSUPERCHEMGlucose1UreaNitrogenCreatinineTotalProteinAlbuminTotalBilirubinAlkalinePhosphataseALT(SGPT)AST(SGOT)Cholesterol

Neg

36161.06.54.00.10605222239

Neg

70-1386-250.5-1.65.0-7.42.7-4.41-0.35-13112-11815-6692-324

mg/dLmg/dLmg/dLg/dLg/dLmg/dLU/LU/LU/Lmg/dL

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Determiningthekeynutrientsofconcernandtheirtargetlevelsisfundamentaltothepracticalapplicationofnutrition.TheAssociationofAmericanFeedControlOfficials(AAFCO)publishesrecommendednutrientprofilesfordogandcatfoods.ThesenutrientprofilesaretheofficialsourcefornutrientinformationfordogandcatfoodsintheUnitedStates.

ThevaluespublishedbyAAFCOaredeemedadequatetomeettheknownnutrientneedsofhealthydogsandcats.Besidesrecommendationsforlowerlimits,AAFCOlistsupperlimitsforcertainnutrientswiththeobviousimplicationthatsomenutrientexcessescanbeharmful.

TheconceptofkeynutritionalfactorsgreatlysimplifiestheapproachtonutritionbecausemostcommercialpetfoodssoldintheUnitedStatesprovideatleastAAFCOallowancesofallnutrients.Thus,ifacommercialfoodisfed,veterinariansandtheirhealthcareteamsneedtounderstandandfocusondeliveringthetargetlevelsforafewnutrients(keynutritionalfactorsornutrientsofconcern)ratherthanallnutrientscurrentlyrecognizedfordogsandcats.Minimizingexcessesisofprimaryconcern.

Figure 11. AAFCO Official Publication.


The nutrients often of greatest concern are water, protein, fat, carbohydrate, calcium, phosphorus, fiber, and magnesium.

Assess The Pet

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The patient’s nutrient needs serve as the benchmark for assessing the food.


Keynutritionalfactorsencompassnutritionalriskfactorsfordiseasetreatmentandpreventionbutalsonutrientsthatarekeytooptimizingnormalbodyprocessessuchasgrowth,gestation,lactation,andwork.Thefollowingpointsshouldbeconsideredindeterminingkeynutritionalfactorsandtheirtargetlevels:

•Thepatient’slifestageandphysiologicstate •Environmentalfactorssuchastemperature,housing,andpet-to-pet competition •Thenatureofanydiseaseorinjury •Theknownlossesofnutrientsthroughskin,urine,andintestinaltract •Theinteractionsofmedicationsandnutrients,ifapplicable •Theknowncapacityofthebodytostorecertainnutrients •Theinterrelationshipsofvariousnutrients.

Besidesnutrients,otherfoodcharacteristicsmaybeimportanttoconsider.Thesecharacteristicsmightincludesuchthingsasthefood’sinfluenceonurinarypH,thefood’stexture,andthefood’sproteinsources.

Theprimarygoalofpatientnutritionalassessmentistoestablishthepatient’snutrientneeds,especiallyforthekeynutritionalfactors.

Assess The Pet

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Thecomponentstofoodassessmentinclude:

•Physicalevaluationofthefood •Evaluationofthepetfoodlabel •Evaluationofthefood’snutrientcontentrelativetotheanimal’snutrient needs(keynutritionalfactors) •Determinationofthepresenceorabsenceofspecificfoodcharacteristics.

Physicalevaluationofthefoodcanprovideinformationaboutpackage quality,consistency,andpresenceorabsenceofextraneousmaterials suchashairorbone.Physicalevaluationofthefoodisprobablymostusefulforassessingwhetherornotthefoodhasspoiled

The ingredient panel of the pet foodlabelprovidesgeneralinformationaboutwhichingredientswereusedandtheirrelativeamounts.Theingredientsusedintheproductarelistedindescendingorderbyweight.Theingredientpanelcanbeusefulifspecificingredientsarecontraindicatedforcertainanimalsoranownerhasaningredientconcern.However,thequalityoftheingredientscannotbedeterminedfromthelabelandmuchmisinformationexistsregardingpetfoodingredients.Thenutritionaladequacystatementofapetfoodlabelwillalsorevealwhetherthefoodhasbeenfedtoanimalstosubstantiatelabelclaims.Buttherealproofishowthefoodmeetstheneedsoftheindividualpatient.That’swheremonitoringandlifelong,repeatednutritionalassessmentsbytheveterinaryhealthcareteamarecritical.(Formoreinformation,seetheModuleI.6:PetFoodLabels.)

Figure 12. Example of a commercial canned cat food. Note bone pieces throughout.


Assess the Food

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CommercialpetfoodsthathaveundergoneAAFCO-prescribedfeedingtestsprovidereasonableassuranceofnutrientavailabilityandsufficientpalatabilitytoensureacceptability(i.e.,foodintakesufficienttomeetnutrientneeds).Feedingtestsalsoprovidesomeassurancethataproductwilladequatelysupportcertainfunctionssuchasgestation,lactation,andgrowth.Itisprobablyprudenttochangetoamoreappropriatefoodifthere’sadiscrepancybetweenthelevelsofkeynutritionalfactorsinafoodandananimal’sneeds.SmallAnimalClinicalNutrition,4thed.containsnutrientprofilesforselectedcommercialfoodsandtreatssoldintheUnitedStatesandCanada(SeeAppendicesLandM,andindividualchapters).

Figure 12. Small Animal Clinical Nutrition, 5th ed. Contains authoritative nutritional information


Assess the Food

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Howaclientfeedsapetisanothercriticalfactorinfeedingsuccess.Thereareatleastthreethingstoconsiderregardingfeedingmethods:

Feedingroute Amountfed Howthefoodisoffered(when,where,bywhom,howoften).

Feeding route.Whetherornotthefeedingrouteisappropriatedependsonthepet’scondition.Althoughmostpetsareabletofeedthemselves,orphansandcertaincriticalcarepatientsmayrequireassistedfeeding.


Assess The Feeding Method

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Theamountoffoodbeingfedshouldbedeterminedwhenthehistoryofthepetisobtained.Ifthedogorcatinquestionhasanormalbodyconditionscore(3/5)withnohistoryofweightchanges,itislikelythattheamountfedisappropriate.

Figure 14. Additional feeding recommendations on Science Diet® Adult for dogs.



Amount fed.Thenutrientneedsofapetaremetbyacombinationofthenutrientlevelsinthefoodandtheamountoffoodfed.Evenifafoodhastheappropriatenutrientprofile,iftoomuchortoolittleisconsumed,significantover-orundernutritioncouldresult.Thus,itisimportanttoknowiftheamountbeingconsumedisappropriate.

Figure 13. Syringe-feeding techniques for cat and dog, using Prescription Diet® Canine/Feline a/d®

Label feeding instructions are only meant as starting points and guidelines. Your involvement is important in determining the ideal amount for a pet.

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How the food is offered.Theamountfedisusuallyofferedinoneofthreeways:

Freechoicefeeding(dogsandcats) Food-restrictedmealfeeding(dogsandcats) Time-restrictedmealfeeding(dogs)

Free-choice feeding(alsoreferredtoasadlibitumorselffeeding)occurswhenmorefoodthanthedogorcatwillconsumeisalwaysavailable;therefore,theanimalcaneatasmuchasitwants,wheneveritchooses.Withfood-restricted meal-feeding,thedogorcatisgivenaspecific,butlesser,amountoffoodthanitwouldeatiftheamountfedwerenotrestricted.Time-restricted meal-feeding occurswhenthepetisgivenmorefoodthanitwillconsumewithinaspecifiedperiodoftime,generally5-15minutes.Timerestrictedmeal-feedingisoflimitedusefulnessindogsandhaslittleifanypracticalapplicationincats.

Figure 15. The three most common feeding methods for dogs and cats.


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Manydogscaneatanentiremealinlessthantwotothreeminutes.Bothtypesofmeal-feedingarerepeatedataspecificfrequencysuchasoneormoretimesaday.Somepetownerscombinefeedingmethods,suchasfree-choicefeedingadryfoodandmeal-feedingacannedfood.Cannedfoodsandmoisteneddryfoodsleftatroomtemperatureforprolongedperiodscanspoilandarenotappropriateforfree-choicefeeding.

Mostclinicallynormaladultdogsthatarenotlactating,working,orstressedwillhaveasufficientappetite,andthephysicalcapacitytoconsumeallthefoodneededdailyinasingle10-minuteperiod(assumingfoodoftypicalnutrientdensity).Catsarelesslikelytoeattheirentiremealinone10-minutesitting,althoughonceadayfeedingisadequateforthemajorityofhealthyadults.

Methods Advantages Disadvantages Food formsFree choice

Meal fed*

ConvenientEnsures adequate food availabilityMimics natural feeding behavior Quieting effect in a kennel Less dominant animals have a better chance to get their share

Enhances human-animal bondFacilitates monitoring of appetite and food intake Enhances control of food intakeEarly detection of altered appetite Better control of body weight

Overconsumption leads to weight gain and/or obesityDifficult to monitor appetite and food intakeMoist food may spoilLess owner contact

Large meals may result in vomiting Less convenient Three or more meals are needed for nursing cats and dogs, kittens and puppies and debilitated animals Intermediate labor intensive Most knowledge required for food dose calculation

Dry Semi moist

Dry Semi moist Canned

Source: Small Animal Clinical Nutrition, 4th ed.*one or more individual feedings per day, one to two hour availability per feeding.**Dry foods available free choice, canned foods meal fed one or more times daily.

Table 2. Advantages and disadvantages of various feeding methods.


Time-restricted feeding

Intermediate control of food dose Some monitoring of appetite possible

Inaccurate control of food intake Risk of obesity similar to free choice Most labor intensive


Combination** Enhances human-animal bond (vs. free choice)

Poor monitoring of appetite and food intakePoor control of food intake Less convenient than free choice


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Afterthepet,food,andcurrentfeedingmethodhavebeenassessed,afeedingplanisformulatedbasedonnutritionalobjectivesthatarerealisticandquantifiable.Thefeedingplanwillguideselectionoffoodandfeedingmethod.Therearetwostepstoformulatingthefeedingplan:

DeterminewhatfoodtofeedDetermineafeedingmethod.

ClickhereforHill’sKeytoClinicalNutrition

Determine A Feeding Plan

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Comparingthefood’skeynutritionalfactorstothepet’sneedsdetermineswhethernutrientexcessesordeficienciesexist.Ifthepet’scurrentfoodisadequate(keynutritionalfactorsinbalancewithitsneeds)thenthefoodcurrentlybeingfedisprobablyappropriate.Ifyouandyourteambelievenutrientexcessesand/ordeficienciesexist,thenafoodthatbettermeetsthepet’snutrientrequirementsshouldbefed. Changingfoodsformosthealthydogsandcatsisofminorconsequence.However,vomiting,diarrhea,belching,andflatulencemaybeassociatedwithsudden,rapidswitchingoffoods.Itisprudenttorecommendthatownerschangetheirpet’sfoodoverthecourseof5-7days,astheyincreasetheproportionofnewfoodanddecreasetheproportionofoldfood(Figure16).However,nearlyallpetstolerateaseven-daytransitionperiod. Instructions:Clickonthedaysbelowtoseethepercentageofoldandnewfoodtotransition.


Determine What Food To Feed

Figure 16. Percentage change in a transition schedule.

Old Food

N ewN ew

N ewFood

Old Old

DAYS 1&2 DAYS 3&4 DAYS 5&6 DAY 7

N ew

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Determine the Feeding MethodAsmentionedabove,thereareseveralthingstoconsiderregardingfeedingmethods.Theyincludefeedingroute,amounttofeed,andhowtheamountfedisprovided.

Thefeedingroutewilldependontheabilityofthepettoself-feed.Ifitcannotself-feed,itwillhavetohaveassistancesuchassyringeortubefeeding.

Anestimateoftheamounttofeedcanbeobtainedfromproductinformationsuchasfeedingguidelinesfromtheproductlabel.Theamountfedshouldbeadjustedtoassureanormalbodycondition(3/5).

Howthefoodisprovidedandhowoftenitisprovideddependsonthepet’sconditionandthelifestyleoftheowner.Eachsituationwilldictatewhatmethodismostdesirableinprovidingthefood(freechoice,time-restrictedmealfeeding,orfoodrestrictedmealfeeding).


Determine What Food To Feed

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Thesamestepsinthescreeningprotocolforpatientassessmentshouldbeusedinmonitoring.Thehealthcareteamshouldrecordclinicalsigns,bodyweight,bodyconditionscore,clientcompliance,etc.andmakeanychangesnecessarytooptimizepatientcare.

Petswithspecificconditions,diabeticsforexample,needmonitoringtests,suchasurineandbloodglucoseandketoneevaluations.Petswithmultiplemedicalconditionsoftenrequireseveralpharmaceuticalstohelpmanagetheirconditions.Theeffectsofdrugsonnutrientabsorptionandmetabolismandnutrientsondrugavailabilityneedtobecloselymonitored.

Theentireveterinaryhealthcareteamneedstobeinvolvedinnutritionalassessmentincludingmonitoringpatientprogressandclientbehavioralchanges.Yourinvolvementdramaticallyimprovesthelikelihoodofcomplianceandimprovedhealthforyourpatients.RepeatingthenutritionalassessmentcycleinFigure17eachtimeapetisseenconveystoclientstheimportanceofnutritionandsendsconsistentmessagesthatavoidconfusion.

Ideally, most healthy pets should receive a nutritional assessment 2-4 times a year, more frequently for diseased or injured pets.

Figure 17. The two-step nutritional assessment process.


Reassessment/Monitoring

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Everyoneontheveterinaryhealthcareteamcancontributetotheunderstandingofeachpet’snutritionalassessment.Thiscanbedoneina“teamwork”approachwhereeveryoneunderstandshisorherrole,andtheroleofothersinprovidingthebestadvicetotheclient,careforthepet,andbenefitstothepractice.

Tocontinue,youwillneedtocompletethequizforthismodule.Whenyouareready,clickontheforwardarrowbelowtotakeyoutothequiz.


Summary

Are You Ready?

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