Pick your diet and nutrition battles carefully (Proceedings)

I would like to propose a line of thinking to simplify your nutritional assessment of a client's questions or statements concerning pet food products:

How to assess any diet or question posed by pet owners – 3 simple questions:

• Is the product claim complete and balanced?

• Would this particular nutrient profile harm my patient?

• Is this a food safety issue?

Is the product claim complete and balanced?

• The dreaded AAFCO statement now has becomes your new “BF” best friend.

• Good news: AAFCO label regulations do not distinguish between conventional and non-conventional pet foods and is required on every pet food label sold in USA except if:
• made/sold only in AK or NV

• clearly labeled as treat, snack or supplement

• is homemade diets (see more below).

• It is the most important preliminary piece of information on the label when assessing the diet for a particular patient. The statement will be one of only 3 types:
• Nutritionally complete and balanced (or prefect, scientific, 100% nutritious) is known or shown to be nutritionally complete.

• For supplemental or intermittent feeding only is assumed or known to be nutritionally incomplete as sole source of nutrition for an extended time. The specific clinical sign that may appear first and when is dependent upon the first limiting nutrient and magnitude of the variance from the recommended level (toxicity or deficiency).

• Feed under the supervision or direction of a veterinarian as seen on veterinary therapeutic dietary products. Many have passed AAFCO protocol feeding trial protocols but use Vet only label. A topic for another time.

• You only need to distinguish between 1 and 2: Nutritional complete and balanced or NOT!
• If yes - done √

• If not – now need to explain this to the pet owner and that should not be too difficult, i.e., no guarantee the diet contains all the nutrients known to be essential to the dog or cat.

Homemade diets: the AAFCO statement cannot help you here. 21% of dog owner and 15% of cat owners fed human food or a homemade diet.[i] Home prepared diets do not carry any nutritional adequacy statement because they are not sold as products – only as a recipe. Recipes are readily available in popular press pet books, textbooks, chat room, blogs and web sites from the one-dog-wonder pet owner, neighbor, family, friends, breeders, veterinarians, and various types of nutritionists (animal, human and veterinary) but only the latter two groups would be held accountable for their recommendations based on their training. Given 95% of 200 recipes reviewed were found to be nutritionally inadequate,[ii] it is important to have some form of nutritional guarantee from the author of the recipe.

There are two major areas of concern with homemade diets:

• Is the nutrient profile appropriate (species, lifestage and BW/BCS)?

• Does the client make the recipe according to original instructions (still)?

Each of these problems has been documented to cause malnutrition in pets.[iii],[iv],[v],[vi],[vii]

• Is the nutrient profile appropriate? Checking the nutritional adequacy of recipes is not a simple task and beyond the skill set of and time available to most practitioners to do correctly b/c software, formulation skills, nutritional knowledge and access to ingredients databases is required. Therefore, practitioners should be willing to:
• Assess (Y/N) the recipe for 5 key nutrient sources, and refer if needed:[viii]
• Protein source - should contain 25 to 30% cooked meat for dogs, (one part meat to two or three parts grain) and 35 to 50% cooked meat for cats

• Carbohydrate source - optimal grain to meat ratios should be at least 2:1 to 3:1 for dog foods and 1:1 to 2:1 for cat foods. Cooked corn, rice, wheat, potato or barley are better than 85% digested by both dogs and cats

• Fat source - need only 1% to meet essential fatty acid requirement - animal source is best.

• Calcium Source - a specific calcium supplement (with little or no phosphorous) is essential.

• Multivitamin and trace mineral source - cannot be met using “whole” foods such as fruits, vegetables b/c pet can simply not consume enough vegetable material to meet the stated recommendations. Synthetic supplements are required to ensure a complete diet.

• Offer known nutritionally adequate recipes; or

• Help the client obtain advice from a veterinary nutritionist.

• Diet Drift: It is important once the homemade diet has been documented as nutritionally sound, the recipe specifics should be maintained in the medical record and reviewed on a regular basis with the owner, i.e., control diet drift. Food substitutions are usually possible but consult the originator of the recipe first.

Boarded veterinary nutritionists, like other veterinary specialists, have advanced training and can be of particular assistance with homemade diets. Checking and correcting nutritional imbalances are generally not difficult for nutritionists; hence most recipes can be completed and balanced if the owner insists on feeding a particular foods, e.g., cases of food reaction.

Would this particular nutrient profile harm my patient?

• If nutritionally complete and balanced, embedded in this Complete and Balanced statement will be the 1) specie and 2) life stage

• Match up the information with your patient ……
• Specie - must be named (canine or feline)
• Some products are sold as one for both, i.e., cat food

• Life stage - There are only 3 life stage claims possible:
• growth-gestation-lactation

• adult or maintenance

• all life stages – sounds very convenient but designed for growth

• The most common mismatch is an owner feeding an “all life stage” food to a middle aged, obese prone breed, neutered dog or indoor middle aged, neutered cat with a body condition score greater than 6/9.

• You  could help the owner determine such a product was inappropriate for their pet and to help them select a more appropriate product to maintain a healthier weight and improve longevity.[ix]

Is this a food safety issue?

• Once the nutritional adequacy statement has been checked on a particular product it is unlikely to change unless recalled for a formulation error or potential contaminate and then it should appear on the FDA Pet Food Recall list.
• Naming dropping a familiar pet food or manufacturer does not preclude the formulation errors. There were more than 30 recalls in 2013 and some of the products were from familiar ‘major' pet food companies.

• Pet food product recalls are now required with 24hrs (FSMA 2012) and listed on the FDA Pet Food Recall List.

• Beware of companies “never having a recall” – they probably are not testing.

• Consider subscribing to the AVMA Animal SmartBriefs https://www2.smartbrief.com/getLast.action?mode=sample&b=avma

• Feeding raw meat or eggs to household pet. There are still two health issues here:
• Nutritional Integrity - raw food diet has several names but can be grouped by source:
• Homemade
• Usually not complete or balanced2

• Can be done but should be checked by nutritionist

• Commercial - sold as
• ‘Complete and Balanced' - very few still

• ‘Supplemental or Intermittent feeding' - most   

• Food safety -  there are now several consensus statements that cannot be ignored:[x]
• AAHA - Raw Protein Diet. Found at www.aaha.org/professional/resources.
• Subsequently endorsed by The American Association of Feline Practitioners and the National Association of State Public Health Veterinarians.

• AVMA - Raw or Undercooked Animal-Source Protein in Cat and Dog Diets. Found at www.avma.org/KB/Policies

• CVMA - Policy on Raw or Undercooked Animal-Source Protein in Cat and Dog Diets. Found at www.CVMA.net.

Case example #1:  ‘Not much info in the product name'

Clients says:                       “I am interested in that new highly sustainable diet called the New Age Professional Earthworm Formula. What do you think?”

You ask:                            “Does the product claim to be nutritionally complete and balanced?”

Client says:                        “Yes it claims to be complete and balanced according to AAFCO”

You think ………..           would this particular nutrient profile harm my patient?

You ask:                            “What is the specie and life stage in the AAFCO statement?”

Client says:                        “Well it mentioned maintenance adult dogs”

You agree the client has an adult 4 yr neutered healthy dog with a BCS 5/9.  

You think …….…            is this a food safety issue?

You ask:                           “How is this product sold;  kibble, canned, raw, freeze-dried, frozen, dehydrated?”

Client says:                        “yes it's a new canned food”

You pull up the FDA Pet Food Recall list from your browser's favorites, and seeing it not listed, you would have to conclude that the product is worthy of a food trial. You could suggest a 30 days food trial making clear that with any changes in the dog's appetite, activity, attitude, GI function or habits or weight, you would like her to contact you.

Case example #2:  ‘Lifestyle issues verses nutritional issues'

Clients says:                       “I have been feeding a diet that uses all natural, organic, ingredients with nothing from china and no GMO corn, wheat or gluten but I forgot the name of it, so let me find it on my phone”

You ask:                            “Does the product claim to be nutritionally complete and balanced?”

Client says:                        “Yes it says it's complete and balanced according to AAFCO”

You think ………..           would this particular nutrient profile harm my patient?

You ask:                            “What is the specie and life stage in the AAFCO statement?”

Client says:                        “Well it says for all life stages of the cat”

You see the client has a 14yr neutered cat with history of rising creatinine levels and BCS 8/9.    

You think …….…               is this a food safety issue?

You ask:                            “How is this product sold;  kibble, canned, raw, freeze-dried, frozen, dehydrated?”

Client says:                        “yes it's a dry food”

You pull up the FDA Pet Food Recall list from your browser's favorites and not find it on the list.

The claims of “natural, organic, ingredients, nothing from china and no GMO corn, wheat or gluten” are lifestyle issues that do not affect the nutrient profile of the product. The mismatch here is feeding a cat food designed for growing kittens to an older overweight, IRIS stage 2, adult cat. The nutrients of concern are the protein and phosphorous levels for feline growth exceed those recommended for feline renal disease, and the high fat and caloric density are not appropriate for BCS > 6/9.

References

[i]. APPA National Pet Owner Survey 2011-2012. Canine p84; Feline p188

[ii]. Stockman j, Fascetti,AJ, Kass PH, et al. Evaluation of recipes for home-prepared maintenance diets for dogs. JAVMA 242[11]:1500-1505, 2013.

[iii]. Streiff EL, Zwischenberger B, Butterwick RF, et al. A Comparison of the Nutritional Adequacy of Home Prepared and Commercial Diets for Dogs. J Nutr. 132:1698S-1700S, 2002.

[iv]. Roudebush P, Cowell CS. Results of a hypoallergenic diet survey of veterinarians in North America with a nutritional evaluation of homemade diet prescriptions. Vet Derm 3:23-28, 1992.

[v]. Niza, MMR, Vilela CL, Ferreria LMA. Feline pansteatitis revisited: hazards of unbalanced home-made diets. J Feline Med Surg 5:271-277, 2003.

[vi]. Polizpoulou ZS, Kazakos G, Patsikas MN, et al. Hypervitamoinosis A in the cat: a case report and review of the literature. J Feline Med Surg 7:363-368, 2005.

[vii]. Fornel-Thibaud P, Blanchard G, Escoffier-Chateau L, et al. Unusual case of osteopenia associated with nutritional calcium and vitamin D deficiency in an adult dog. JAAHA 2007;43:52-60.

[viii]. Remillard RL, Paragon, BM, Crane SW, et al. Making Pet Foods at Home. In: Small animal Clinical Nutrition. (4thed). Hand MS, Thatcher CD, Remillard RL, Roudebush, P (Eds) MMI Associates, 2000 pp164-181. https://s3.amazonaws.com/mmi_sacn5/Chapter+10+-+Making+Pet+Foods+at+Home.pdf

[ix]. Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. JAVMA 220[9]:1315-1320, 2002.

[x]. Freeman LM, Chandler ML, Hamper BA, et al. Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats. J Am Vet Med Assoc 2013 Dec1;243(11):1549-58.