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| ACVN NutritioN Notes 54 today's Veterinary Practice July/August 2014 tvpjournal.com table 4. recommended nutrient levels for diets (% dry Matter basis) a NUTRIENT RANGE FAT CHO PROTEIN N-3 FA b Healthy Dogs Low < 5 < 25 < 18 Nr c Moderate 10–15 25–54 18–22 Nr High > 15 > 55 > 22 Nr Healthy Cats Low < 9 < 24 <26 Nr Moderate 11–20 ≈ 30 27–30 Nr High > 20 > 40 > 30 Nr Canine Cancer Patients d % Dry matter basis 25–40 < 25 30–45 > 5 % Metabolizable energy 40–65 < 20 30-40 Feline Cancer Patients e % Dry matter basis 25–40 < 24 40–50 > 2 % Metabolizable energy 40–65 < 20 30–45 a. based on aaFCO minimum nutrient allowances for adult and growth life stages b. n-3 Fa = omega-3 fatty acids, including dha and ePa c. nr = values not reported in aaFCO; suggested n-6:n-3 ratio of 1:1–2.5:1 d. Canine values derived from reference 3 e. Feline values extrapolated from canine values; lower dietary fat based on concurrent disease states, such as pancreatitis, hyperlipidemia, and cholangitis. table 5. Commercial diet types appropriate for veterinary Cancer Patients a CATEGORY OF DIET CANINE APPROPRIATE FELINE APPROPRIATE Fish as primary protein source (otC b ) Yes Yes Grain-free (not calorie- reduced) Yes Yes Kitten No Yes Performance Yes No Puppy Yes No Recovery/critical care Yes Yes Hypoallergenic, diabetic (selected diets) Yes c Yes d a. these categories of commercial diets fall within the nutrient profiles recommended for veterinary cancer patients. b. OtC = over the counter c. royal Canin diabetic (canned) d. hill's Prescription diet d/d (canned) and m/d, iaMS Skin & Coat response lb, Purina dM, royal Canin hypoallergenic (canned) and diabetic (canned) Supplements: Appropriate for Veterinary Cancer Patients? Caregivers are often keen to provide im- mune-enhancing, health-boosting supple- ments to their pets diagnosed with cancer. limited evidence-based studies are avail- able to substantiate dosage, duration, tim- ing, or risk versus benefit; therefore, it is best to proceed with caution. some supplements have been docu- mented through clinical studies in the can- cer patient: Omega-3 fatty acids , which include ePA and DHA, are recommended in various formats: • omega-3 fatty acids = > 5% dry matter 3 • ratio of omega-6 to omega-3 (ePA/ DHA) = 1:1 to 2.5:1 3 • ePA/DHA = 450 mg/100 kcal of daily energy requirement (Der); calculated based on Hill's Prescription Diet n/d nutrient profile Antioxidants are contraindicated during ongoing chemotherapy or radiation ther- apy. • Although oxidant-induced cellular damage is significant following completion of treatment protocol, human studies have reported conflicting results regarding AoX supplementation. 16 • to date, no companion animal studies evaluating AoX supplementation have been reported. Glutamine (GlN) is a primary fuel for en- terocytes that can become depleted dur- ing prolonged anorexic–hyporexic states, especially with associated Gi stress. Many tumors exhibit high rates of GlN con- sumption. • GlN has been shown to improve: 17 » Protein balance in tumor-bearing animals » Natural killer cell function. • recommended supplementation following Gi surgery = 500 mg GlN/100 kcal Der 14 • No consensus on usefulness of GlN supplementation in nonsurgical cancer patients For further information on the use of nutritional supplements in veterinary medicine, read Surveying Supplements: Current Trends, Research, & Recommendations—in the May/June 2014 issue of Today's Veterinary Practice— at tvpjournal.com.