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Introduction to nutrition Feeding Healthy Dogs & Cats
Nutrition series – 2
Dr. Sarah Wilson

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Feeding healthy dogs & cats - Outline
- Nutritional assessment
- Screening & extended evaluation
- Healthy Dogs & Cats - Categories
- Feeding healthy dogs & cats
- Amount, management, diet choices
- Life Stage Nutrition
Note: No conflicts to disclose. Any images of specific diets are not an endorsement of that specific food or company – simply a visual aid

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How to evaluate basic nutrition
WSAVA
Global Veterinary Development
Nutritional Assessment Guidelines
Image from: https://www.wsava.org/ WSAVA/media/Documen ts/Committee%20Resour ces/Global%20Nutrition %20Committee/English/ Diet-History-Form.pdf

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Nutritional Assessment
Two part process depicted in Figure 1
1)Screening Evaluation
2)Extended Evaluation
Figure 1 taken from (https://www.wsava.org/Guidelines/Global -Nutrition-Guidelines)
Screening nutritional assessment
Nutritional risk factors present
Extended nutritional assessment
No risk factors present
No further action required
Figure 1. An illustration of the two-part nutritional assessment process.
A Screening evaluation is performed on every patient.
Based on this screening, pets that are healthy and without risk factors need no additional nutritional assessment.
An Extended Evaluation is performed when one or more nutrition-related risk factors are found or suspected based on the screening evaluation.
Journal of Small Animal Practice
Vol00
June 2011
2011 WSAVA

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Nutritional Assessment
- Iterative process evaluating factors affecting nutritional status
- Animal
- Diet
- Feeding management
- Environmental

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Nutritional Assessment
- Animal – specific factors:
- Age, neuter status, activity level, BCS
- Problems – intolerances, allergies, organ disease

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Nutritional Assessment
-Diet – specific factors:
- Appropriate (lifestage/balanced), safe, palatability, volume
- Problems – nutrient imbalances, contamination/spoilage, adulteration

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Nutritional Assessment
- Feeding management factors:
- Frequency, location, timing, method of feeding
- Problems – over or underfeeding, excessive treats

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Nutritional Assessment
- Environmental factors
- Space and quality of pets' surroundings, number of pets
- Problems – competitive eating, lack of appropriate environmental stimulation

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Screening Evaluation
Physical Examination
- TPR, pain, nutrition
- Body Condition Score (BCS) – every visit
- Indicate scale (i.e. 5/9)
- Muscle Condition Score (MCS) – every visit
- Normal, mild, moderate, & severe muscle loss

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Screening Evaluation
- Nutritional assessment – routine history
- Be sure to get animal, diet, feeding management, & environmental factors
- Certain factors may not cause concern – i.e. adult intact dog 4 y
- High or low activity, multi-pet household, gestation, lactation, puppies under 1 year, animals as they age 'senior'

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Extended Evaluation
- Any red flags – investigate further
- Further history details
- Possibly diagnostics
- radiographs, bloodwork
- Need to implement a plan
- Diet (+/- treats, supplements)
- Feeding plan with details
- Monitoring & follow - up
Images from: https://wsava.org/WSAVA/media/Documents/Committee%20Resources/Global%20Nutrition%20Committee/English/ Nutritional-Assessment-Checklist.pdf

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Monitoring
- Healthy dogs and cats (BCS & MCS included) should be reassessed regularly
- A dog or a cat with a BCS of 7/9 is not considered healthy! Address overweight/obese
- Monitoring frequency – determined by individual patient needs
- Owners can monitor at home
- Food intake, appetite, BCS, BW, GI signs (stool quality, vomiting, diarrhea), overall coat quality, appearance, activity level

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Nutritional Assessment
Two part process depicted in Figure 1
1)Screening Evaluation
2)Extended Evaluation
Figure 1 taken from (https://www.wsava.org/Guidelines/Global -Nutrition-Guidelines)
When patient returns for re-check begin the process again
Screening nutritional assessment
Nutritional risk factors present
Extended nutritional assessment
No risk factors present
No further action required
Figure 1. An illustration of the two-part nutritional assessment process.
A Screening Evaluation is performed on every patient.
Based on this screening, pets that are healthy and without risk factors need no additional nutritional assessment.
An Extended Evaluation is performed when one or more nutrition-related risk factors are found or suspected based on the screening evaluation.
Journal of Small Animal Practice
Vol 00
June 2011
2011 WSAVA

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Normal feeding behaviour
DOGS
- Omnivores
- Pack eaters
- Increase intake – social facilitation
- Competition style – may need to adjust feeding
- i.e. feeding, Bolting change food - food puzzles, type separate (canned to while dry)
CATS
- Obligate carnivores
- Small frequent meals
- Not great drinkers
- Lack of sensory/environmental stimuli & excessive calories can lead to weight gain
-Consider alternate feeding methods - hunting food toys, increase activity with toys during the day - be sure cats aren't stealing food

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Healthy Dogs & Cats
- Nutrient profiles
- Nutrient requirements
- Association of American Feed Control Officials (AAFCO 2018)
(Dogs & Cats)
- Growth & Reproduction
- Adult Maintenance
- National Research Council: Nutrient Requirements of Dogs & Cats (NRC 2006)
- Growth (4-14 weeks*, 14 weeks & older*, & after weaning) (*puppies only)
- Late Gestation & Peak Lactation
- Adult Maintenance

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Healthy Dogs & Cats
- Nutritional Adequacy Statement
- AAFCO
- Complete and balanced, life stage (maintenance, growth, all life stages)
- If NOT – ""intermittent or supplemental use only "" = TREAT only (<10%)
-Only acceptable longer term use if using a veterinary therapeutic diet
- i.e. Chronic Kidney Disease
This pet food is formulated to meet the nutritional levels established by the Association of American Feed Control Official (AAFCO) dog food nutrient profiles for adult maintenance.
Image from: https://www.pfiaa.com.au/Feeding-Pets/Pet-Food-Labelling-Keeping-up-the- Standard.aspx

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Healthy Dogs & Cats
- Nutritional Adequacy Statement
- AAFCO
- Statement should indicate how the diet was substantiated to be complete and balanced
-Feeding trial, formulated
- Statement should indicate what life stage the diet is designed for
-Growth & reproduction, adult maintenance, all life stages
This pet food is formulated to meet the nutritional levels established by the Association of American Feed Control Official (AAFCO) dog food nutrient profiles for adult maintenance.
Image from: https://www.pfiaa.com.au/Feeding-Pets/Pet-Food-Labelling-Keeping-up-the- Standard.aspx
Animal feeding tests using Association of American Feed Control Officials(AAFCO)procedures substantiate that Purina Pro Plan Veterinary Diets EN Gastroenteric Dry Canine Formula provides complete and balanced nutrition for growth of puppies and maintenance of adult dogs. Animal feeding tests using AAFCO procedures substantiate that EN Gastroenteric Canned Canine Formula provides complete and balanced nutrition for maintenance of adult dogs.

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Feeding healthy dogs & cats - Feeding amount
- How much to feed?
- Determine ideal intake
- Diet history – best if accurate, patient is weight stable at ideal weight & BCS
- Energy calculations – MER & adjust intake with monitoring
- Follow directions on commercial diet – Starting point, adjust intake with monitoring

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Feeding amount – Diet history
- Be as specific/detailed as possible
- Name and amount of food
- Name and amounts of snacks/ treats/ supplements
- Feeding frequency and style of feeding
- Access to other sources
- How long has food been fed

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Feeding amount - Energy requirements
- Resting Energy Requirements (RER) – the energy needed for a normal unfasted animal at rest under normal temperature conditions
- Maintenance Energy Requirements (MER) – the energy needed to keep an animal in a maintenance state
- Includes activities necessary for work, growth, reproduction, lactation
- Also referred to as Daily Energy Requirement (DER)

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Feeding amount - Energy requirements - RER
- RER calculations (provide an estimate of daily resting energy requirement)
- 30 x (Body weight in kg) + 70 (linear)
Or
-70 x (Body weight in kg)0.75
Metabolic body weight = kg0.75
- Example: 10 kg dog (M/N, 3 y, BCS5/9)
- 370 kcal / day RER (linear)
- 394 kcal / day RER

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Energy requirements - MER
MER = RER x Factor = estimate of maintenance energy requirement
Canine
- Intact Adult 1.8
- Neutered Adult 1.6
- Puppies < 4mos 3.0
- Puppies >4 mos 2.0
- Obese prone 1.4
- Low activity 1.4
- Weight loss 1.0
- Critically ill 1.0
Feline
- Intact Adult 1.4
- Neutered Adult 1.2
- Kittens < 4mos 3.0
- Kittens >4 mos 2.0
- Obese prone 1.0
- Low/No activity 1.0
- Weight loss 0.8-1.0
- Critically ill 1.0

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Feeding amount - Energy requirements - MER
- MER = RER x Factor = estimate of maintenance energy requirement
- Example: 10 kg dog (M/N, 3 y, BCS 5/9)
- RER (previously calculated)
- 370 kcal / day (linear)
- 394 kcal / day
- MER = 394 kcal/ day x (Neutered adult factor 1.6)
- MER = 592 kcal / day(linear)
- MER = 630 kcal /day
Use 630 kcal/day as a starting point to feed

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Feeding management
- Once feeding amount is determined – how will that food be provided?

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Feeding management – Ad-lib
Extruded diets only (dry kibble)
Ad-libitum/Free choice +
- Pet +/- regulates own intake
- Low effort for owner
- Allows cats natural feeding behaviour
- Allows pets a chance to eat (slow, picky, subordinates in multi-pet household)Ad-libitum/Free choice -
- Pet +/- regulates own intake
- Lack of monitoring (may miss decreased intake)
- Can lead to weight gain
- May lead to animals in multi-pet household not achieving adequate intake

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Feeding management – Timed
All diets - Extruded & canned diets
Timed feeding +
- Dog +/- regulates own intake within time limit
- Reasonably low effort for owner
- Allows for monitoring of intake
Timed feeding -
- More effort for owner than ad-lib feeding
- May lead to bolting or other problems (i.e. excessive intake, aerophagia) in some animals
- Doesn’t allow time for slow or picky eaters
- May not allow subordinates in multi-pet household adequate access\

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Feeding management – Portion-control
All diets - Extruded & canned diets
Portion control +
- Allows careful management of intake
- Decrease chances of excessive intake leading to overweight/obesity problem
- Problems of intake identified earlier
- +/- Allows cats natural feeding behaviour (only if using dry & cat grazes)
Portion control -
- Most effort for owner

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Feeding management - Treats
- Owners give snacks/treats regularly
- Must account for those calories
- Less than 10% of total intake – otherwise unbalances diet
- Remember to ask about extras – dental chews, peanut butter in toys, training tools, supplements
Image from: https://www.petfoodindustry.com/articles/5232-trends-in-pet-treats via gvictoria.image/BigStockPhoto.com

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Diet choices - Common
- Dry commercial pet foods – 6-10% moisture
- + Cost effective, long shelf life, can be fed ad-lib
- - Palatability, improper formulation or preparation can lead to nutrient imbalances
- Canned commercial pet food – 75% moisture
- + Highly palatable, can increase water intake (cats), long shelf life
- - Palatability (excessive intake), cost, can not be fed ad-lib, cat specific preferences (mouth feel), improper formulation or preparation can lead to nutrient imbalances
- Semi-moist pet foods – 15-30% moisture
- + Highly palatable (often treats), convenient, less smell (vs. canned)
- - Costly, can dry out, improper formulation or preparation can lead to nutrient imbalances

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Diet choices – Alternatives – Raw1
- Fresh, frozen, freeze-dried
- + Highly palatable, often see decrease in stool quantity (vs. dry food)
- - Higher risk of bacterial contamination, zoonotic risk, expensive, perishable, may not be balanced, improper formulation or preparation can lead to nutrient imbalances

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Raw diets - Risks
- Zoonotic risk
- Campylobacter, Clostridium, Escherichia coli, Listeria, Staphylococcus (enterotoxigenic), Salmonella, Toxoplasmosis etc.
- Can shed bacteria or oocysts although asymptomatic
- Tooth fractures, GI perforation
- Nutritional adequacy of the diet
- Fecal quality - HCD vs raw
- No documented benefit

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Raw diet position statements
- AAHA
- www.aaha.org/professional/resources/raw_protein_diet.aspx
- AVMA
- https://www.avma.org/KB/Policies/Pages/Raw-or-Undercooked-Animal- Source-Protein-in-Cat-and-Dog-Diets.aspx
- CVMA
- https://www.canadianveterinarians.net/documents/raw-food-diets-for-pets
Raw protein diet
past proponents of raw food diets believed that this was the healthiest food choice for pets. It was also assumed that feeding such a diet would cause no harm to other animals or to humans. There have subsequently been multiple studies showing both these premises to be false. Based on overwhelming scientific evidence, AAHA does not advocate or endorse feeding pets any raw or dehydrated nonsterilized foods, including treats that are of animal origin.

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CVMA Position statement
position
The Canadian Veterinary Medical Association(CVMA)and the public Health Agency of Canada(PHAC)believe that there is a body of evidence supporting the potential health risks for pets fed raw meat based diets, and for humans in contact with either raw meats or pets fed a raw meat diet.
The CVMA holds that the documented scientific evidence of potential animal and pubilc health risks in feeding raw meats outweigh any perceived benefits of this feeding practice.
The CVMA advises veterinarians that do recommend raw meat diets for pets under their care to be aware of potential liability concerns should a pet or in-contact human become ill due to pathogens originating in the diet.
The CVMA advocates that veterinarians recommending raw food diets must inform pet owners of potential risks(Background 3) and educate the owners on how to mitigate the real risk of pathogen exposure in both handling the food and in managing pets consuming raw meat diets.

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Diet choices – Alternatives – Home-prepared diets
- Fresh, frozen (Commercial or owner prepared)
- + Highly palatable, may be tailored to individual (using board certified veterinary nutritionist), highly digestible, strengthen human animal bond, perceived as natural/healthier/better
- - Nutritional adequacy 2,3,4,5 requires expertise
- Nutritional secondary hyperparathyroidism
- Not ideal for growth or reproductive stages
- - Expensive, perishable, bioavailability & digestibility not determined, diet drift

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Diet Drift... An example

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How do you choose?
- Balance: Patient & owners' needs & preferences
- WSAVA guidelines for "Selecting the Best Food for your Pet"

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Feeding healthy dogs & cats
- Many classifications - Life stages
- Growing
- Adult
- Reproduction – gestation & lactation
- Work / Exercise
- Senior?

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Energy requirements - MER
MER = RER x Factor = estimate of maintenance energy requirement
Canine
- Intact Adult 1.8
- Neutered Adult 1.6
- Puppies < 4mos 3.0
- Puppies >4 mos 2.0
- Obese prone 1.4
- Low activity 1.4
- Weight loss 1.0
- Critically ill 1.0
Feline
- Intact Adult 1.4
- Neutered Adult 1.2
- Kittens < 4mos 3.0
- Kittens >4 mos 2.0
- Obese prone 1.0
- Low/No activity 1.0
- Weight loss 0.8-1.0
- Critically ill 1.0

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Feeding life stages - Growth
- Meal feed puppies (kittens can be fed ad-lib)
- High quality food* appropriate for life stage (growth or all life stages)
- Large breed dogs – large breed puppy food or high quality puppy food
- Developmental Orthopedic Disease
- Feed to appropriate BCS
Growth rates first 5 months:
Puppies: 2-4 grams/day/kg of anticipated adult weight
Kittens: 50-100 grams/week

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Feeding life stages - Reproduction
- Gestation and lactation are the most energetically demanding life stage
- Ensure good BCS (dystocia, fertility)
- Gestation
- Queens increase intake immediately; Bitches increase intake in last third of pregnancy
- During peak lactation queen/bitch should have access to high quality growth food – may need 3-4 times normal calorie intake (more if large number of kittens/puppies)
- Peak production 3-4 weeks post partum; litter size is very important
- Free access to water – lactation = water

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Feeding life stages - Reproduction
- Weaning should be done gradually introducing puppies & kittens to gruel of high quality growth diet
- Once weaned bitch/queen should return to original maintenance amount

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Feeding life stages - Adult
- Best to maintain ideal BCS (4-5/9)
- Feed to individual needs – ex. more active, intact, lean high energy breed
- Many appropriate choices available to feed healthy adult dog or cat
- High price doesn’t always equal high quality

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Feeding life stages – Working dogs
- Many type of working animals - job determines energy requirements
- Hunting dogs, racing greyhounds, sledding huskies, agility trial dogs, show dogs, service dogs & cats, bomb sniffing dogs etc.
- Studies done on how to best feed prior to energy expenditure, or how to help recovery post exercise
- Maintain a healthy BCS

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Feeding life stages - Senior
- No actual agreed upon definition of senior dogs or cats
- Nutrient requirements undefined
- Diets: Highly digestible, increased fibre, high protein, reduced protein etc. - Goals:
- Maintain healthy BCS & MCS
- Prevent or slow disease onset
- Improve or manage clinical signs of current disease
- Ensure supplements/treats appropriate

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Veterinarian’s role
- Address owners concerns
- Pros & cons of various feeding strategies
- Validate owners desire to do the best for their pet
- Encourage a dialogue to develop a plan
- Nutrition can address disease and promote health
- Client education
- Discuss options – commercial vs HCD (properly formulated)
- Regularly check in with owner & pet!

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Helpful internet resources & references
- World Small Animal Veterinary Association (WSAVA) Global Nutrition Guidelines - https://www.wsava.org/Guidelines/Global-Nutrition-Guidelines
- American College of Veterinary Nutrition
- https://acvn.org
- Pet Nutrition Alliance
- http://www.petnutritionalliance.org/
- Online nutrition text: Small Animal Clinical Nutrition
- Http://bookstore.markmorrisinstitute.org/t/digital-books/sacn5-chapters- downloadable

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Helpful internet resources & references
Table from: https://www.wsava.org/WSAV A/media/Documents/Guideline s/WSAVA-Nutrition- Assessment-Guidelines-2011- JSAP.pdf
Helpful internet resources & references
Table 2 Useful web sites for client and staff education
1. AAFCO Association of American Feed Control Officials(Nutrient profils, feeding trials, ingredients)
http://www.aafco.org
2. AAHA American Animal Hospital Association
http://www.aahanet.org
3. AAVN American Academy of Veterinary Nutrition
www.aavn.org
4. ACVN American College of Veterinary Nutrition(Specialty college for board certification; list of institutions that provide consultation; continual updates of links to resources for diet formulation and analysis)
http://www.acvn.org
5. AVNT Academy of Veterinary Nutrition Technicians
http://nutritiontechs.org
6. European Society of Veterinary Clinical Nutrition
http://www.esvcn.com
7. FDA Center for Food Safety and Applied Nutrition(regulatory and safety issues,adverse event reporting, meetings,industry information)
http://www.fda.gov/AboutFDA/CentersOffices/CFSAN/default.htm
8. FDA pet Food Site (infomation,links,food safety issues,recalls,pet food labels,selecting nutritious foods, handling raw foods)
http://www.fda.gov/AnimalVeterinary/Products/AnimalFoodFeeds/PetFood/default.htm
9. European Pet Food Industry(Nutritional guidelines,guide to good food practice)
http://www.fediaf.org
10. Indoor Pet Intiative(Comprehensive recommendations for environmental enrichment for dogs and cats.)
http://indoorpet.osu.edu
11. NRC National Research Council(Nutrient Requirements of dogs and cats)
http://www.nap.edu/catalog.php?record_id=10668#toc
12. NRC Downloadable booklets.Yur Cat's Nutritional Needs and Your Dog's Nutritiona Need.Versions for pet owners:BANR Board on Agriculture and Natural Resources Petdoor Nutrient Requirements of Dogs and Cats.
http://dels-old.nas.edu/banr/petdoor.html/
13. NIH Office of Dietary Supplements(Evaluating supplements,internet health info, and more)
http://ods.od.nih.gov
14. University of California Davis Diet History Form(Downloadable Word document)http://www.vetmed.ucdavis.edu/vmth/small_animal/nutrition/newsletters.cfm
15. Pet Food Institute(Information on ingredient definitions,laveling regula-tions,ets.)
http://www.petroodinstitute.org/index.cfm?Page=Consumers
16. United States Pharmacopeia Dietary Supplement Verification Program(voluntary program)
www.usp-dsvp.org
17. USDA Food and Nutrition Information Center(General suppement and nutrition information,links to a varity of dietary supplement websites)
http://www.nal.usda.gov/fnic/etext/000015.html
18.USDA Nutrient Database(full nutrient profiles on thousands of human foods)
http://www.nal.usda.gov/fnic/foodcomp/search

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References
- Small Animal Clinical Nutrition 5th Ed. (Hand et al., 2010)
- Nutrient Requirements of Dogs & Cats (NRC, 2006)
- Applied Veterinary Clinical Nutrition (Fascetti & Delaney, 2012)
- Association of American Feed Control Officials (AAFCO, 2018)
- Manual of Veterinary Dietetics (Buffington et al., 2004)
- Canine and Feline Nutrition, A resource for companion animal professionals (Case et al., 2011)

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References – Alternative diet choices
1. Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats. Freeman et al. 2013; 243:1549 2. Evaluation of recipes of home-prepared maintenance diets for dogs. Stockman et al. JAVMA 2013; 242:1500 3. Evaluation of recipes for home-prepared diets for dogs and cats with chronic kidney disease. Larsen et al. JAVMA 2012; 240:532 4. Assessment of commercial diets and recipes for home-prepared diets recommended for dogs with cancer. Heinze et al. JAVMA 2012; 241:1453 5. Evaluation of the nutritional adequacy of recipes for home-prepared maintenance diets for cats. Wilson et al. JAVMA 2019;254:1172