Today's Veterinary Practice

NOV-DEC 2017

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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26 ACVN NUTRITION NOTES PEER REVIEWED Clinical Considerations in Dogs • At each visit, obtain a full dietary history that includes treats, chews, table scraps, and food used for medication administration to help ensure consistency and improve diabetic control. Sample diet history forms, as well as other helpful nutrition resources for veterinarians and clients, can be found online at the World Small Animal Veterinary Association Nutrition Toolkit site ( wsava.org/nutrition-toolkit ). 5 • When higher-fiber diets are considered, let clients know in advance that the increased fecal bulk will result in more frequent need to eliminate. For dogs, this may mean that clients need to schedule more walks during the day to avoid accidents. • Commercial diets are a better source of fiber supplementation because they can be formulated to still provide the appropriate essential nutrients to pets (added fiber can decrease absorption of nutrients from the diet). Canned pumpkin is popular with clients as a fiber supplement, but the amount needed to see an effect may unbalance the total diet (ie, the pumpkin would provide substantially more than 10% of the pet's total calories). • Avoid fiber supplements containing added flavors or sweeteners, such as xylitol, which can be harmful to pets. FELINE DIABETES Unlike dogs, cats can be diagnosed with IDDM or NIDDM, although the typical presentation is overweight cats with NIDDM. Also contrary to dogs, some cats with NIDDM can achieve remission. Obesity has been associated with NIDDM in cats and should be an initial consideration in selecting diets (ie, diets with lower calorie density that are appropriate for weight loss if necessary in obese cats). Any dietary change, especially one incorporating weight loss, should be introduced only after the cat has been stabilized on an insulin regimen. Regardless of overweight status, adequate protein should remain a priority throughout diabetic management. Protein needs may change during weight loss (because of caloric restriction and relative nutrient density) or as a result of the catabolism that can accompany uncontrolled diabetes. The exact needs of each cat will differ and should be monitored by assessing muscle condition and altering protein content of the diet as needed. Fiber Versus Carbohydrates: What's the Evidence? Only a handful of published studies address optimal diet composition (particularly fiber and carbohydrates) for cats with naturally occurring diabetes. Most have evaluated the effect of lower-carbohydrate diets. However, a study in cats with NIDDM fed a diet high in insoluble fiber (5.8 g/100 kcal) showed improved glycemic control compared with a diet low in insoluble fiber (1.1 g/100 kcal). 6 Other studies have shown a positive effect of low- carbohydrate diets (<5 g/100 kcal), including improved glycemic control and diabetic remission, in cats with naturally occurring NIDDM. 7–10 Although it may seem that a low-carbohydrate diet has solid evidence to support its use, almost all of these studies have noteworthy limitations, such as not controlling for caloric intake or weight loss, small sample size, or comparison of diets that differed in more than just carbohydrate content. With at least some evidence to support both low-carbohydrate and high–insoluble-fiber approaches, the bottom line from the available studies is that both approaches may have some benefit in the regulation of feline diabetes, although low-carbohydrate diets look more promising. Low-carbohydrate diets may not be appropriate for every cat. For example, many low-carbohydrate dry diets tend to be higher in calories because of the need for fat and protein to replace the carbohydrates. High-calorie foods, even if low carbohydrate, would be contraindicated in an obese cat with NIDDM because diabetes is so closely associated with obesity. Each cat should be evaluated individually, with considerations made for overall health. Clinical Considerations in Cats • Although it is not as common for cats to be given a variety of treats, clients often switch out flavors or textures, assuming that diets within the same line or product name are similar. These can have drastically different nutrient profiles, and clients should be instructed to carefully read labels and not switch foods without consulting with the veterinarian first. • Similarly, dry and canned diets, even of the same product (veterinary therapeutic diets included), may not have the same nutrient profile and should not be used interchangeably without ensuring the nutrient profile meets the needs of the pet.

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