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Effects of a urinary food supplemented with milk protein hydrolysate and L-tryptophan on feline idiopathic cystitis – results of a case series in 10 cats

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Abstract

Case series summary. The effects of a urinary food supplemented with milk protein hydrolysate and L-tryptophan fed for eight weeks in eighteen household cats with feline idiopathic cystitis (FIC) are described. Cat emotional, quality of life (QOL) and taste perception scores were recorded every fortnight, as were feline lower urinary tract disease (FLUTD) signs. Eight cats did not complete the study due to various reasons (six of which were due to non-food related factors). In the ten cats that completed the study, FLUTD signs, cat emotional and QOL scores improved significantly during the study period. Taste perception of the food was rated excellent throughout the study. Relevance and novel information. FIC is frequently seen in veterinary practice and is difficult to manage. Stress is a known risk factor in the development of FIC. At present, no studies of urinary foods with ingredients known to control anxiety in cats with FIC have been reported. This case series provides provisional evidence that such food improves both FLUTD signs and anxietyrelated behaviours in cats with FIC.

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... Different new kinds of therapeutic diets were produced which do not intend to only protect the improvement of crystals, but also the management of the risk factors on occurring FIC. These diets are enriched with hydrolyzed casein and ltryptophan ingredients are known to help manage stress and anxiolytic effects for cats (Landsberg et al., 2017;Naarden and Corbee, 2019). A study about urinary stress diet (Hills Prescription Diet c/d Feline Urinary Stress) provides that diet develops both FLUTD signs and anxiety associated behaviors in cats shows FIC signs (Meyer and Becvarova, 2016). ...
... These diets are enriched with hydrolyzed casein and ltryptophan ingredients are known to help manage stress and anxiolytic effects for cats (Landsberg et al., 2017;Naarden and Corbee, 2019). A study about urinary stress diet (Hills Prescription Diet c/d Feline Urinary Stress) provides that diet develops both FLUTD signs and anxiety associated behaviors in cats shows FIC signs (Meyer and Becvarova, 2016). Additionally, FLUTD treatment contains several multipurpose choices. ...
... A study shows that live but unculturable bacteria are detected in the urine and DNA of bacteria has been identified in negative urine culture from cats (Lund et al., 2015;Bartges and Kirk, 2006). Antimicrobial therapies are the key points of the treatment for urinary tract infections (UTI) and therapy which is commonly recommended for 10 to 14 days (Dunning, 2002;Passmore et al., 2008). Clients complain during treatment and animals get more stress because many traditional antibiotics have a short life and need have repeated dosing. ...
Article
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This study aims to analyze the effects of multimodal environmental modification (MEMO) of cats with recurrence of lower urinary tract signs (LUTS). Treatment of FLUTD included pharmacological treatment, dietary management, and multimodal environmental modification approaches. Twenty client-owned indoor-housed cats with recurrence of lower urinary tract signs had been covered in this observation. Diagnosis of lower urinary tract was made primarily based on the cat's clinical signs, results of laboratory parameters, urinalysis and ultrasonographic examination. Cats were divided into two groups as cefovecin (8 mg/kg sc, single time use) + meloxicam (0.1mg/kg q24h, 3 days) + dry food including l-tryptophan and milk protein hydrolysate to dissolve struvite stones (Group 1) and cefovecin + meloxicam + dry food including l-tryptophan and milk protein hydrolysate to dissolve struvite stones + multimodal environmental modification (Group 2). Clinical and urinary parameters are scored as 0, 1, 2, 3 or 4 points on initial, third, seventh days. Scores of clinical parameters were significantly different between (p<0.05) group 2 and group 1 on the third and seventh days and scores of urinary parameters are significantly different between (p<0.05) group 2 than group 1 on the seventh day. Clients who were contacted after 1 year reported that they did not see any clinical signs of urinary tract diseases. Keywords: FLUTD; MEMO; cats; behavioral medicine; multiple treatment; cefovecin
... Tracking parameters: Following the diagnosis of urolithiasis for each patient, urine examination and microscopy, ultrasonographic study, and clinical scoring were recorded. Clinical scoring was determined regarding the modification of the scoring presented by Meyer and Bečvářová (2016) as follows; during the clinical examinations, the pH value of the urine and the presence of protein, leukocytes, and blood in the urine and the clinical findings of pollakiuria, hematuria and stranguria were evaluated. Clinical scoring was performed by giving "0 "or "1" points according to the absence or presence of each existing parameter. ...
Article
Lower urinary tract problems were increasingly encountered in small animal practice. Urinary stones and crystals are common problems in these cases and are still a problem in cats and dogs. Dilution of urine or restriction of mineral intake is a way to reduce urolithiasis/crystalluria. Viburnum Opulus was prescribed as anti-urolitiatic in human medicine. The objective of this study was to evaluate the efficacy of Viburnum Opulus in urolithiasis or crystalluria in companion animals. For this purpose, 42 animals were presented with urinary system problems and diagnosed with urolithiasis or crystalluria, which were included in the study and divided into two main groups (21 calcium oxalate, 21 struvite) and two subgroups (Control and Study). The urinary score was noted as the presence of pollakiuria, crystals in the microscopic examination, hematuria, stranguria, proteinuria, leucocytes, and blood in the urine. The mean ages were 3.81 and 3.95 for the calcium oxalate and struvite groups, respectively. It was determined that the clinical urinary score of the calcium oxalate control group was 11.39 before the treatment and increased to 14.06 at the end of 2 weeks. However, it was observed that this score decreased from 10.71 to 8.71 in the calcium oxalate study group. In calcium oxalate-diagnosed animals, a decrease in clinical scores was significant in the Viburnum opulus group than in controls. The urinary scores decreased in both struvite subgroups, but no statistical differences were determined. All animals except the calcium oxalate control group were clinically healthy at the second visit. Using Viburnum opulus as an integrative medical approach will provide safe and effective treatment for urolithiasis/crystalluria. Keywords: viburnum opulus, urolithiasis, crystalluria, small animal, supplement
... That was the first study reporting a significant impact of nutritional intervention on the long-term recurrence of idiopathic cystitis in cats. The effects of a therapeutic urinary stress diet 1 have since been evaluated in an open trial case series in cats with FIC without a control group (Meyer & Bečvářová, 2016). This study is the first cohort study designed to evaluate the effect of therapeutic urinary stress diet, 1 in comparison with control commercial diets, on the short-term recurrence of FIC in client-owned cats with naturally occurring FIC. ...
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Analysis of large datasets of uroliths is necessary to illustrate the prevalence and risk factors of urolithiasis. Furthermore, it may help to improve treatment and prevention of urolithiasis. In this study, 7866 uroliths (44.5% feline and 55.5% canine) from veterinary practitioners in the Netherlands between 2014 and 2020 were analysed. Between 2014 and 2020 the distribution over the different types of uroliths remained similar over time. Female cats, obese cats, Domestic Shorthair cats, female dogs, and large breed dogs had an increased risk for struvite. Neutered cats, all cat breeds except Domestic Shorthair, neutered dogs, male dogs, intact male dogs, and small breed dogs had an increased risk for calcium oxalate urolithiasis. Cystine and urate were found predominantly in male dogs. Dalmatians were at highest risk for urate urolithiasis. The findings of this study in the Netherlands were similar to findings in previous studies from different countries. However, urate urolithiasis in the English Cocker Spaniel and cystine urolithiasis in the Yorkshire Terrier were new associations. Body condition score, information about recurrence of urolithiasis, medical history, and diet history should be included in submission sheets in the future to explore other possible associations.
... Complementary remedies such as melatonin, plug-in pheromones 8,15 (Feliway Classic and/or Friends aka MulticatCeva Animal Health Ltd.), suntheanine (Pet Remedy and/or Anxitane Virbac), milk protein hydrolysate (Zylkene Intervet Schering Plough) 71 , essential oils (e.g., lavender) 8,15,17 and amino acid/herbal combinations (e.g., Help My Pet-Nerves, VetPartners Limited), may help in re-establishing the sleep-wake cycles and reducing anxiety. ...
Article
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Cognitive dysfunction syndrome (CDS) is an established condition in cats that shares many similarities with human Alzheimer's disease (AD), where cognitive decline ultimately results in dementia. Cats with CDS display behavioural abnormalities, including excessive Vocalisation, altered Interaction with owners (increased affection/attention), altered Sleep‐wake cycles, House‐soiling, Disorientation (spatial and/or temporal), alterations in Activity, Anxiety, and/or Learning/memory deficits (i.e., VISHDAAL). These cats develop neuropathologies, such as accumulation of β‐amyloid and hyperphosphorylated tau deposits. Because of its similarities to those in the brains of people with cognitive impairment and AD, the domestic cat could be a natural model for human dementia studies. It is important to diagnose CDS promptly in cats, ruling out other causes for these behavioural changes, to provide effective management. Interventions include environmental enrichment (e.g., easy access to key resources, calming pheromones), dietary supplementations (e.g., Senilife, Aktivait for cats, SAMe), specific diets (e.g., containing antioxidants, medium‐chain triglycerides) and, potentially, medication (e.g., selegiline or propentofylline). This article reviews the literature about CDS in cats, its causes, neuropathology, clinical signs, diagnosis and potential management options. By doing so, it furthers our understanding of this condition and allows improved health, welfare and quality of life of affected cats.
... The same ingredients were used for a special diet to reduce the signs of feline idiopathic cystitis. The "cat emotional and quality of life score" improved significantly after the diet was administered for eight weeks [32]. Other studies [4,6,8,33], focusing on stress and behaviour, used the cat-stress-score (CSS) designed by Kessler and Turner [33]. ...
Article
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The aim of this study was to evaluate the impact of α-s1 casozepin on cat stress responses at a veterinary practice. Cats feel confident in their familiar surroundings and daily routine. A visit, and transport, to the veterinarian is a stressful experience for cats and their owners. Stress can mask clinical signs and has physiological impacts. Alpha-s1 casozepin (Zylkène; Vétoquinol) could potentially minimize stress in cats with its calming and anxiolytic characteristics. A randomized, partial double-blind and placebo-controlled study was carried out with 60 adult cats. The trial was designed for three groups: low dose (15 mg/kg q24 h α-s1 casozepin for six days), high dose (75 mg/kg q24 h α-s1 casozepin for three days), and a placebo (one fructose capsule per day for three days). For the study, cats had a checkup at their trusted veterinarian without the dietary supplement, followed by a second one four weeks later. Alpha-s1 casozepin or a placebo was administered three to six days before the checkup. Fecal cortisol metabolites (FCMs) were measured to non-invasively evaluate the impact of α-s1 casozepin on adrenocortical activity. The cat owners and veterinarians also assessed the physiological reactions (respiratory rate, sweaty paws, pupils, panting, and vocalization) of the cats at home, in the waiting area, and in the examination room. The only significant effect (kappa coefficient κ = 0.007 and κ = 0.003) found in this study was the absence of sweaty paws in cats who were treated with the high dose of α-s1 casozepin over three days, observed in the waiting area and examination room of the veterinarian’s practice, respectively. Alpha-s1 casozepin also showed a small but insignificant reduction in FCM levels. Alpha-s1 casozepin influences the autonomic nervous system, and can inhibit sweaty paws during stressful situations for cats.
... That was the first study reporting a significant impact of nutritional intervention on the long-term recurrence of idiopathic cystitis in cats. The effects of a therapeutic urinary stress diet 1 have since been evaluated in an open trial case series in cats with FIC without a control group (Meyer & Bečvářová, 2016). This study is the first cohort study designed to evaluate the effect of therapeutic urinary stress diet, 1 in comparison with control commercial diets, on the short-term recurrence of FIC in client-owned cats with naturally occurring FIC. ...
Article
Full-text available
The aim of this cohort study was to evaluate the effect of a therapeutic urinary stress diet on recurrent clinical signs of lower urinary tract disease in cats with idiopathic cystitis. The effects of feeding a therapeutic urinary stress diet were compared with feeding a non‐therapeutic diet for a duration of 5 weeks. The owners selected themselves which food to feed their cat. Of 31 cats with acute non‐obstructive idiopathic cystitis, 17 were fed the test food and 14 the control food. An episode of recurrence was defined as a minimum of one day with at least two clinical signs; i.e. stranguria, periuria, haematuria, dysuria and pollakiuria. The number of cats fed the therapeutic urinary stress diet that had an episode of recurrence (5/17) was significantly lower compared with cats that were fed other commercial diets (11/14). The formulation of the foods fed to the participating cats (dry, moist or a combination of both) was not found significant compared with the recurrence of idiopathic cystitis. Apart from type of diet, no other risk factors affected the short‐term recurrence of FIC. A prospective clinical trial is needed to confirm these findings.
... 23 A more recently released diet containing alpha-casozepine has been shown to improve anxiety scores and help to reduce the signs associated with feline lower urinary tract disease. 20 It should be noted that these diets contain other functional ingredients, such as tryptophan, which may also contribute to their effectiveness. ...
Article
Behavioral problems of companion animals are becoming more widely recognized. As a result, there are a growing number of behavioral nutraceuticals and diets on the market. These products may be useful for the treatment of mild conditions, for clients who are hesitant to give their pet a psychopharmacologic agent, or sometimes in conjunction with psychopharmacologic agents. Veterinarians should critically review the research associated with nutraceuticals and diets, and have an understanding of the functional ingredients and their mechanisms of action before prescribing treatment. This article provides an overview of nutraceuticals, their mechanisms of action, and relevant research regarding their use.
... In an open, non-controlled trial, 10 cats with idiopathic cystitis were fed a therapeutic food in dry or wet form or combination thereof (9). The foods contained milk protein hydrolysate and on average 235 mg L-tryptophan/MJ. ...
Research
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Therapeutic de-stressing foods for cats Some cats are easily stressed by things such as unfamiliar people, other pets and noise. Signs of feline stress and anxiety may include aggression, urine spraying or going outside the box, compulsive licking, hiding and not eating. Owners wish to comfort their anxious cats. The marketplace offers calming products in the form of collars, plug-in diffusers and sprays that are claimed to emit volatile relaxants. Chews making de-stressing claims are also available. Cat foods for stress relief are almost exclusively found among the therapeutic foods. The primary or secondary disease indication of these foods is lower urinary tract disease, particularly so-called feline idiopathic cystitis (FIC). Affected cats show abnormal urination that may be frequent, painful, difficult, bloody or at inappropriate places. Clinical signs usually resolve spontaneously, but recur after variable periods. Stress is assumed to mediate the development of FIC. As treatment of FIC, veterinarians often recommend stress reduction through environmental modification and/or a therapeutic food containing hydrolysed milk proteins and extra L-tryptophan. The hydrolysate is positioned as a source of alpha-casozepine, a small protein purported to inhibit anxiety. However, the quantitative equivalent to effective alpha-casozepine is unknown. L-tryptophan is an essential nutrient present in proteins. It is advanced to stimulate brain serotonin synthesis thereby promoting better mood. Current research data on L-tryptophan and alpha-casozepine supplementation are inadequate to substantiate their application in feline stress management. There is no scientific evidence that therapeutic de-stressing foods are effective in anxious cats or in FIC for that matter. L-tryptophan The tryptophan allowance for adult cats is 78 mg/MJ of metabolisable energy (1), which corresponds with 0.12 % in a dry food (1.55 MJ/100 g). Complete dry foods for healthy, adult cats generally contain at least 0.20 %. L-tryptophan can be converted into serotonin, which is believed to enhance mood. Supplemental L-tryptophan can only reduce stress when the pathway leading to serotonin is not saturated with substrate. In a double-blinded study (2), the food of multi-housed cats was topped with a placebo (n=12) or L-tryptophan (12.5 mg/kg body weight.day; n=13) for 8 weeks. The tryptophan content of the food is not reported. Additional L-tryptophan (about 50 mg/MJ) reduced agonistic and house-soiling behavior. It also restricted affiliative and explorative behavior, which is undesirable. The data are insufficient to select dose and support effectiveness of supplemental L-tryptophan in feline stress control. Alpha-casozepine
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Idiopathic cystitis is a diagnosis of exclusion, since its characteristic symptoms of stranguria, dysuria, periuria, macrohematuria, urinary retention are inherent in other pathologies associated with diseases of the genitourinary system in cats. In the differential diagnosis of idiopathic cystitis in cats, it is necessary to exclude: urolithiasis, renal failure, urinary tract infection, all forms of acute and chronic cystitis, behavioral periuria, structural abnormalities of the urinary tract organs, since to date there is no single diagnostic method that allows to unambiguously establish this diagnosis. The article presents the results of studies on the peculiarities of the spread of the disease idiopathic cystitis in cats in the veterinary clinic “Vetdoktor” in the city of Yekaterinburg. The frequency of cases of the disease for 2021-2023 was analyzed, where the diagnosis of idiopathic cystitis was determined in 944 animals, which averaged 7,1% of the total number who applied to the clinic. It was found that the number of cases of idiopathic cystitis of cats is evenly distributed by seasons and is 26,5% in autumn, 28% in winter, 22,5% in summer and 23% in spring. The age dynamics of the incidence of idiopathic cystitis in cats has been studied. Where it was determined that the most common idiopathic cystitis occurs in cats aged three to five years and amounted to 45,4%, as well as 39,7% aged one to three years and 14,8% in animals older than five years. The results of clinical and laboratory research methods are presented physical and chemical parameters of urine microscopy. Ultrasound diagnostics revealed signs of bladder inflammation in all animals.
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Research into cognition in cats and the impact of nutrition on cat cognitive health lags behind that in dogs but is receiving increased attention. In this review, we discuss the evolutionary history of the domesticated cat, describe possible drivers of domestication, and explore the interrelationships between nutrition and cat cognition. While most cat species are solitary, domesticated cats can live in social groups, engage in complex social encounters, and form strong attachments to humans. Researchers have recently started to study cat cognition using similar methods as those developed for dogs, with an initial primary focus on perception and social cognition. Similar to dogs, cats also show cognitive and behavioral changes associated with stress and aging, but these signs are often gradual and often considered a consequence of natural aging. Despite the fundamental role of nutrition in cognitive development, function, and maintenance, research into the association between nutrition and cognition in cats is only preliminary. Ultimately, additional research is needed to gain a full understanding of cat cognition and to explore the role of nutrition in the cognitive health of cats to help improve their welfare.
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The purpose of this study was to evaluate the use of a body condition scoring system as a tool to manage body weight in our dog colony. We believe that body condition extremes have a pronounced potential impact on pharmaceutical assessment studies. We selected animals from our colony for participation in a dietary management program based on body condition scoring and body weight. Dietary amount was adjusted according to the current and desired conditions of the animal. Animals were re-evaluated monthly, and diet was adjusted based on the progress the animal was making toward its goal. Retrospective analysis of the data showed that approximately 3 months of enrollment in the dietary management program was required to optimize body condition in our dogs. Nearly twice as many female than male animals were enrolled in the program for weight loss, and they were enrolled at a significantly younger age (784.3 days versus 1063.9 days, respectively, P = 0.02). Nearly six times as many female animals were enrolled for weight loss as weight gain. Conversely, twice as many males than females were enrolled for weight gain, but differences in age for these animals were not significant. There was a significant negative correlation (-0.68, P < 0.01) between age and rate of loss of body condition for female dogs. Body condition scoring was a less sensitive indicator of progress on the program than was body weight, with a 6.5% to 7.2% change in body weight seen for each incremental change in score. It took between 2 and 4 months for the body condition score to change by one increment. Correlations between change in body condition and body weight were poor, except in the group of male animals enrolled for weight loss (0.84, P < 0.01). We conclude that body condition scoring is useful for dietary management of a dog colony within the time frame we have described, with the caveat that correlations between weight change and body condition score change is somewhat variable. Older female dogs offered particular challenges for management of obesity.
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This prospective observational study evaluated client-reported recurrence of lower urinary tract signs (LUTS) and other signs of abnormalities in cats with idiopathic cystitis after institution of multimodal environmental modification (MEMO). Forty-six client-owned indoor-housed cats with idiopathic cystitis, diagnosed based on a history of recurrent LUTS and evidence of absence of urolithiasis or bacterial urinary tract infection were studied. In addition to their usual care, clients were offered recommendations for MEMO based on a detailed environmental history. Cases were followed for 10 months by client contact to determine the effect of MEMO on LUTS and other signs. Significant (P<0.05) reductions in LUTS, fearfulness, nervousness, signs referable to the respiratory tract, and a trend (P<0.1) toward reduced aggressive behavior and signs referable to the lower intestinal tract were identified. These results suggest that MEMO is a promising adjunctive therapy for indoor-housed cats with LUTS, and should be followed up with prospective controlled clinical trials.
Morbidity of UK cats: Results of a health survey
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Prevalence of lower urinary tract disorders of dogs and cats in the United States
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Sparkes, A. Feline Idiopathic Cystitis: Epidemiology, risk factors and pathogenesis. Proceedings Hill's Global Symposium on Feline Urinary Tract Health, 2014.
Role of hypothalamo-piuitary-adrenal axis and the sympathetic nervous system in the pathogenesis of feline idiopathic cystitis. Proceedings Hill's Global Symposium on Feline Urinary Tract Health
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Westropp, J. Role of hypothalamo-piuitary-adrenal axis and the sympathetic nervous system in the pathogenesis of feline idiopathic cystitis. Proceedings Hill's Global Symposium on Feline Urinary Tract Health, 2014.
Effect of dietary intake of L-Tryptophan supplementation on multi-housed cats presenting stress related behaviors
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Pereira, G.G., Fragoso, S., Pires, E. Effect of dietary intake of L-Tryptophan supplementation on multi-housed cats presenting stress related behaviors. Proceedings of the 53rd BSAVA Congress 2010.