Today's Veterinary Practice

SEP-OCT 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice ac V n n u T ri T i O n nOT e S Peer r eviewed 87 • Supplemental fish oil is used as adjunctive therapy for inflammatory conditions, such as inflammatory skin disease and osteoarthritis, cancer, hyperlipidemia, and cardiac disease. 16 • d H a is supplemented in growth diets to support optimal retinal function and neuronal development. 17 • Supplementation with fatty acids, including la and e P a / d H a , is used to treat dermatologic disease. 1,18,19 i f fatty acid supplementation is indicated, a full clinical assessment, including medical and dietary history and physical examination, is necessary to determine the most appropriate fatty acid supplement for the patient. AREAS OF CAUTION IN CLINICAL PRACTICE a lthough fatty acids are essential nutrients and provide many benefits to dogs and cats, providing too much dietary fat or excessive fish oil supplementation can have detrimental effects: • i n patients in which dietary fat restriction is recommended—such as those prone to hyperlipidemia or other diseases associated with fat intolerance—supplementation of additional fatty acids could be detrimental. • Omega-3 fatty acid supplementation can result in potential adverse effects, including gastrointestinal signs (ie, vomiting or diarrhea), decreased platelet aggregation, alterations in immune function, decreased wound healing, and nutrient–drug interactions. 10 d ue to the potential for detrimental effects, use caution when recommending high fat diets or fish oil supplements in certain patients. u se high fat diets with caution in patients that: • a re overweight or obese (due to high calorie content of dietary fat and fatty acid supplements) • Have fat-intolerant conditions, such as hyperlipidemia, canine pancreatitis, or lymphangiectasia. u se caution when recommending fish oil supplements in patients: • With thrombocytopenia, large or nonhealing wounds, or gastrointestinal disease • r eceiving drugs that alter platelet function, such as aspirin. 10 F is H oil su PP l E m EN t A tio N & dosi NG Fish oil is a commonly used supplement in dogs and cats and is added to many pet foods. Some manufacturers supplement with flaxseed oil, which is a rich source of ALA, instead. However, the conversion rate of ALA to EPA is very low in dogs, and production of AA and EPA from LA and ALA, respectively, is virtually zero in cats due to low activity of the enzyme delta-6 desaturase. 3,4,6 Therefore, if the goal is therapeutic supplementation of specific fatty acids, such as omega-3s, those particular fatty acids likely need to be provided in the diet. For example, the most efficient way to increase EPA and DHA in a pet's diet is to provide these fatty acids in a supplemental form, such as fish oil. It can be challenging, however, to supplement EPA and DHA in the form of fish oil capsules to large dogs because EPA and DHA concentrations in standard fish oil capsules are not extremely high. d osing Calculations Several methods can be used to calculate a dose for a fish oil supplement, and there is no consensus on the most appropriate way to dose EPA and DHA. Fish oil can be dosed as: • Milligrams EPA + DHA (combined) per kg body weight (body weight 0.75 ) or per kg metabolic body weight (body weight 0.67 ) • Grams per 100 g of food on an as fed or dry matter basis • Grams per 1000 or 100 kcal of diet fed • An omega-6 to omega-3 ratio. 20 Although more research is needed to determine the most appropriate dose and dosing method, I typically dose fish oil at: • d ogs: 50 to 75 mg EPA + DHA (combined) per kg body weight • Cats: 30 to 50 mg/kg. Considerations of s upplementation When recommending fish oil supplementation for a patient whose food already contains EPA and DHA, consider reducing the dose of supplemental fish oil. Some diets, such as those designed for skin or joint disease, contain significant quantities of EPA and DHA. With these diets, additional supplementation of EPA and DHA may exceed the NRC safe upper limit for a particular patient, and could be potentially harmful. On the other hand, not all diets or supplements that contain "omega-3 fatty acids" include EPA or DHA. Therefore, reading the ingredient list or supplement information is necessary. In many cases, it may be necessary to call a manufacturer to get the EPA, DHA, and ALA concentrations in a diet or supplement. r ecommended Allowances & u pper l imits The NRC has established an adequate intake and a recommended allowance for EPA + DHA for all canine and feline life stages. In addition, a safe upper limit of 2.8 g EPA + DHA per 1000 kcal has been established for puppies, adult dogs, and reproducing dogs. No safe upper limit has been published for cats at any life stage. 8 Therefore, I use more caution when supplementing EPA and DHA to cats. t able 5 provides examples of adequate intake, recommended allowance, and safe upper limit for an adult dog weighing 10 kg and an adult cat weighing 5 kg, in addition to suggested total EPA + DHA doses for patients requiring fish oil supplementation.

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