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53 ACVN NutritioN Notes | PrACtiCAl APProACHes to FeeDiNG tHe CANCer PAtieNt July/August 2014 today's Veterinary Practice tvpjournal.com Diet Ingredients When choosing or recommending a commercial food for a pet with cancer, reviewing the product ingredient list may be helpful. Examples of ingredients are listed in Table 3. • Protein sources of animal origin provide more essen- tial amino acids for dogs and cats compared with plant- derived protein sources. • Soluble CHO sources are more readily available sources of glucose compared with complex CHO counterparts. Since glucose is thought to be a primary nutrient source for solid tumor types, reducing the overall soluble CHO content of the diet may be beneficial. • Soluble fibers are another complex CHO source in pet foods; in excess, fiber may decrease overall diet digestibility, but soluble fibers promote GI health. Therefore, inclusion of soluble fiber sources is considered overall beneficial. • Fat-enriched diets, such as recovery or growth life-stage diets, should be avoided in pets with concurrent medical issues (ie, pancreatitis, hyperlipidemia, cholangitis) that require dietary fat restriction. The pet's current clinical picture helps determine which CHO/fiber sources are most beneficial. For example: • With concurrent diseases such as renal or hepatic dis- ease: Soluble fiber sources • Canine diabetes mellitus: Complex CHO sources (whole grains and soluble fibers) • Shortened bowel: Soluble fiber sources. Table 4 (page 54) outlines appropriate nutrient levels for both healthy pets and those with cancer; Table 5 (page 54) provides a list of commercial diets that are appropriate for use in veterinary cancer patients. Unconventional Diets Some pet caregivers request alternatives to commercial therapeutic (prescription or OTC) foods. For pets with cancer, home-prepared meals are often recommended, but raw diets are contraindicated, especially in patients undergoing chemotherapy or radiation therapy. Raw food can significantly increase the risk of infec- tion and/or sepsis in an immunocompromised patient; pets treated with chemotherapy and radiation become severely neutropenic and immunocompromised. Homemade diets can be specifically formulated to ad- dress the nutrient needs associated with single or multiple comorbidities when an appropriate commercial diet is not available for pets with cancer. Pet caregivers often perceive the diet preparation process as a way to bond with their pets, especially when pets are experiencing undesired clini- cal signs associated with their anticancer treatments. If a pet caregiver does not feed a commercially prepared diet, emphasize the importance of ensuring the diet fed is nutritionally complete and balanced, which may require the assistance of a board-certified veterinary nutritionist. Feeding Frequency Providing the daily food allotment in smaller, frequent meals can be beneficial by: • Enhancing overall nutrient uptake via the GI tract • Minimizing intolerance due to meal volume • Providing a sustained energy source throughout the day • Decreasing stress associated with large meal feeding. Assisted Feeding As cancer progresses, patients may require assisted feed- ing to ensure receipt of adequate nutrition. When the pet is not consistently consuming at least 66% of resting energy requirement (RER) calories, 14 assisted feeding is indicated. Hand or enteric tube feedings are viable options for general practice and at-home settings. In some cases, constant delivery of nutritional support via an enteric feeding tube is best tolerated, although this method usu- ally requires hospitalization and close monitoring. table 2. tumor Utilization of amino acids METABOLIC FUNCTION AMINO ACID Protein synthesis All amino acids ATP production Glutamine Glucose production Alanine, threonine, serine, glycine Nucleotide synthesis Glutamine Polyamine synthesis Arginine, ornithine Nitric oxide synthesis Arginine Methyl group transfer Methionine Serotonin synthesis tryptophan table 3. examples of Pet Food ingredients INGREDIENT EXAMPLES Animal protein Beef, chicken, turkey, duck, fish, lamb, venison Vegetable protein Corn gluten meal, soybean meal, soy isolate Soluble CHOs Ground grains, meals, flour, and starch Complex CHOs Whole grains and soluble fibers (guar gum, beet pulp, fructopolysaccharides, sweet potato, brown rice) What About GMO & Processed Foods? Many clients that have pets with cancer ask about the role of genetically modified organisms (GMo) and/or processed foods in cancer and their pets' diets. un- fortunately, the jury is still out on the relationship be- tween GMo/processed foods and cancer in humans because adequate data is not yet available.