Conference PaperPDF Available

Therapeutic diets in clinical and pet nutrition

November 2006

Conference: CAS in Animal Nutrition

Authors:

Artabandhu Sahoo

ICAR-National Institute of Animal Nutrition and Physiology

Beneficial role of inulin and fructo-oligosaccharides

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dog has fresh and clean

rblication, Association of

trol Officials Inc., Atlanta,

': Its Behavior, Nutrition,

owa: Iowa State University

29th World Congress of

I Animal Veterinary

ier

6-9, 2004, Rhodes,

al Science. Albany, New

hers, Inc.

it. (1985). Nutrient

igs. Washington, D.C.:

ress.

.. 2006. In: Proc. National

Practice and 3rd Annual

Society for Advancement

February 10-12, 2006,

5-193.

In:

Significance of

Livestock Health and

., Garg, AX., Pattanaik,

:hra, U.R. (Eds). Centre

; in Animal Nutrition,

:arch Institute, Izatnagar,

'cent Trends in Rumen

technology. Chaudhary,

unra, D.N. and Mehra,

Advanced Studies in

an Veterinary Research

dia, pp. 83-88.

ClinicalNutrition of Livestock and Pets:

An Advanced Short Course

CAS in Animal Nutrition, IVRI, lzatangar

November 3-23, 2006

Therapeutic Diets in Clinical Pet Nutrition

A. Sahoo and R.K. Singh

Environmental (climate, micorbes,

fauna, parasites, toxicants, and injury) stimulus

that initiates an adaptive change or stress

response, in the animal alters its normal

physiological metabolism and hence the system

is in need of therapeutic support, viz. therapeutic

treatment and supportive diets. While assessing

the nutritional requirement of such clinically ill

pet animals, it involves assessment of the

nutritional requirements for various life stages

and operational tasks, and formulations of

balanced and complete diets and/or therapeutic

diets for different patho- or pathophysiological

conditions. It involves nutrition of clinically ill

animals, supportive nutrition for the

convalescent animals, and preventive nutrition

to fight against the occurrence of clinical illness

(Sahoo, 2002). Therapeutic nutrition thus plays

a fundamental role in determining the health and

performance of any animals, and also, a correctly

balanced diet is essential to avoid disease

associated with a deficiency or toxicity of a

particular nutrient. Furthermore, disease and

nutrition are closely interlinked and dietary

modification forms an important part of the

veterinary management of the case and thus the

concept is coined in the name of 'therapeutic

diets'.

Infection and dietetics

Nutritional deficiency apparently

increases the severity of infection by viral,

bacterial, fungal or paratsitic pathogens. Studies

indicate that most nutrition may affect

pathogenesis either synergistically or

antagonistically (Scrimshow

et al.,

1968) and

also has significant impact on cell mediated

immunity (Latshaw, 1991). Infection induced

immune stimulation decreases appetite and

muscle protein aceretion, increases metabolic

rate, body temperature and oxidative damage to

cells (Swick, 1995). Increased incidence and

severity of infections secondary to

immunological impairement as a result of

generalized malnourishment as well as selective

nutrient deficiencies may result in vaccination

failure, increased condemnation and mortality,

poor feed conversion, and increased morbidity

and medication costs.

Nutritional support replenishes tissue

stores, improves immune function and wound

healing and prevents death from cachexia. In

persistent clinical illness nutritional status can

be severely compromised by the combined

effects of reduced feed intake and increased

metabolic demands secondary to fever and

tissue catabolism. The clinically ill animals are

usually less active and while calculating energy

requirements, it is best to use the estimated

requirement for animals confined to stalls and

multiply these basal energy requirement by a

"fudge factor" that reflects the severity of the

disease and stress (Ralston, 1985). Oral

supplementation is preferred first, and extra-oral

or parenteral nutrition are alternatives to feeding

animals that do not respond to managerial or

chemical stimulants of appetite.

The specificity of therapeutic diets with

respect to its composition, special/essential

supplements and/or additives, feeding and

management for different disease conditions are

briefed under specific disease conditions.

Cardiovascular disease

The conditions are congestive heart

failure, hypertension, ascites and edema. The

diet should be highly digestible and easily

metabolized with low sodium and saturated fat

and extra potassium, B-complex vitamins and

taurine.

SAHOO AND SINGH _

Respiratory disorder

The commonly associated disease

conditions are bronchitis, pharyngitis and

pneumonia. The ill pets should be provided with

a highly palatable balanced diet with readily

metabolizable carbohydrate, added antioxidant

vitamins (C, A and E) and expectorants

(glycerine, honey).

Nephrotic disorder

Renal failure is commonly associated

with early stages of congestive heart failure,

hepatic disease associated with encephalopathy

and hypertension. The therapeutic diet should

be balanced with caloric requirement from non-

protein sources and it should have low protein,

low P and Na, added K, water soluble vitamins

and sources of 003 and

ro6

FA. Renal calculi

(urolithiasis) are a systemic disease and in

majority cases it occurs because of disturbances

in one way or the other in the uptake, metabolism

or excretion of urolith constituents (struvite:

magnesium ammonium phosphate, calcium

oxalate, urate, purines and cystine) (Senior et

al., 1996). Cats are observed to be at higher risk

than dogs. Typical diet for treatment of

urolithiasis in dog should contain 8%CP, 0.3%

Ca, 0.12% P, 0.02% Mg and 1.2% Na in the DM

(Lewis, 1989). The factors that predispose cats

and dogs to urolithiasis include inadequate

liquid intake, sudden change to a dry diet with

excess total minerals (P, Mg or Na), alkaline diets

or diets supplying inadequate K (Wolter, 1990).

Acidifying diets, often termed as 'struvite' diets

contain acidifiers like ammonium chloride with

low base (Na or Ca carbonates), DL-methionine

and should be used judiciously. The diet should

have low mineral content (Ca, Mg, and P) and

oxalates and may be enriched with alkalizing

ingredients. Urate uroliths can be treated by

feeding low protein diets with low purine food

type and xanthine oxidase inhibitors and cystine

uroliths by low protein and low sodium diets.

Liver disorder

Various {Oxicmetabolites of food origin

or from infections impaired liver function

resulting in disease conditions like hepatitis,

cirrhosis, hepatic encephalopathy, etc. The pets

should have a maintenance balanced diet with

low fat, low protein with high biological value

(low purine containing foods), highly digestible

starch and sugar, supplemental deficient

digestive enzymes and B-complex vitamins with

lipotropic factors.

Toxicity and oxidative stress

Dietary components playa crucial role

in the health of companion animals, especially

those exposed to elevated levels of toxins and

free radicals. Investigation into animals' hepatic

antioxidant and metabolite conjugation systems,

and the metabolic processes that influence them,

provides some understanding regarding the

relationship of diet to disease prevention and

treatment. The results of recent in vivo

assessments, clinical trials, and observational

studies show oral supplementation with vitamin

E, selenium, glutathione, and taurine to be

beneficial for both maintaining natural

antioxidant systems and protecting against a

number of degenerative diseases associated

with free radical damage and toxin exposure

(Scanlan, 2001). In many instances, it has been

observed that the introduction of specific

nutrients positively influences the health status,

symptomatic presentation, and life span of

animals whose natural detoxification systems are

compromised.

Gastro-intestinal diseases

Different disease conditions are

enteritis, gastritis and diarrhea, inflamatory bowel

disease, malabsorption and maldigestion,

exocrine pancreatic insufficiency,

lymphangiectasia, pancreatitis, hepatic disease

not associated with encephalopathy,

hyperlipidemia. The diet should be complete and

balanced for growth of puppies and maintenance

of adults that contains highly digestible

carbohydrate and protein of high bilogical value,

low fiber and gluten free, low lactose,

hypoallergenic food proteins, low long chain

triglycerides (LCT) , source of medium chain

94 _

triglycerides (MeT,:

and w6 fatty acids, pI

care should be n

electrolytes and wat

and diarrhea.

Diarrhoea

Diet plays

of all aspects of d

Inappropriate diet,

primary cause, bu

duration of diarrhc

cause is not diet-n

consideration of die

some cases is an ess

(Simpson, 1988). )

water is reabsorbed

small decrease in

secretion) can readi

water content and (

Oral rehydration

therapy is importan

excessive loss offlt

depletion and acic

1989). Fluids and e

orally in mild dise

severe cases. Oral

the lower sodium

appropriate for the

in the dog, in whicl

an important aet

solutions with big

provide additional

hypertonic and rna:

(Leiper, 1986; M

increase luminal O!

osmotic diarrho

potentially, dam

(Kameda et al, 19~

solutions should

cases with reduce

villus atrophy or (

where the possib

increased (Simrm

appears that hyp

glucose polymers

isotonic or hypertc

iditions like hepatitis,

lalopathy, etc. The pets

nee

balanced diet with

high biological value

lOds),highly digestible

plemental deficient

complex vitamins with

ress

ents playa crucial role

onanimals, especially

d levels of toxins and

into animals' hepatic

econjugation systems,

esthat influence them,

mding regarding the

sease prevention and

, of recent in vivo

Is, and observational

ientation with vitamin

e, and taurine to be

iaintaining natural

protecting against a

diseases associated

: and toxin exposure

instances, it has been

duction of specific

Ices the health status,

In, and life span of

xification systems are

se conditions are

ea,inflamatory bowel

and maldigestion,

insufficiency,

titis, hepatic disease

encephalopathy,

ouldbe complete and

liesand maintenance

highly digestible

high bilogical value,

ree, low lactose,

ins, low long chain

e of medium chain

••

__________________________ Therapeutlc Diets in Pet Nutrition

triglycerides (MCT, 22-34% of fat), source ofw3

and w6 fatty acids, probiotics(yogurt). However,

care should be taken to infuse parental

electrolytes and water replacement in vomiting

and diarrhea.

Diarrhoea

Diet plays a key role in the management

of all aspects of diarrhoea (Zimmer, 1986).

Inappropriate diet, for example, may be the

primary cause, but it may also prolong the

duration of diarrhoea even if the underlying

cause is not diet-related. Conversely, careful

consideration of diet can speed recovery and in

some cases is an essential component of therapy

(Simpson, 1988). Approximately 95% of this

water is reabsorbed from the colon, so a relatively

small decrease in absorption (or increase in

secretion) can readily result in increased colonic

water content and diarrhoea.

Oral rehydration therapy: Appropriate fluid

therapy is important in acute diarrhoea to check

excessive loss of fluids, dehydration, electrolyte

depletion and acidosis (Zenger and Willard,

1989). Fluids and electrolytes may be provided

orally in mild disease or parenterally in more

severe cases. Oral rehydration solutions with

the lower sodium concentration may be most

appropriate for the treatment of acute diarrhoea

in the dog, in which viral infection appears to be

an important aetiological factor. Further,

solutions with high concentrations of glucose

provide additional energy, but are considered

hypertonic and may reduce net water absorption

(Leiper, 1986; Maughan and Leiper, 1990),

increase luminal osmolality thus contributing to

osmotic diarrhoea (Farthing, 1988) and,

potentially, damage the intestinal mucosa

(Kameda et al, 1986). Use of highly hypertonic

solutions should be avoided, particularly in

cases with reduced absorptive capacity due to

villus atrophy or damage (rotavirus infection),

where the possibility of glucose overload is

increased (Simmons and Bywater, 1991). It

appears that hypotonic solutions containing

glucose polymers may be more beneficial than

isotonic or hypertonic solutions (Farthing, 1990;

Maughan and Leiper, 1990). Some dogs with

acute diarrhoea, concurrent with substantial

stool losses of potassium, may develop

hyperkalaemia. A potassium concentration in

the range of 20-30mmol/L is normally adequate

to replace existing losses (Farthing, 1988).

Substantial stool losses of chloride are known

to occur during acute diarrhoeal episodes

(Hirschhorn and Greenough, 1991). Chloride is

normally included in oral rehydration solution

as the anion of the sodium and, occasionally,

potassium salts. Citrate and other base

precursors (bicarbonate and acetate) have been

shown to promote sodium and water absorption

in normal mammalian intestine (Farthing, 1988).

Inclusion of glycine in oral rehydration solutions

may be of benefit since additional absorption of

this amino acid may enhance sodium and water

absorption and thereby reduce stool output.

(Hirschhorn and Greenough, 1991).

'Bland' diets: A bland diet can be defined as a

high quality, highly digestible, non-spicy diet

containing components that pose a low risk of

adverse reactions, such as a protein source that

is novel to the animal. Following an acute bout

of diarrhoea, this type of diet helps to ensure

that the enterocytes are presented with minimal

digestive challenge, and the acquired food

allergies or intolerance is minimised.

Elimination diet and/or hypoallergenic diet:

Acquired sensitivities may develop as a result

of increased permeability of the inflamed gut,

which facilitates the uptake of dietary antigens

that can then initiate a hypersensitivity response.

Potentially, hypersensitivity could develop to

one or more protein sources that are fed during

this critical period. Although the response is

normally short lived, it may be sustained

following repeated presentation of these

allergens resulting in chronic diarrhoea. To

reduce the risk of possible complications, a

minimal number of. protein sources should be

fed during, and following, a period of acute

diarrhoea. Preferably, the protein source should

be novel to the animal and should not form part

of the maintenance diet that will be used

_____________________________ 95

SAHOOAND SINGH _

following recovery. It should have no additives

or supplements and be fed to the exclusion of all

other foods for at least 4 weeks before

considering an alternate diet. Components of

the original diet may be introduced one at a time

once the patient has responded to the elimination

diet (Patterson, 1995). The introduction of a

second 'novel' protein diet after a minimum

period of 4 weeks is usually made in the long-

term management of the patient. It is important

that the diet is nutritionally complete and

balanced and that the actual level of protein is

not compromised, since this· may hinder

enterocyte repair. High digestibility of the protein

will help to reduce the amount ofluminal antigen

available for absorption and, hence, the risk of

sensitization.

Small intestinal disease (SID)

Specific causes of small intestinal

diarrhoea include exocrine pancreatic

insufficiency (EPI), dietary sensitivity, neoplasia,

bile acid deficiency and short bowel syndrome.

Small intestinal bacterial overgrowth (SmO) is a

common problem that may occur asa

complication in up to 50% of dogs with chronic

diarrhoea. Idiopathic disorders include

inflammatory bowel disease (mD), which is

characterised most commonly by infiltration with

lymphocytes and plasmacytes, or occasionally

by eosinophils. Lymphangiectasia is a chronic

condition characterised by insufficiency and

marked dilation of the intestinal lymphatics, which

may result in protein losing enteropathy and fat

malabsorption with diarrhoea (and steatorrhoea).

Diet plays an important role in the

management of many small intestinal diseases,

generally in conjunction with appropriate

pharmacological therapy. High fibre diets are

contraindicated for the management of small

intestinal disease. Restriction of dietary fat (low

fat: 12-20% of ME; moderate fat: 20-30% of ME)

reduces the challenge to an already compromised

gastrointestinal tract and is recommended in a

range of small intestinal diseases. In some cases,

medium chain triglycerides (MCTs) may form a

useful supplemental source of energy, since

some MCTs can be absorbed intact from the

gastrointestinal tract and can reach the

circulation via portal rather than lymphatic

channels, which suffers damage in many SID

and are hydrolysed by gastric lipase more

readily than long chain fatty acids. Moderate to

high quantities of good quality protein are

recommended, since protein deficiency may

further compromise a diseased intestinal tract

through impairment of immune function and the

luminal barrier, arid through decreased formation

of brush border enzymes. Highly digestible

sources of carbohydrate, such as rice, are

recommended. Mono-and disaccharides,

particularly lactose, should be avoided because

they provide an osmotic load in the gut.

Although dietary fibre is commonly used in the

non-specific therapy of acute diarrhoeas, it is

generally contraindicated in chronic diseases

because of its interference in digestion and

absorption thereby further compromising an

impaired gastrointestinal tract. Specifically,

soluble fibre is contraindicated in exocrine

pancreatic insufficiency (EPI) since this may

interfere with pancreatic enzyme activity and

aggravate fat malabsorption. Several small

intestinal diseases can result in deficiencies of

water soluble B-complex vitamins. Patients with

EPI are particularly susceptible to cobalamin

(vitamin B12)deficiency due to binding of the

vitamin by bacteria; decreased pancreatic

intrinsic factor, which is essential for cobalamin

absorption in the ileum; and decreased

production of pancreatic proteases to release

cobalamin fromR-proteins (Simpsonetal, 1989).

Diets for small intestinal disease are, therefore,

supplemented with B-complex vitamins, although

additional parenteral administration of cobalamin

may be necessary in cases of EPI.

Nutritional management of exocrine pancreatic

insufficiency

In EPI, there is impaired digestion and

absorption of fat and, toa lesser extent,

carbohydrate and protein, resulting in weight

loss, despite a ravenous appetite, and diarrhoea

with steatorrhoea. Management of the condition

therefore involves:

96 _

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amounts. base

weight

• Divide food a

day

• Prescribe thea

replacer.Dnc

gradually inc

enzyme replac

• If diarrhoea re

food, or if the

too quickly, fal

gradually rein

• Use only the :

of stabilisatio

• For long term

or moderate

dietary chang

and only afte

sometime.

• Any diet char

in dose of the

Large intestinal

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diarrhoea includ

bacterial infectio

Escherichia coli

large intestinal di~

supplementation v

responsive' whet

as functional dian

bowel syndrome'

part in the mana.

intestinal origin.

dietary proteins :

aetiology of a

nui

conditions, inclur

which may be mo

highly digestibl

number of novel]

source providinj

forms may be b

treatment of sorm

helps to normalis

content (Lieb, 19

rbed intact from the

md can reach the

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amage in many SID

~astric lipase more

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quality protein are

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tune

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. Highly digestible

, such as rice, are

nd disaccharides,

be avoided because

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unmonly used in the

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in chronic diseases

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tract. Specificaliy,

icated in exocrine

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nzyme activity and

on. Several small

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amins. Patients with

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entof the condition

___________________ .•...•• Therapeutic Diets in Pet Nutrition

• Feed a highly digestible, low fat diet in

amounts. based on the dog's current body

weight

• Divide food allowance into two meals per

day

• Prescribe the appropriate amount of enzyme

replacer. Once faecal character is restored,

gradually increase food allowance and

enzyme replacer to allow body weight gain

• If diarrhoea recurs because of access to other

food, or if the food allowance is increased

too quickly, fast the animal for 24 hours before

gradually reintroducing the regimen

• Use only the low fat diet during the period

of stabilisation

• For long term maintenance, alternative (low

or moderate fat) diets may be tried but all

dietary changes should be made gradually

and only after the dog has been stable for

sometime.

• Any diet changes may necessitate a change

in dose of the enzyme supplement.

Large intestinal disease

Specific causes of large intestinal

diarrhoea include parasitism, neoplasia and

bacterial infections (Clostridium perfringens,

Escherichia coli etc.). Some idiopathic cases of

large intestinal diarrhoea may respond to dietary

supplementation with fibre and are termed 'fibre-

responsive' whereas others may be classified

as functional diarrhoea, often known as 'irritable

bowel syndrome'. Dietary fibre plays a major

part in the management of diarrhoea of large

intestinal origin. However, sensitisation to certain

dietary proteins appears to have a role in the

aetiology of a number of chronic inflammatory

conditions, including idiopathic chronic colitis,

which may be more effectively managed using a

highly digestible diet based on a restricted

number of novel protein sources. Adding afibre

source providing both insoluble and soluble

forms may be beneficial in the symptomatic

treatment of SOmelarge bowel diseases, as fibre

helps to normalise transit time and faecal water

content (Lieb, 1991). Infective diarrhea can also

be managed with feeding of probiotics-

Lactobacillus acidophilus (Pasupathyetal.,

200 1) or plant bioactive components like essential

oil (Singh, 2(05).

Irritablebowel syndrome: It is thought to be

associated with stressful situations that lead to

altered intestinal motility. Dietary fibre

supplementation may be beneficial in some cases

through its physical properties, which help to

normalise colonic contractility. Although acute

cases resolve spontaneously and chronic cases

generally respond to antibiotic therapy, dietary

fibre supplementation may be of benefit in

intermittent cases which require long term

therapy. This may be due to the effects of soluble

dietary fibre on microbial population and the

production of an acidic environment from short

chain fatty acids.

Idiopathic chronic colitis (ICC): It is one of the

most common causes of chronic diarrhoea in

the dog (Bush, 1985). Diet plays an important

role in the pathogenesis of this condition and it

seems that both digestibility and the allergen

component of the diet are key factors in

successful dietary management (Leib, 1991;

Nelson et al, 1988). Studies involving dogs with

confirmed lymphocytic plasmacytic colitis have

shown that the condition could be successfully

managed using a commercial low residue,

'hypoallergenic' diet, in which the protein

sources were limited to chicken and rice (Nelson,

1988; Simpsonetal, 1998). The rationale behind

the use of a highly digestible, 'hypoallergenic'

diet can be based on three criteria: high

digestibility of macro-nutrients reduces the

digestive challenge to the terminal gut. Low

antigen content reduces the chance of an

immunological reaction and high digestibility;

further limit the dietary antigens entering the

colon. The rationale for using high fibre diets in

colitis is primarily related to the fact that bacterial

fermentation of dietary fibre results in changes

in colonic flora and production short chain fatty

acids (SCF A), and epithelial energy deficit may

be partly responsible for progression of colitis

(Kripke et al., 1987; Roediger, 1982; Settle, 1988).

administration of certain hormones and drugs

(glucocorticoids, progesterone-like drugs).

juvenile form of diabetes mellitus sometimes

occurs in dogs of less than one year of age to

an extent of 1.5% of canine diabetes with a

definite breed predisposition. Factors

precipitatingthe development of diabetes

mellitusare estrus, pregnancy, pancreatitis,

genetic, pharmaceutical .• (glucocorticoids,

magestrol acetate), hormonal, immunologic,

infectious (viral), stress, illness and obesity.

Until the establishment of oral hypoglycemic

agents, insulin will remain the primary therapy

for canine diabetes mellitus. However, long-

term diabetic management involves weight

control and dietary management. Dietary

components may directly influence insulin

sensitivity and insulin output, and hence

contribute to hyper-insulinaemic, insulin-

resistant state independent of obesity.

Dietary therapy should therefore be

designed to enhance insulin therapy and

improve glycemic regulation of the diabetic dog.

Commonly recommended guidelines for feeding

diabetic dogs are as follows:

• Daily caloric intake should maintain the dog

at its ideal body weight. If the diabetic dog

is obese, a weight reduction program

should be initiated.

• The daily caloric requirement should be

between 40 and 50 kcallkg of ideal body

weight depending on age and activity. If

the dog is obese, the calculated daily caloric

requirement should be reduced to an

additional 40% to promote weight loss.

• An ideal initial daily feeding schedule

consists of three meals, fed at 6 hr intervals,

beginning at the time of the insulin injection.

Subsequent adjustments in the time of

feeding should be based on results of serum

blood glucose determinations.

• Soft-moist foods should not be fed to

diabetic dogs; dry. and canned foods are

more acceptable diets as the former mostly

contains readily absorbable mono- and di-

saccharides.

SAHOOANDSINGH •.•..•. ...•....__

In dogs, however, high fibre diets have proven

much less efficacious than 'hypoallergenic' diets

in the management of ICCand there are

suggestions for supplementing various fiber.

sources inhypoallergenic diets to obtain the best

response (Guilford, 1996; Simpson, 1998).

Appropriate ratios of

(CIHi):

(co-

3)polyunsaturated

fatty acids help in regulating the severity and

chronicity of colitis (Simpson, 1998).

Diabetes

Diabetes mellitus is characterized by an

absolute or relative lack of the pancreatic

hormone, insulin,' resulting in glucose

intolerance. It results from impaired or deficient

insulin secretion or impaired action of insulin in

peripheral tissues. Insufficiency

insulin has

consequences on carbohydrate, lipid and

protein metabolism with secondary disturbances

of water and electrolytes. Based on the causative

factors diabetes is of three main types, viz.

insulin-dependent diabetes mellitus (IODM) -

Type 1, noninsulin-dependent diabetes mellitus

(NIODM) - Type 2 and secondary diabetes

mellitus. Type I is most common in the dog and

is characterized by hypoinsulinaemia and

impaired insulin secretion even after a glucose

challenge with a necessity for insulin injection

and a tendency to develop keto-acidosis. It

usually occurs between 5 and 12 years of age

and affects females twice as frequently as males

and is seen commonly in small dogs. Type 2 is a

form of insulin resistant one, which is usually

diagnosed in older overweight ones. The

increased amount of adipose tissue is believed

to inhibit the interaction of circulating insulin

with fat cell-associated insulin receptors.

Therapy for Type 2 diabetes mellitus includes

dietary management and use of oral

hypoglycaemic agents to stimulate insulin

secretion or increase peripheral tissue sensitivity

to the action of circulating insulin. Due to

degeneration of pancreatic beta cells, Type 2

may progress to Type I. The third type occur

secondary to conditions like, pancreatitis,

acromegaly (growth hormone overproduction),

Cushing's syndrome, and prolonged

• Based on re

with

diabetes

60% comple:

and<25%fa

of fibre.

• Although, in

fibre intake

has not beet

diabetic dog,

some of the

• Dietary then

depending 01

disorders, me

Obesity

energy, stored

imbalances betwe

energy. The incide

males (Mason, 19~

to play and intend

effects (hypotl

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approaches inch

restriction by redu

normal diet or

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with the dog recei'

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there are

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1996). Chromiun

increase lean 1

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humans

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Geriatrics

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twelve years old.

result in health is

of skin and coat,

frequent intestinal

dental problems, ,

off infection. ~

unavoidable and '

___________ ••••• ••••• T,herapeutic Diets in Pet Nutrition

.hormones and drugs

erone-like drugs). A

• mellitus sometimes

in one year of age to

nine diabetes with a

iposition. Factors

opment

of diabetes

nancy, pancreatitis,

I••

(glucocorticoids,

tonal,

immunologic,

illness and obesity.

f oral hypoglycemic

the primary therapy

tus. However, long-

mt involves weight

nagement. Dietary

y influence insulin

output, and hence

rlinaemic, insulin-

It of obesity.

should therefore be

.sulin therapy and

,nof the diabetic dog.

midelines for feeding

midmaintain the dog

t. If the diabetic dog

'eduction program

-Based on recommendations for humans

with diabetes, the. diet should contain 55-

60% complex carbohydrates, 20% protein

and

25% fat and reasonably good amount

of fibre.

- Although, influence of increased dietary

fibre intake on improving glycemic control

has not been completely established in

diabetic dog, it proved to be beneficial in

some of the patients.

- Dietary therapy may need modification

depending on the presence of concurrent

disorders, most notably pancreatitis.

Obesity

Obesity is the accumulation of excess

energy, stored as fat in the body due to

imbalances between intake and expenditure of

energy. The incidence was higher in females than

males (Mason, 1970). Drugs usually have no role

to play and intended at treating the progressive

effects (hypothyroidism, hyperadreno-

corticodism, diabetes mellitus, etc.). The dietary

approaches include partial or total calorie

restriction by reducing the quantity of the dog's

normal diet or by diluting the calorie

concentration of the diet or by starvation or skip-

a-meal practice or by prolonged hospitalization

with the dog receiving only water and a vitamin!

mineral supplement (Markwell, 1990). Besides,

there are neuro-molecular approaches involving

leptin treatment for the control of obesity (Wood,

1996). Chromium has also been reported to

increase lean body mass and decrease

percentage body fat leading to weight loss in

humans (Anderson, 1998).

Geriatrics

Dogs and cats begin to show visible

age-related changes when they are seven to

twelve years. old. Changes in body tissues may

result in health issues, including deterioration

of skin and coat, loss of muscle mass, more

frequent intestinal problems,arthritis, obesity,

dental problems; and decreased ability to fight

off infection. Some of the changes are

unavoidable and others can be managed with

uirement should be

:al/kg of ideal body

age and activity. If

lculateddaily caloric

be reduced to an

aoteweight loss.

feeding schedule

fed at 6 hr intervals,

theinsulin injection.

nts in the time of

I on results of serum

nations.

iuld

not be fed to

I canned foods are

s the former mostly

able mono- and di-

diet. Nutritionaladjustment should begin early,

but the exact age in dogs is not as simple as it is

in cats. Cats should start eating a senior diet at

about 7 years of age. The age for dogs depends

upon its size. Since smaller dogs live longer and

don't experience the age-related changes as

early as bigger dogs and thus size is used to

determine the time to change diets.

The main objectives in the feeding of

geriatric dogs. and cats should be to maintain

health and optimum body weight, slow or

prevent the development of chronic disease and

minimize or improve clinical signs of diseases

that may already be present. Older dogs and

cats have been shown to progressively put on

body fat in spite of consuming fewer calories.

This change in body composition is inevitable

and may be aggravated by either reduced energy

expenditure or a change in metabolic rate. Either

way, it is important to feed a diet with a lower

caloric density to avoid weight gain from fat and

with a normal protein level to help maintain muscle

mass. Studies have shown that the protein

requirement for older dogs does not decrease

with age and that protein levels do not contribute

to the development or progression of renal

failure. It is important to feed older dogs diets

that contain optimum levels of highly digestible

protein to help maintain good muscle mass.

Avoid "senior"diets that have reduced levels

of protein. Other special nutrients with beneficial

role in older animals are:

Vitamin E for senior cats can increase their

antibody level back to levels seen in younger

cats.

Gamma-linolenic acid (GLA), an ~6 fatty acid

that acts like an

0>-3

plays a role in the

maintenance of a healthy skin and coat. It is

normally produced in the dog's liver, but at old

age its levels may be diminished and therefore,

needs supplementation.

Fiber and fructooligosaccharides (FOS) in

senior diets promote the growth of beneficial

bacteria at the expense of detrimental ones since

older dogs often have changes in the intestinal

SAHOOAND SINGH _

bacterial population which can result in clinical

signs of gastrointestinal disease (e.g. diarrhea)

(Simpson, 1998; Pasupathy et al., 2002). Inulin

and Fructo-oligosaccharides (POS) are the newly

discovered members of the carbohydrate family

thatact asprebiotics and their beneficial role is

summarized in Table 1.

Skeletal abnormalities

The major osteopathic conditions are

rickets and osteomalacia, osteoporosis, arthritis

and abnormal bone growth. The diet of diseased

animals should be balanced for growing pups

(extra protein for growth) and adult maintenance

with meat and bone based supplement. It should

(Zn, Fe, Ca, P,

(lysine, methion

Further Readin

Abdulla, M.,

Ande

Svensson,

86-92.

Anderson; RA. 11

Bush, B.M. (1985:

and Raw,

Farthing, MJ.G.lI

Guilford, W.G. 19'

'TX, pp. 5

Hirschhorn, N. al

Parenteral

Kameda, H., Abe

Physiol., ;

Kripke, S.A, Fox,

Surgery F<

Latshaw, D.L. 19!

30: tn-r:

Leib, M.S. (1991).

Philadelph

Leiper, J.B. (1986)

Lewis, L.D. 1989.

165: 665.

Markwell, PJ., val

and Shant

Anim. Pra

Table 1. Beneficial role of inulin and fructo-oligosaccharides

Benefits Purpose

Promotes the growth of beneficial bacteria

in the intestine

Enhances mineral absorption, especially

Ca for healthy bones

Lowers triglycerides, LDL and total cholesterol

Controls blood glucose

Reduces calorie intake

Delays gastric emptying time

Antioxidant such as vitamin E and beta-carotene

help eliminate the free radical particles, which

accumulate and can damage body tissues and

contribute to the signs of aging. Antioxidants

can also increase the effectiveness of the immune

system in senior cats and dogs.

Routine care for geriatric pets should

involve adherence to a consistent daily routine,

regular attention to normal health care

procedures and periodic veterinary examinations

for assessment of the presence or progression

of chronic disease. Stressful situations and

abrupt changes in daily routines should be

avoided and if at all a drastic change must be

made, attempts should be made to minimize

stress and to accomplish the change in a gradual

manner.

Formation of soft stools, supportive therapy in

animals exposed to strong antimibioticslhigh

stress levels. and in constipation (supports good

bowel movement)

Maintenance of adults, supports during

osteoporosis, osteomalacia, arthritis

Supports to hypereholesterolemic/dyslipidemic

adults

Supports to diabetic patients

Weight management in obese/overweight adults

Early satiety- supports to diabetic, obese/

overweight pets

have added Ca and P at proper ratio (1.3:1) and

adequate vitamin A and D. In conditions like

arthritis and joint pain, the protein content

should be low to support minimum maintenance

and should have prebiotics like. inulin and

oligofructans and nutraceuticals (glucosamine,

chondroitin sulfate).

Surgical operations

Various surgical conditions are

gastrectomy and intestinal surgery, wounds or

burns, surgery of joints or bones, etc. The

patients should have provision for complete and

balanced diet with emphasis on pre and

postoperative nutrition, viz. liquid preparations,

high protein and calorie based diet, nutrient

dense low volume diet, enzyme preparations,

added vitamins (A, C and E), added minerals

Mason, E. 1970. V

Maughan, R.J. a

Therapeutii

Nelson, R.W., Stoc

Vet. Intern

Pasupathy, K., Sal

N.N.2002

364.

Pasupathy,

Saho

Anim. Nut!

100. _

_______ ...••. Therapeutic

Diets in Pet Nutrition

teopathic conditions are

ia,osteoporosis, arthritis

wth.The diet of diseased

anced for growing pups

It}and adult maintenance

ed supplement. It should

(Zn, Fe, Ca, P, etc.),supplemental amino acids

(lysine, methionine, arginine).

Therapeutic diets in clinical and pet nutrition

Figures

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