Rx diets Flashcards

Question

What are some common antioxidants

Answer 1

Vitamins Vitamin E, Vitamin C Minerals Selenium, Manganese Amino acids Taurine, glutathione Other Green tea polyphenols (also inhibit inflammation, inhibit the destruction of cartilage and promote collagen synthesis) Combats oxidative stress

Answer 2

Perna canaliculus Species of mussels found along the coast of New Zealand Mussels act as a sea water filter and tend to retain essential nutrients Contain large number of active substances: Omega 3 fatty acids Chondroitin and Glucosamine Vitamins E and C Zinc, Copper, Manganese

Answer 3

Weight loss if necessary 6% reduction in weight has been shown to improve mobility and quality of life in dogs Many multi-function options available Multimodal therapy! Analgesics, physiotherapy, alternative therapies

Answer 4

Obesity can contribute to various health conditions, decreased quality of life and life span Preventable and treatable

Answer 5

Promote healthy weight loss Restrict energy without restricting nutrients

Answer 6

Reduced fat (calories) Reduced carbohydrates (lower glycemic index) Increased fibre (satiating effect; lowers caloric density) Increased proteins (maintain lean body mass) L-carnitine (promotes the use of fat as an energy source) Balanced levels of nutrients, minerals and vitamins to ensure needs are being met despite marked caloric restriction

Answer 7

Promote healthy exercise Carefully measure portions Smaller, more frequent feedings Consider treats Canned food or adding water to diet Prevention is key

Answer 8

Proteins that we eat have epitopes on the surface The cells in our bodies have matching IgE receptors When we eat proteins to which a sensitivity has developed, these epitopes cross-link to two or more IgE receptors to “unlock” a histamine release See inflammation and the clinical signs of an allergic reaction

Answer 9

Reduce the clinical signs associated with food allergies Cutaneous Adverse Food Reactions (cAFR): pruritus, skin infections, hair loss Non-cutaneous Adverse Food Reactions (typically GI): vomiting, diarrhea Diets need to be formulated with extensive quality control methods to avoid the risk of protein contamination (ie, off-label protein sources)

Answer 10

Appropriate protein source that does not elicit an allergic reaction Novel protein Hydrolyzed protein

Answer 11

Dependent on the individual patient and individual allergies Need to consider what has this pet NOT been exposed to previously? Cross-reactivity can occur between closely related species (ie, chicken and duck) but possible non-related species (ie, fish and mammals)

Answer 12

Proteins are broken down into smaller fragments to evade the immune response Depending on the size of the protein pieces and the sensitivity of the pet, may or may not elicit and allergic reaction 40% of dogs with a chicken allergy responded to a partially hydrolyzed poultry diet; 60% did not! 0% of dogs with a chicken allergy responded to an extensively hydrolyzed poultry diet

Answer 13

Complete dietary history necessary to determine what proteins pet has been exposed to previously Trial should be performed for 8 weeks, and diet fed EXCLUSIVELY Dietary challenge can be performed after positive response seen Add in single protein source one at a time to see if pet will respond Positive response to challenge indicates a protein the pet is sensitive to No response to challenge indicates a “safe” protein Helps determine potential long-term feeding options

Answer 14

Hypersensitivity of the immune system to allergens in the environment Pollen, fleas, cleaners, plants Clinical signs often seasonal Associated with seasonal allergens However can be year-round if allergen is year-round (ie, dust mites) Typically clinical signs associated with skin Can also affect the respiratory or gastrointestinal system Includes a weakened skin barrier which increases water loss and access of allergens

Answer 15

Improve skin health and reduce clinical signs of skin disease and environmental allergies

Answer 16

Highly digestible protein w appropriate amino acid profile Healthy fats EPA and DHA B vitamins and histidine Glycyrrhizin (licorice root extract)

Answer 17

30% of dietary protein goes to support skin and coat Heal skin and regrow hair coat

Answer 18

Maintains healthy skin barrier Reduces evaporation of water from the skin (less itching from dry skin) Reduces ability of environmental allergen to be absorbed through skin

Answer 19

Reduces inflammation Omega 3’s from fish oil (ie, EPA/DHA) shown to improve pruritus and inflammation better than omega 3’s from mineral oil or flax seed oil

Answer 20

Shown to help improve ceremide production and decreased transepidermal water loss Improve the skin barrier Decreases permeability of skin to allergens

Answer 21

Glycyrrhizin (licorice root extract) Immunomodulating effect (decrease activation of Th 2 IL4)

Answer 22

Multi-modal management Topical therapies Shampoos Immunotherapy Medications Allergen avoidance Possible concurrent cAFR

Answer 23

Wide variety of conditions that result in gastrointestinal disturbances The nutritional strategy is not always the same Consider whether the pet needs: Fat reduction Fibre modification Hydrolyzed or novel protein (ie, non-cutaneous adverse food reaction):

Answer 24

Support GIT, minimize irritation Promote emptying Normalize motility Address the symptoms–vomiting, diarrhea, constipation, weight loss, etc

Answer 25

Highly digestible protein Novel or hydrolyzed protein source if food reaction suspected Lower fat Aids in passage of food Necessary in fat-responsive conditions (ie, canine pancreatitis) Cats quite fat-tolerant! Supplemented electrolytes Fibre to help regular motility Can address both colitis and constipation Consider fibre types! Highly digestible carbohydrate sources Prebiotics to support healthy GIT microbiota

Answer 26

Consider food volume needs Post sx may require smaller food volumes–high calories Small, frequent feedings to avoid overloading the GIT Prebiotic fibre to feed the enterocytes Avoid repeated dietary changes Allow 3-6 weeks for the microbiome to adjust to the new diet

Answer 27

Liver aids in digestion, removal of waste products and production of molecules and substances necessary for both bodily function Many different conditions that can affect the liver A diagnosis is not made (ie, elevated liver enzymes) Need to consider the degree of disease, age of onset and specific condition Ie , PSS or MVD typically present in very young dogs Copper storage disease Genetic mutation related to copper excretion Can occur in Bedlington terriers, Labrador Retrievers, Dalmatians Results in excess copper build up in the liver

Answer 28

Provide an appropriate amount of protein In cases of PSS or MVD, lower protein recommended However low protein can result in muscle wasting Hepatic encephalopathy can be worsened when muscle mass is low since ammonia is metabolized by the liver Vegetable based proteins tend to be lower in purine which lower the metabolic demand on the liver Moderate sodium levels Management of portal hypertension Restricted copper levels When necessary

Answer 29

Contains pharmaceutical compound silymarin Silymarin is a liver protectant Used in liver disease, cancer patients, patients who are on chronic drug therapies with adverse liver effects Such as phenobarbital or steroids There is a wide therapeutic range (mg/kg dose) and has few adverse effects

Answer 30

Kidneys function to process and eliminate waste products via the urine, as well as conserve water and balance minerals Kidney dysfunction results in build up of waste products and loss of concentrating ability of the kidneys Kidney disease is diagnosed and staged based on evaluation of various laboratory tests (creatinine, SDMA, RenalTech, USG, proteinuria,etc) Staging is important to understand the medical and nutritional priorities of the patient Very generally, the nutritional recommendations can be broken down into early renal recommendations (IRIS Stage I-II in dogs, IRIS Stage I in cats) and advanced renal recommendations (IRIS Stage III-IV in dogs, IRIS Stage II-IV in cats) Some exceptions exist!

Answer 31

: Slow down the progression of renal disease No diet can “prevent” or “stop” renal disease Support energy requirements Maintain lean muscle mass Support hydration

Answer 32

Protein may play a role in progression of renal disease High levels of dietary protein were historically linked to faster progression of experimentally induced kidney disease in cats Lower protein diets are recommended to manage chronic renal insufficiency Would you recommend a lower-protein diet to protect against renal disease? High protein intake has not been shown to contribute to the development of CKD in healthy pets More recent studies show that the role of dietary protein in the progression of CKD is confounded by caloric intake and differences in protein source Exact protein requirements of animals with CKD is unclear Dietary phosphorus restriction is key to help slow down disease progression Most of phosphorus from the ingredients comes from the protein source Protein restriction in renal disease = phosphorus restriction

Answer 33

High quality protein (mitigate muscle loss) Moderate phosphorus restriction (below AAFCO minimum not necessary at this time) Omega 3 FA (anti-inflammatory, improve blood flow to the kidneys) Antioxidants (Vitamin E & C,ß carotene)

Answer 34

Low protein (mitigate urea and creatinine build up) Low phosphorus (highest link to longevity) Low sodium (mitigate hypertension) Omega 3 FA (anti-inflammatory, improve blood flow to the kidneys)

Answer 35

Diet transitions in advanced stages are SLOW (sometimes weeks) Need to consider nausea and malaise that may be affecting appetite Ensure adequate hydration SQ or IV fluids may be necessary Ensure energy needs being met In advanced stages feeding tubes may be necessary

Answer 36

Characterized by an overproduction if the thyroid hormone, resulting in an increased metabolic rate Weight loss Polyphagia Restlessness, aggression Night wandering, vocalization Common in older cats (typically >12 years) Some environmental risk factors including exposure to some pollutants, have hypothesized to be a predisposition

Answer 37

Hill’s y/d is the only formula to nutritionally manage hyperthyroidism Limited iodine intake to control T4 production L-carnitine to maintain muscle mass Needs to be fed exclusively Good option in cases where there are no concurrent health conditions needing nutritional management, and when other methods of treatment not possible

Answer 38

Urine is not just water Also contains minerals and mineral precursors Genetic predispositions and lifestyle factors can increase the risk of certain minerals accumulating to form crystals or uroliths (stones) Most common stone types are struvite and calcium oxalate

Answer 39

Risk factors include: Obesity Stress Diet Breed Water intake

Answer 40

Increase urine volume Typically by increasing water intake Results in lower USG Dissolve struvite crystals/uroliths Calcium oxalate stones cannot be dissolved, must be removed Create urinary environment less favorable to development of crystals/stones

Answer 41

In dogs, almost always secondary to a UTI In cats, the cause is multifactorial

Answer 42

Genetic predisposition Medical conditions resulting in hypercalcemia

Answer 43

Controlled levels of magnesium and phosphate (struvite) Controlled levels of calcium (calcium oxalate) Acidifying (struvite) Alkalinizing (calcium oxalate) Additionally, can manage concurrent conditions which increase risk Obesity Stress

Answer 44

Encourage water intake Fresh water Alternative water types (still, filtered) Alternative watering methods (fountain, bowl, tap) Alternative receptacles (bowl size, shape, depth) Small frequent feedings Provide opportunities to urinate

Answer 45

Size–small breeds Breed–Greyhounds, Basset Hounds, Boxers Age–increased with age Anatomy–brachycephalics, retained deciduous teeth Lifestyle–hard chews Disease–Felk, FIV, certain medications

Answer 46

COHAT Brushing Chews/treats/diets

Answer 47

Crunching action of dry should clean teeth Less residue in the mouth with dry Less dental disease? Studies suggest no Many kibbles shatter with chewing, no mechanical cleaning Size, shape and texture of the kibble can have positive effect Dietary fibre can affect plaque and tartar formation This really only benefits chewing teeth

Answer 48

Promote chewing and full contact with teeth Texture, shape, size Prevent the mineralization of plaque to tartar Calcium chelators Limited calcium levels Antioxidants to reduce oxidative stress

Answer 49

Esophageal foreign body obstruction Tongue entrapment High calories (weight gain) Nutritional imbalances if fed excessive treats Gastrointestinal upset Fractures from very hard chews (antlers, hooves, nylon bones) Should be able to dent chew with a fingernail