Current Concepts

Nutrition is often overlooked in patients that present for wellness visits; however, it is important to collect a thorough nutritional history for all new and continuing patients, both sick and well, and update this history regularly. healthy lab photoA few short minutes spent on nutrition for every patient can result in better preventative care for well animals and improved outcomes for ill and hospitalized patients.  

It is useful to have a specific nutritional history form that clients will fill out when they first visit your practice. The form can then be updated at yearly visits. Important information to collect includes: brand and variety of diet(s) fed, the amount fed, whether the pet has access to other pet’s food, if the food is removed after eating or left out, food storage, the types and amounts of treats consumed, and the supplement types and amounts.

It is also important to note the pet’s general health – is the body weight appropriate, does the coat look healthy? Body weight should be obtained on every patient at every visit and entered into the permanent record. Body condition scoring (BCS) is also very useful and should be included in the record for every visit. Handouts on body condition scoring can be given to clients and they can be taught how to score their pets in between visits. Obesity is easier to prevent than to treat, so addressing BCS at every appointment and educating owners will help keep your patients healthier.

Muscle condition should be assessed in all animals and can be subjectively graded as normal muscle condition (A), mild muscle loss (B), moderate muscle loss (C), or severe muscle loss (D)

Muscle condition scoring is a useful adjunct to body weight and body condition score, as in most disease conditions, muscle is the primary tissue lost.

 

Wellness Visits – Red Flags 

Certain responses to the diet history should lead to follow-up questions designed to determine if the diet and feeding method is appropriate for the individual patient. Some common “red flags” include:

  • Feeding adult food to growing puppies and kittens – While foods labeled for “all life stages” of cats or dogs may be appropriate for kittens and some puppies, adult maintenance foods do not contain adequate amounts of nutrients to support ideal kitten or puppy growth. Additionally, some adult and “all life stages” dog foods contain excessive calcium and calories for large breed puppies, which can contribute to developmental orthopedic disease. All puppies expected to mature around 50 pounds or greater should be fed a diet specifically labeled for large breed puppies. All puppies (regardless of size) and kittens should ideally be fed a puppy/kitten food that has completed Association of American Feed Control Officials (AAFCO) feeding trials for growth or all life stages from weaning until adult size is reached (12 months in cats and smaller breed dogs, up to 18 months in giant breed dogs).
  • Free-feeding – Puppies and kittens should be meal-fed (i.e., feed individual meals instead of free choice feeding) to maintain a lean body condition (BCS 4/9 for large breed puppies, 4-5/9 for small and medium breeds, and 5/9 for kittens). Regardless of breed or species, clients should be counseled that food intake will usually need to be controlled after spaying or neutering to prevent weight gain. Meal feeding should continue throughout adulthood as a large percentage of adult dogs and cats will become overweight or obese if allowed free access to food
  • Home-cooked diets – If done correctly, home-cooking can be a viable alternative to commercial diets for adult dogs and cats. However, most home-prepared diets, whether designed by the pet owner or obtained from a book or online, are deficient in essential nutrients, especially those diets with variable ingredients. As growth is a critical period when marginal nutrient imbalances can lead to lifelong health problems, home-cooked diets are contraindicated for growing puppies and kittens. All clients interested in feeding a home-cooked diet should be urged to consult a board-certified veterinary nutritionist, such as those with the Tufts Clinical Nutrition Service.
  • Raw diets – Raw diets, especially home-prepared, generally have the same challenges as home-cooked diets. Most homemade raw diets are based on muscle meat and bone, and this combination is invariably deficient in numerous essential nutrients required for both normal growth and adult maintenance. These problems are compounded by the concern for pathogen exposure of both humans and animals. Exposure to pathogenic bacteria and parasites is particularly of concern for young puppies and kittens as well as in older animals that have altered immune systems due to disease or medications. However, even healthy animals can become ill from food-borne infections. Human pathogen exposure also is a concern, particularly for pets that live with young children, the elderly or people with altered immune systems (e.g., cancer patients).
  • Unlikely feeding amounts – e.g. an 80 pound dog being fed only 2 cups of food per day. Be sure to clarify that the food is measured using a standard 8 fluid ounce measuring cup. Some dogs and cats have very low energy requirements and will eat significantly less than the amounts recommended by the manufacturer of the diet. Pets of ideal body weight eating less than approximately 80% of the lower end of the manufacturer’s feeding range for their weight should be switched to a diet with a lower energy density (e.g., a light or low fat or reduced energy version of the current diet or a veterinary therapeutic weight management or weight loss diet) to help prevent nutrient deficiencies due to inadvertent nutrient restriction.
  • Excessive treats – treats should not exceed 10% of total daily calories to avoid an unbalanced diet by nutrient dilution. Most treats do not list caloric content on the package and most pet owners don’t realize the calories ingested due to these “treats.” Most dental treats are very high in calories (and usually are not nutritionally balanced), so they should be used sparingly to avoid obesity. The newly opened Tufts Obesity Clinic for Animals can also help guide clients with questions about weight management and optimal diet choice.