2011 Nestle Purina Veterinary Symposium On Companion Animal Medicine

Nestl Purina Veterinary Symposium
on companion animal medicine

Sponsored by
2011
ABOUT THE AUTHORS:

Dr. Debra F. Horwitz received her Doctor of Veterinary Medicine degree from Michigan State University. She is a diplomate of the American College of Veterinary Behaviorists and is currently its president. Dr. Horwitz is an established veterinary speaker and author and presently owns a behavioral practice in St. Louis, Mo. Dr. Michael R. Lappin received his Doctor of Veterinary Medicine degree from Oklahoma State University and his PhD in parasitology from the University of Georgia. Dr. Lappin is the Kenneth W. Smith Professor in Small Animal Clinical Veterinary Medicine, the Assistant Department Head for Research, and the Director of the Center for Companion Animal Studies at Colorado State University.
Dr. Dottie Laflamme received her Doctor of Veterinary Medicine degree, Master of Science degree in ruminant nutrition, and PhD in philosophy in physiology and nutrition from the University of Georgia. She also completed her nutritional residency there, as an ALPO Fellow in Clinical Nutrition. She is a diplomate in the American College of Veterinary Nutrition. Dr. Laflamme is currently a senior research scientist at Nestl Purina PetCare Research.
Dr. Joseph Wakshlag received his Doctor of Veterinary Medicine degree and PhD in pharmacology from Cornell University, where he is now an assistant professor of clinical nutrition. He is also a diplomate in the American College of Veterinary Nutrition and American College of Veterinary Sports Medicine and Rehabilitation.
2011 Nestl Purina. The views and opinions in this publication are those of the participants and do not necessarily represent the views of the sponsor. Cover art Getty Images/Ryan Kramer. To view online, visit www.dvm360.com/Purina2011.
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Veterinary Symposium
WHATS INSIDE:
2 9 14 23
Understanding pet owner behavior to achieve weight loss in companion animals Debra F. Horwitz, DVM, DACVB Clinical and research experiences with probiotics in cats Michael R. Lappin, DVM, PhD, DACVIM When pieces are better than the whole: Hydrolyzed protein diets Dottie Laflamme, DVM, PhD, DACVN From fat to fitAvoiding six common mistakes while helping pets combat obesity Joseph Wakshlag, DVM, PhD, DACVN, DACVSMR
Understanding pet owner behavior to achieve weight loss in companion animals

Debra F. Horwitz, DVM, DACVB
Owner, Veterinary Behavior Consultations St. Louis, Mo.
Obesity in companion animals has become a serious medical problem. Data published in Australia found 33.5% of dogs were classed as overweight, whereas 7.6% were judged to be obese, findings which are likely comparable to those in the USA.1,2 The prevelance of obesity in cats appears to be similar.3 Overweight animals may experience orthopedic problems, metabolic diseases, a reduced quality of life, and a shorter life span. Even with a plethora of weight-loss diets available to them, some pet owners seem unable to help their companion animals lose weight. When owners try a weight-loss diet for their pet, and the pet does not lose weight, the owners may conclude the diet or your advice is ineffective. Considering the behavioral factors in weight loss will improve owner compliance and benefit the pet with better overall health.
Health risks associated with obesity

Research has indicated that overweight dogs with hip osteoarthritis will show fewer clinical signs of lameness with an 11% to 18% weight loss.4 Caloric restriction and maintaining a lean body condition throughout life have been associated with an increase in the median life span of dogs.5 Research has found that the risk of health problems was higher in overweight catsheavy cats were 2.9 times as likely to be taken to veterinarians because of lameness not associated with cat bite abscesses. Obese cats were also 3.9 times as likely to develop diabetes mellitus, 2.3 times as likely to develop nonallergic skin conditions, and 4.9 times as likely to develop lameness requiring veterinary care.6 Indoor confinement and physical inactivity (often found in cases of obesity) have also been associated with diabetes mellitus.7 Puppies and kittens that are overweight are more likely to become overweight adults. Spayed and neutered individuals may be at a higher risk for weight gain because of decreased energy requirements.8 Naturally, certain chronic disease conditions and medications can also contribute to excessive weight gain. Finally, obesity can lead to other behavior problems if it causes pain or if it causes anxiety or competition over food resources, which may even result in aggression.
Understanding the problem

In most situations, the weight issue is not complicated. Pet obesity results from overconsumption of food provided. Yet the problem goes deeper; with both the owner and the pet contributing issues and behaviors that make food consump-
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eating with increased intake may be interpreted as hunger, or very slow eating may be interpreted as dislike of the product provided. However, both can simply be a sign of competition or anxiety about food. For cats, if necessary resources, such as food bowls, are not adequately provided and spaced within the home, a cat may overeat or eat very quickly when a food bowl is available. These behaviors could lead to obesity, vomiting, or tion about more than nutrition. For many owners feeding their pet is a bonding experience associated with love and caring. They like to show their pet how much they care, and providing the pet with delectable food, treats, and special tidbits symbolizes love. Owners of overweight cats were found to have a closer relationship with their cats and view them as substitutes for human companionship when compared with owners of normal weight cats.9 Owners of overweight dogs also tend to feel that their dogs are a substitute for human companions and spend more time with their dogs during meals.10 Additionally, owners of overweight dogs tend to interpret every need of their dog as a request for food.10 receive food, this reinforces scavenging and begging behavior, making these behaviors more likely to recur. Acquiring food through a certain behavior is a Pavlovian learned response that is difficult to extinguish. The feeding ecology of felids is different, and many owners are unaware that cats would naturally eat multiple small meals daily rather than one or two larger ones. Even if owners are aware of a cats natural tendency, they may not know how to feed their cat in that manner and maintain weight or achieve weight loss. Cats may vocalize to the owner for attention or to play, but owners often assume that the cat is hungry, especially if the cat follows them into the kitchen. Even rubbing behavior, a typical cat greeting behavior, can be misinterpreted as food seeking.
Feeding ecology of dogs and cats Because of the feeding ecology of canids, a dogs food-seeking behavior may not be hunger driven, but the natural foodscavenging behavior of dogs. Dogs tend to eat in a feast or famine mode, eating large quantities when food is available since hunting and catching prey is unreliable. In life, food is an important commodity; some dogs will ask for food even if they receive adequate daily nutrition. The smell or presence of food is enough to elicit this response in most dogs. If they
Social factors in food consumption Social factors within the home can have a profound influence on consumptive behavior in dogs and cats. Group eating in dogs results in social facilitation of eating and for some dogs an increase in consumption. Dogs may threaten, fight, or intimidate other dogs when food is being prepared and consumed, altering the amount consumed or the eating pattern of other dogs. Common signs may include an altered consumption rate; faster
A dogs food-seeking behavior may not be hunger driven, but the natural food-scavenging behavior of dogs.

other gastrointestinal problems. Severe social pressure between household cats may result in increased vomiting, and the owner may presume that the food is at fault or that there are hairballs. Owners may attempt to switch food without success, instead of addressing the underlying social factors. Cats also prefer to eat in privacy and take prey to a secluded location for consumption, and cats may replicate this eating behavior in the home.
Satiety versus meeting caloric needs Another issue is satiety, the sensation of fullness, which may not be achieved or noted by the pet. When the pet is fed a food that is highly palatable it may be stimulated to consume more than it needs. Alternately, if the food has high caloric density per piece, resulting in smaller portions being offered, the animal may not feel full. Although ideally an animal should eat to meet its caloric needs, if it does not feel full, begging and foodseeking behavior may persist. Learning contingencies Most behavior is influenced by the if/then relationshipif I do behavior A, then outcome B occurs. The stronger the relationship is between the behavior and outcome, the more difficult it will be to change the behavior. In weight-loss issues, several if/ then situations arise that may be obstacles to success. In fact, the mere presence of the owner may be a signal that food is forthcoming, resulting in a classically conditioned response. For the owner, the pets apparent delight at receiving food is the reward for giving treats or tidbits from the table. The owner might be unaware of how to provide bonding and enrichment for the pet without using food. Appropriate enrichment and owner-pet activities can be another way to strengthen the human-animal bond. In addition,
keeping dogs and cats more active encourages weight loss.
Identifying the issues

The first step in identifying the behavioral issues underlying a pets weight problem is to gather pertinent information about the household routine. For starters, ask owners to identify all sources of food being provided to their pets, including all set meals and treats. Provide owners with a measuring tool for food and treats and ask them to measure the amount of food provided each day for one week. Ask owners to identify the feeding pattern (once daily, twice daily, several small meals, free choice). (For a complete list of questions to ask pet owners, see Table 1.)
Many owners are unaware that cats would naturally eat multiple small meals daily rather than one or two larger ones.
Dietary and environmental management in dogs

Feeding set meals rather than free-choice feeding works well for many dogs and is often recommended. Most dogs would prefer to eat at least two meals a day, and feeding multiple meals may help with begging behavior. All food provided to the pet must be measured using the same measurement tool every meal. Alternately, a weeks worth of meals can be set up and then dispensed at mealtime. Regularly scheduled meals will help create predictability for the pet and may reduce owner overfeeding. In a multiple-dog home, certain rec-
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Table 1. Explore the feeding behavior
Ask pet owners these questions to gain insight on their household routines. How many other animals are in the home and how are they fed? How is food provided to each animal in the home? Where are resources located? Where is the pet fed? (in a bowl only, from the table, treats for coming inside, etc.) Are daily snacks incorporated into the diet? Who feeds the animal? Is the daily routine constant? Can the pet get food from other sources? (scavenging, raiding other pets food, etc.) What are the if/then situations? If the dog is around when food is prepared, does food fall on the floor? If the pet is present during consumption of human food, does the pet receive tidbits? If the cat vocalizes when a human enters the kitchen, does it receive food? If the dog vocalizes at the treat jar, will it receive a treat? What type of daily activities does the pet engage in? Is outdoor access provided? Do the owners take the pet for a walk? If not, why not? (time, pulling on the leash, behavior) Is covered and safe outdoor access available for cats? Do the owners play with their pet? If yes, what type of play and for how long? Are adequate opportunities and toys provided for enrichment and self-play?
ommendations may make compliance easier. (See Table 2.) For some dogs, slowing down the rate of eating and having the dog work for its food can increase satiety and decrease begging. The best options for doing this are fooddispensing toys. These must be used cautiously in a multipledog home since fighting over food-dispensing toys can occur. (See Table 3 for a resource list.) If food-seeking behavior and begging occur while human food is being prepared and eaten, then the dog should be confined elsewhere during these activities. However, owners are often unable or unwilling to comply with this recom-
mendation. One alternative is to use part of the pets daily ration as table treats that are given when the dog begs at the table. Another is to feed the dog during these times using a fooddispensing toy or a long-lasting treat. A more useful tip is to explain to the owners that the begging behavior is reinforced by the dog intermittently receiving food, which makes the dog hopeful that this will occur again. Therefore, when they stop feeding the dog from the table, begging behavior is likely to continue and actually may increase, until it finally goes away if no food is given. If food sharing is a large component of the human-animal
bond, create an acceptable food-sharing plan that includes the approved diet or some low-calorie substitute such as carrots or apples. Identifying and dealing with this problem is likely to increase compliance overall. In some situations, countersurfing and garbage-raiding will test the owners patience. Discussions about how to keep these items away from the dog can help. These include keeping garbage under the sink, rather than in an accessible garbage can, and placing bread in a covered breadbox. Treats are almost always an issue. Many dogs get treats for simply being cute or just coming inside. These can add up to

Table 2. Feeding routines for a home with multiple pets
Feeding routine in a multiple-dog home Separate dogs for feeding, preferably in different rooms. Give each dog its own food bowl. If anxious or excited behavior is a component of the feeding routine, prepare food when the dogs are out of the room. Once the dog has finished its allotted amount, let it out of its confinement area. Pick up and put away the food bowl until the next feeding time. Feeding routine in a multiple-cat home Provide multiple feeding stations throughout the home. If possible, meaning one cat will not empty the entire bowl, opt for free-choice feeding. This allows cats to eat multiple small meals. If free-choice feeding is not possible, provide each cat with its own bowl in a separate spot for feeding times. When cats are on different diets or need additional food, certain environmental changes may help: Use a timed feeding bowl that opens only at certain times for the cat with the corresponding collar. Use an electronic cat door into a room with the selected food, so that only the cat wearing the corresponding collar can enter. If the obese cat is not agile, place food bowls on elevated surfaces to allow the more agile, slimmer cats access to food.
many additional calories over the course of a day. Although we would like owners to stop giving the pet treats, realistically most will not. By calculating the number of treats given each day, it is possible to ask the owners to break each treat in half and decrease the number of treats by 50%. Once they realize that the size of the treat does not seem to matter to the pet, it is often easy to substitute something else or switch to a low-calorie option. Owner and pet become conditioned to use food as a bond-
ing exercise. Replacing this bonding exercise with another is crucial to success. Increasing exercise, bonding, and play is critical. It is often assumed that a dog with a fenced yard will exercise itself, but once the dog is out of adolescence, this is simply not so. Therefore, the owner needs to find a way to increase activity levels. Walks are a good alternative. In many situations, the owner is unable or unwilling to walk the dog due to its behavior on a leash. Appropriate control products,
such as head halters or no-pull body harnesses, can be used to address leash-walking problems. As part of the weight-loss plan, the owner could meet with a veterinary technician to learn how to use these devices for more pleasurable walks. Walks do not need to be long, but should be frequent. Be sure to counsel owners that an increase in exercise does not mean that the dog can increase its intake of food. If the dog likes to play with toys, then the owner and the dog can play fetch. Most owners have a difficult time getting the dog to drop the ball so that the game can continue. This can be overcome by using two objects. When the dog returns with one object, the owner holds up the second one, asks the dog to drop the object and when it does, the new object is thrown. Other games are possible, such as hide and seek or even basic training or tricks to keep the pet moving.
Dietary and environmental management in cats

The feeding ecology of a cat differs from that of a dog. Cats generally will eat multiple small meals a day, some say up to 12 to 15. Cats often like privacy when they eat, so placing food bowls in noisy or busy locations may alter feeding patterns and lead to either under- or overconsumption.
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The type of food and the way food is provided seem to influence weight loss in cats. A randomized, single-blind study in 2009 investigated the effect of dietary strategies and diet composition on weight loss in cats.11 Cats in the study were fed either Diet A, a novel dry high-fiber ration; Diet B, pre-prepared portions of dry and moist food; or Diet C, an existing commercial dry high-fiber ration fed with a measuring cup. Mean weight loss was similar among the groups. However, owners using Diet C and the measuring cup recorded higher hunger scores than those for Diet A or B. In addition, owners using Diet C and the measuring cup were most dissatisfied. Owners noted an increase in activity in the cats with all diets. Perhaps encouraging owners to separate out daily portions ahead of time and give those portions to cats as well as using a high-fiber food can increase owner compliance and affect cat behavior. Because social issues can have a profound effect on food consumption in cats, environmental placement of food is very important. (See Table 2.) Owners may not be aware of social issues because aggression between cats is often not overt, but may consist of staring, blocking, and mild chasing, which can intimidate a cat from approaching the food bowl. It often is illuminating to ask when the owner sees all the cats in one place. If that rarely occurs, then distributing
Table 3. Resources
Food-dispensing toys for dogs and cats Kong Products (www.kongcompany.com) Kong and Kong Wobbler Premier Pet Products (www.premier.com) Busy Buddy, Kibble Nibble, Twist n Treat, and Linkables for dogs Funkitty Twist n Treat and Egg-Cersizer for cats Purina Pet Gear (www.purinapetgear.com) The Gratifier, Kitty Treat Ball Control products for dogs and cats Canny Collar (www.cannyco.us) Halti Training Head Collar (most pet supply stores) Premier Pet Products (www.premier.com) Easy Walk Harness Gentle Leader Headcollar Come with Me Kitty Harness & Bungee Leash
resources all over the home is essential because some cats may have their movement and access to resources restricted by another cat. Exercise and increased activity can aid in weight loss in cats. Some cats enjoy interactive play with their owners and the use of toys can greatly enhance this activity. (See Table 3.) Owners should realize that when active play wanes after a short time, removal of the toy and substitution with another would restimulate play activity.12 Adding climbing towers and placing food bowls in outof-the-way places can increase activity. Some cats will use food-dispensing toys and can have at least one meal a day provided in this manner.
Follow up and overcoming pitfalls and lapses in compliance

Owners often get discouraged because weight loss is slow. One pound of weight lost by a dog can equal 5 pounds lost by a person. Explaining the weight loss as a percentage of body weight sometimes helps. For example, 5 pounds lost in a 50-pound dog can seem like a small amount to the owner. But when you explain to the owner that the dog has lost 10% of its total body weight, the significance of the achievement is more likely to become clear. Moreover, pet owners are often isolated from other pet owners, so opportunities to share experiences through a structured program such as Project Pet Slim

Down (projectpetslimdown.com) can help increase compliance. Evidence exists that weightloss programs that include regular follow up improve compliance and results.13 Not only can follow-up visits be used to weigh the pet, but they are an opportunity to discuss what behaviors are troublesome and interfering with compliance. At that time, the technician can offer alternate solutions that may help the owner keep on track with the treatment plan. Enhanced compliance can occur by offering the owner pre-prepared pet food, fooddispensing toys, play items, and control devices for walking the dog. Effective weight-loss plans are achievable using the proper diet, behavioral interventions for both the owner and the pet, and good coaching and follow up.
References
1. McGreevy PD, Thomson PC, Pride C, et al. Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Vet Rec 2005;156:695-707. 2. Burkholder WJ, Toll PW. Obesity. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small animal clinical nutrition, 4th ed. Topeka, Kan.: Mark Morris Institute, 2000;401-430. 3. Colliard L, Paragon BM, Lemuet B, et al. Prevalence and risk factors of obesity in an urban population of healthy cats. J Feline Med Surg 2009;11:135-140. 4. Impellizeri JA, Tetrick MA, Muir P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. J Am Vet Med Assoc 2000;216:1089-1091. 5. Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc 2002;220:1315-1320. 6. Scarlett JM, Donoghue S. Associations between body condition and disease in cats J Am Vet Med Assoc 1998;212:1725-1731. 7. Slingerland LI, Fazilova VV, Planting EA, et al. Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the
development of feline type 2 diabetes mellitus. Vet J 2009;179:247253. 8. Harperd EJ, Stack MT, Watson TGD, et al. Effects of feeding regimens on a bodyweight, composition and condition score in cats following ovariohysterectomy. J Small Anim Pract 2001;42:433-438. 9. Kienzle E, Berglert R. HumanAnimal Relationship of Owners of Normal and Overweight Cats. J Nutr 2006;136(suppl):1947S-1950S. 10. Kienzle E, Bergler R, Mandernack A. Comparisons of the feeding behavior and the human-animal relationship in owners of normal and obese dogs. J Nutr 1998;12(suppl):128. 11. Bissot T, Servet E, Vidal S, et al. Novel dietary strategies can improve the outcome of weight loss programmes in obese client-owned cats. J Feline Med Surg 2010 Feb;12(2):104-12. 12. Hall SL, Bradshaw JWS, Robinson IH. Object play in adult domestic cats: the roles of habituation and disinhibition. App Anim Behav Sci 2002;79:263-271. 13. Roudebush P, Schoenherr WD, Delaney SJ. An evidence-based review of the use of therapeutic foods, owner education, exercise and drugs for the management of obese and overweight pets. J Am Vet Med Assoc 2008;233:717-725.
Clinical and research experiences with probiotics in cats

Probiotics are live microorganisms that when administered in adequate amounts confer a health effect on the host.1 There have been many studies of the effects of probiotics on the health of people, but very few in small animals. In a recent review of human studies involving probiotics, it was stated that wellestablished probiotic effects include:2 1. Prevention and/or reduction of duration and complaints of rotavirus-induced or antibiotic-associated diarrhea as well as alleviation of complaints due to lactose intolerance; 2. Reduction of the concentration of cancer-promoting enzymes and/or putrefactive (bacterial) metabolites in the gut; 3. Prevention and alleviation of unspecific and irregular complaints of the gastrointestinal tracts in healthy people; 4. Beneficial effects on microbial aberrancies, inflammation, and other complaints in connection with inflammatory diseases of the gastrointestinal tract, Helicobacter pylori infection, or bacterial overgrowth; 5. Normalization of passing stool and stool consistency in subjects suffering from obstipation or an irritable colon; 6. Prevention or alleviation of allergies and atopic diseases in infants; and 7. Prevention of respiratory tract infections (common cold, influenza) and other infectious diseases as well as treatment of urogenital infections. Infectious diseases are very common in small animals, so the potential beneficial effects of probiotics could impact veterinary practice significantly. All mechanisms of immune modulation have not been characterized and it is likely these effects vary by the probiotic. It is known that many probiotics in the lactic acid bacteria group help balance the endogenous microbiota and some can inhibit replication of pathogenic bacteria. The proposed mechanisms of action include competition for essential nutrients or receptor sites, binding with pathogenic bacteria, and production of inhibitory substances. It is also now known that some probiotics can beneficially influence innate and acquired immunity by a variety of proposed mechanisms including inducing cytokine production, natural killer cell activity, and both specific and nonspecific immunoglobulin production.2 Several recent review articles in human medicine suggest that the evidence to support the theory that probiotics are beneficial in a variety of human conditions, such as Clostridium difficile diarrhea and hospital-acquired pneumonia, is minimal and that larger, more rigorously controlled multicenter studies should be performed.3-5
Michael R. Lappin, DACVIM
DVM, PhD,
College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins, Colo.

These findings emphasize that biological effects of individual probiotics will vary and that each probiotic introduced should be rigorously evaluated in a controlled fashion to define the potential for clinical utility. In addition, the source of the probiotic should also be considered. For example, in a recent study in Canada, the majority of diets claiming to contain probiotics generally did not meet the label claim when evaluated.6 The effect on CDV-specific IgG and IgA antibodies in serum was only seen after the puppies had been supplemented for 31 and 44 weeks, respectively. It was believed that SF68 prevented the decline in antibody titers observed in the control group by maintaining high levels of antibodies. extracts from samples taken at 9 and 27 weeks of age were analyzed for total IgA and total IgG. Other tests included randomly amplified polymorphic DNA (RAPD)-PCR on feces. RAPD-PCR was done to determine if viable E. faecium SF68 was in the stools of treated cats and to assess whether the probiotic was accidentally transmitted by laboratory staff from the treated kittens to the control kittens. Complete blood counts, serum biochemical panels, and urinalyses were performed to detect adverse events induced by the probiotic. Antigen-specific humoral immune responses were estimated by measuring FHV-1-specific IgG, FHV-1-specific IgA, FCV-specific IgG, and FPV-specific IgG in sera, as well as FHV-1 specific IgG and IgA levels in saliva using adaptations of previously published ELISA methods. Total IgG and IgA concentrations in sera, fecal extracts, and saliva were estimated using a commercial ELISA or radial immunodiffusion assay. Cellular immune responses were assessed via flow cytometry and whole blood proliferation assays. Lymphocytes were stained for expression of CD4, CD8, CD44, MHC Class II, and B cells. In addition, lymphocyte proliferation in response to concanavalin A and FHV-1 antigens was assessed. Body weight and fecal scores were not statistically different between the two groups. Feces from seven of nine treatment
SF68 and immune stimulation in cats

After publication of the puppy study, a similar collaborative study with Nestl Purina PetCare was performed in healthy kittens.9 In that study, it was hypothesized that feeding E. faecium SF68 to kittens would enhance nonspecific immune responses; humoral immune responses to feline herpesvirus type 1 (FHV-1), feline calicivirus (FCV), and feline panleukopenia virus (FPV); and FHV-1-specific cell-mediated immune responses. Twenty 6-week-old specificpathogen-free kittens were divided into two groups. Starting at 7 weeks of age, one group was fed SF68 daily and the other group was fed a placebo. At 9 and 12 weeks of age, a commercial FVRCP modified-live vaccine was administered subcutaneously and the kittens were followed until 27 weeks of age. The attitudes and behavior of the kittens were monitored daily throughout the study, and body weight was measured weekly. Blood, saliva, and feces were collected from all cats throughout the study, and fecal
SF68 and immune stimulation in puppies

Enterococcus faecium strain SF68 (NCIMB 10415) was originally isolated from the feces of a healthy baby and was initially shown to inhibit the growth of a number of enteropathogens.7 This bacterium is now the probiotic in the Nestl Purina PetCare Company product named FortiFlora. In one dog study, E. faecium strain SF68 was fed to a group of puppies vaccinated with canine distemper virus (CDV) and the effects compared over time with a control group that was similarly vaccinated, but not fed the probiotic.8 A number of findings suggested that the probiotic had an immune-modulating effect. The puppies supplemented with SF68 had increased serum and fecal total IgA concentrations, increased CDV-specific IgG and IgA serum concentrations, and an increased percentage of circulating B lymphocytes when compared with puppies in the control group.
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cats were positive for SF68 at some point during the study, whereas feces from all control cats were negative for SF68 throughout the study. SF68 DNA was not amplified from feces of any treated cat one week after stopping supplementation (Week 28). Complete blood counts and biochemical profiles were within normal limits for the age group for all cats at all time points. At 21 and 27 weeks of age, the mean levels of FHV1-specific IgA in serum and saliva were numerically greater in the treatment group when compared with the placebo group. Moreover, the mean FHV-1-specific serum IgG levels were numerically greater in the treatment group when compared with the placebo group at 15, 21, and 27 weeks of age. However, these differences in FHV-1 antibody levels did not reach statistical significance. No FHV-1-specific IgG was detected in saliva, and FCVspecific IgG levels in serum were similar between the groups. At 15 weeks of age, the treatment groups serum mean FPV-specific IgG levels were numerically greater than those of the placebo group, but the differences were not statistically significant. There were no significant differences in serum, fecal, or saliva IgG or IgA concentrations between the two groups. However, at 27 weeks of age, the treatment group had a significantly higher percentage of gated lymphocytes positive for CD4 than the placebo group. In this study, it was concluded that SF68 was safe to administer to cats and the increase in CD4+ cell counts in the treatment group (without a concurrent increase in CD8+ counts) demonstrated a systemic immune-modulating effect by the probiotic. Because the results did not show a significant increase in lymphocyte stimulation by FHV-1 or an increase in the expression of the memory cell marker (CD44) on the CD4+ lymphocytes in the treatment group, the increase in CD4+ T lymphocytes may have been nonspecific as the cells appeared to be unprimed. Two major subsets of CD4+ T cells are the Th1 and Th2 subsets. Th1 cells stimulate cell-mediated immune functions (cell-mediated immunity). Th2 cells produce interleukin-4, which stimulates IgE production by B cells (humoral immunity). The CD4+ T lymphocytes of kittens in this study were not additionally characterized via cytokine production profiles or additional cell surface marker characterization. Therefore, it could not be determined whether a Th1 or Th2 response predominated. Furthermore, either the sample size or the duration of this study may have precluded detection of statistical differences between the groups in regards to FPV, FCV, and FHV-1 antibody titers.
Figure 1. Kitten with conjunctivitis secondary to feline herpesvirus 1 i(FHV-1) nfection.
SF68 and management of feline herpesvirus type 1

The results of this study prompted a follow-up study on FHV-1.10 This virus is extremely common in cats and frequently results in recurrent ocular and respiratory clinical signs (see Figure 1). There is no known drug therapy that consistently eliminates the carrier state, and vaccination does not provide sterilizing immunity. It was hypothesized that feeding SF68 to cats with chronic FHV-1 infection would decrease clinical disease and reduce both episodes of FHV-1 shedding and the numbers of FHV-1 DNA copies shed over time. In this study, 12 cats with chronic FHV-1 infection were administered either SF68 or a placebo. The cats were then monitored for clinical signs of disease, analyzed for FHV-1 shedding, and evaluated for FHV-1-specific humoral and cell-mediated immune responses and fecal microbiome stability. After an
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Table 1. D escription of the Purina Fecal Scoring System
Fecal consistency is primarily a function of the amount of moisture in the stool and can be used to identify changes in colonic health and other problems. Ideally, in a healthy animal, stools should be firm but not hard, pliable and segmented, and easy to pick up (Score 2). Score 1 Stool very hard and dry Much effort required to expel feces from body No residue left on the ground when feces picked up Often expelled as individual pellets Score 2 Stool firm but not hard Pliable and segmented in appearance Little or no residue left on ground when picked up Score 3 Stool log-like No segmentation visible Moist surface Leaves residue but remains firm when picked up Score 4 Feces very moist (soggy) Distinct log shape Leave residue and loses form when picked up Score 5 Feces very moist Distinct shape (piles rather than log shape) Leaves residue and loses form when picked up Score 6 Feces has texture but no defined shape Occurs in piles or looks like spots Leaves residue when picked up Score 7 Feces watery, flat, with no texture Occurs as puddles Leaves residue when picked up
equilibration period, mild stress was induced over time by changing the housing of the cats from cages to gang housing repeatedly over a five-month period. The SF68 was well tolerated by all cats. Fecal microbial diversity was maintained throughout the study in cats given SF68, but decreased in cats fed the placebo, indicating a more stable microbiome in cats fed SF68. Upper respiratory signs of disease were not exacerbated by the induced stress, but those fed SF68 had fewer episodes of conjunctivitis than the placebo group during the supplementation period, suggesting that administration of the probiotic lessened morbidity from chronic FHV-1 infection (see Figure 2).
SF68 and diarrhea in shelter animals

In previous research, mice administered SF68 and then infected with Giardia intestinalis shed fewer trophozoites and Giardia antigen than the placebo group.11 In addition, when compared with untreated mice, supplemented mice had increased CD4+ cells in Peyers patches and the spleen, as well as increased anti-Giardia intestinal IgA and serum IgG. This work prompted a study on diarrhea in cats and dogs housed in an animal shelter.12 The hypothesis was that cats and dogs housed in an animal shelter and fed SF68 would have fewer episodes of diarrhea and improved fecal scores than untreated cats and dogs in the same environment. The study
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SF68 Placebo
Nutr 2001;73:361S-364S. 2. De Vrese M, Scherezenmeir J. Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol 2008;111:1-66. 3. McNabb B, Isakow W. Probiotics for the prevention of nosocomial pneumonia: Current evidence and opinions. Curr Opin Pul Med 2008;14:168-175. 4. Dendukuri N, Costa V, McGregor M, et al. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: A systematic review. Can Med Assoc J 2005;173:167-170. 5. Isakow W, Morrow LE, Kollef MH. Probiotics for preventing and treating nosocomial infections: Review of current evidence and recommendations. Chest 2007;132:286-294. 6. Weese JS, Arroyo L. Bacteriological evaluation of dog and cat diets that claim to contain probiotics. Can Vet J 2003;44:212-216. 7. Lewenstein A, Frigerio G, Moroni M. Biological properties of SF68, a new approach for the treatment of diarrhoeal disease. Curr Ther Res 1979;26:967-974. 8. Benyacoub J, Czarnecki-Maulden GL, Cavadini C, et al. Supplementation of food with Enterococcus faecium (SF68) stimulates immune functions in young dogs. J Nutr 2003;133:1158-1162. 9. Veir JV, Knorr R, Cavadini C, et al. Effect of supplementation with Enterococcus faecium (SF68) on immune functions in cats. Vet Therap 2007;8:229-238. 10. Lappin MR, Veir JK, Satyaraj E, et al. Pilot study to evaluate the effect of oral supplementation of Enterococcus faecium SF68 on cats with latent feline herpesvirus 1. J Feline Med Surg 2009;11:650-654. 11. Benyacoub J, Perez PF, Rochat F, et al. Enterococcus faecium SF68 enhances the immune response to Giardia intestinalis in mice. J Nutr 2005;135:1171-1176. 12. Bybee SN, Scorza V, Lappin MR. Effect of Enterococcus faecium SF68 supplementation on diarrhea in cats housed in a northern Colorado animal shelter, in press, J Vet Int Med 2011; in press.
35 30 25 20 15 10 5 0
Percent conjunctivitis
P<0.0001
Supplementation/stress period
Figure 2. Cumulative conjunctivitis scores in FHV-1-infected kittens.
dogs and cats were divided into groups and housed in separate rooms (two groups of dogs and two groups of cats). The cats and dogs were all fed a standardized diet by species. Animals in one room were supplemented daily with FortiFlora and animals in the alternate room were supplemented daily with placebo. Otherwise, management of the rooms was identical. Before the room was cleaned each morning, one of the investigators would score the feces in each animals cage using the Purina Fecal Scoring System for Dogs and Cats (see Table 1). Feces from dogs and cats with a score of 4 or greater were collected and transported to Colorado State University (CSU) for infectious disease testing. The testing at CSU included microscopic examination for parasite eggs, cysts, and oocysts and immunofluorescent antibody testing for Cryptosporidium oocysts and Giardia cysts.
Diarrhea prevalence rates were low for all dogs in the study and so statistical differences were not detected. However, the percentage of cats with diarrhea of two or more days was 7.7% for the probiotic group and 20.7% for the placebo group. These results suggest that administering SF68 to cats housed in shelters may reduce the number of days with diarrhea. Since this was a shortterm study, this effect was likely from the probiotics influences on intestinal flora rather than its systemic immune-enhancing effects.
Summary
Controlled studies evaluating the use of probiotics in cats is limited and inconclusive. However, there is evidence that SF68 is well tolerated and may have various clinical applications. Further research is ongoing in this area.
References
1. Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbioticsapproaching a definition. Am J Clin
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When pieces are better than the whole: Hydrolyzed protein diets
Clinical signs of food allergy in dogs and cats
Dottie Laflamme,
DVM, PhD, DACVN
Senior Research Scientist Nestl Purina PetCare Research St. Louis, Mo.
Food allergy and food intolerance imply abnormal reactions to a normal food or ingredient. Food allergy is immune-mediated, while food intolerance is considered to be an idiosyncratic reaction. Other forms of adverse reactions to foods can include food intoxication or food poisoning. Unlike food allergy or intolerance, which are abnormal responses to normal foods or ingredients, food poisoning refers to normal, biological reactions to the toxins or infectious agents in foods, rather than to normal foods. Food allergy may manifest with dermatologic or gastrointestinal (GI) signs, or both. Dermatologic signs of food allergy (Table 1) are similar to those of atopic dermatitis, and both food allergy and atopic dermatitis commonly occur together.1 GI signs can include vomiting, diarrhea, and borborygmus. According to veterinary dermatologists, the majority of dogs and cats with food allergies manifest dermatologic signs, although 15% to 50% are now recognized to also have GI signs.1-4 Moreover, veterinary gastroenterologists recognize that a large percentage of patients with GI signs have some form of food allergy or intolerance.2,5,6 In one study of 70 cats with chronic GI signs, 29% were diagnosed as food allergic based on elimination and challenge testing.5 An additional 20% of cats in the study showed a positive response to diet but did not relapse upon challenge. Similarly, another study demonstrated that 50% of dogs with chronic GI signs were food responsive, although only 20% of these were confirmed by challenge to be food allergic.6 Another study evaluating 128 cats with either pruritus, GI signs, or both, identified 22 (17%) cats that were confirmed food allergic by elimination and subsequent challenge testing.2 Among the cats confirmed to be food allergic, 45% exhibited dermatologic signs, 32% expressed GI signs, and 23% exhibited both signs. It appears that patients expressing both dermatologic and GI signs are more likely to be diagnosed as food allergic.2-4 In a study of 418,422 dogs in Switzerland, 259 allergic dogs were identified.4 Of these, 65 were identified as food responsive, while 183 were considered atopic. Concurrent GI signs occurred in 31% of the food-responsive dogs, but in only 10% of the atopic dogs. Similarly, cats with both dermatologic and GI signs (42%) were more likely to be food allergic than those with only dermatologic (16%) or GI signs (13%).2
Pathophysiology of food allergy

The exact mechanisms behind food allergy are not fully known, but are thought to involve type I, III, and IV hypersensitivity reac-
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tions.7,8 The offending allergens are usually proteins or glycoproteins that can interact with the bodys immune system and lead to a hypersensitivity reaction. Interaction between food antigens and the immune system begins in the GI tract, which is the largest immunologic organ in the body.
Table 1. Common clinical signs of food allergy in dogs and cats4,7,8,21

Dogs Pruritus Chronic or recurrent otitis externa Chronic bacterial infection Chronic yeast infection Chronic vomiting or diarrhea Interdigital fistula Pyotraumatic dermatitis Perianal fistula Cats Generalized pruritus with or without lesions Miliary dermatitis Localized pruritus of the head, neck, and ears Otitis externa Secondary alopecia Self-inflicted trauma Chronic vomiting or diarrhea
Role of the GI tract

The GI tract provides numerous means of protecting the body from foreign bacteria, toxic substances, and antigens. It must balance this protective function with the need to absorb and tolerate normal dietary antigens. The primary means of defense against inappropriate allergic responses to dietary antigens include an effective mucosal barrier, efficient digestion of proteins, and oral tolerance developed by the gut-associated lymphoid tissue (GALT). Complete digestion of proteins destroys the antigenic factors. Under normal circumstances, only trace amounts of intact proteins and large peptides can make it past the mucosal barrier. These proteins are removed by the reticuloendothelial cells of the liver and the mesenteric lymph nodes. When excessive antigens are absorbed, such as with increased mucosal permeability, hypersensitivity may develop.7,9 A critical role is played by the GALT in the development of tolerance to food proteins.10 This function is facilitated by micro-
fold cells (M cells) located on the Peyers patches. M cells take up antigens from the intestinal lumen and present them directly to lymphocytes within the Peyers patch. This allows the immune system to develop an appropriate recognition and response to that particular antigeneither to develop a tolerance to a food protein or to mount a defense against an invading organism. Errors in this process can result in development of a food allergy or an infection.
Role of the immune system

Allergic or hypersensitivity reactions are grouped into four types based on the specific mecha-
nisms, immunoglobulins (Ig), and the cells involved. Although type I and III reactions are mediated by IgE or IgG and type IV is a T-cellmediated reaction, other cells play a role in these reactions. Advances in the past decade have contributed to a greater understanding of the pathophysiology of allergy: the key lies in CD4+ and CD8+ T cells and related cytokines.10 Two major subsets of CD4+ T cells are the Th1 and Th2 subsets, which are distinguishable on the basis of their expressed cytokines. Th1 cells stimulate cell-mediated immune functions and inhibit IgE synthesis, whereas Th2 cells produce interleukin (IL)-4, which stimulates IgE production by B
15
cells. A proper balance between these cell types is necessary for normal immune function, and a number of immunopathologies have been associated with an exaggerated Th1 or Th2 response. The cytokines IL-10, transforming growth factor- (TGF-), and others play an important role in maintaining the Th1-Th2 ratio and promoting allergen tolerance. Increased IL-4, IL-6, and tumor necrosis factor- (TNF-) production and a reduced Th1-Th2 ratio associated with increased Th2 cells are found in atopic and food-allergic people. Immunoglobulin and T-cell responses appear to differ between food allergy and atopy, at least in dogs. One study confirmed an increase in IgE in atopic dogs and an increase in IgG in dogs with food-allergic and other forms of gastroenteritis.11 Though no differences were found in the T-cell status of the GI tract between normal dogs and food-allergic dogs, significant changes occurred within the skin of dogs with cutaneous adverse food reactions.12,13 These changes included a pronounced CD8+ T cell-dependent inflammatory response, and increased expression of IL-4, IL-13, and other genes suggestive of a Th2-skewed immune status.14 These changes remained even after clinical resolution of signs, suggesting a continuing pre-activated immune status in dogs with food allergies.14 This is consistent with results from food-allergic children, who have ongoing activation of Th2 cells with increased release of inflammatory cytokines.15 contribute to clinical signs of allergy. This appears to be associated with clinical or subclinical intestinal inflammation. In cats and dogs, food allergy often manifests with primary GI signs, and up to 30% of patients with cutaneous manifestations also develop GI signs. The percentage with subclinical GI involvement is unknown; thus, it is likely that some degree of GI compromise exists in dogs and cats with food allergies. Another factor that may influence the manifestation of clinical signs is the pruritic threshold, which refers to the variation in response to a given allergen. It may relate to the concept of summation, which suggests that multiple allergies or nonallergenic pruritic stimuli are additive in effect. For example, a pruritic dog with concurrent atopy and food allergy may drop below the pruritic threshold by effective control of only one of these conditions. Nonallergenic factors, such as stress, dry skin, and hot weather, can also contribute to pruritus via nonimmunologic means and must be considered in the diagnosis and management of pruritic pets.17
Factors influencing development of allergic conditions

The likelihood of an individual patient developing sensitivity to food depends on permeability of the gut, the presence of allergy to other foods or inhalants, and other factors.9 Heredity is a major predisposing factor in allergic conditions in people. The likelihood of an infant developing atopy or food allergy is 37% if one parent is atopic and 62% if both parents are affected.9 This may also be true in cats and dogs based on breed and familial predisposition, but the mode of inheritance is unknown. Current evidence suggests that dogs with cutaneous food allergy may be predisposed to developing atopic dermatitis.16 This may be because of an underlying immune (Th1/Th2) imbalance, or it may be a result of compromised GI mucosa. As the GI mucosa is a primary barrier to prevent absorption of potential allergenic proteins, a breach in this barrier increases the likelihood of allergens entering the body and contacting the GALT, thus increasing the risk of sensitization or allergic response.9,10 GI permeability and transmucosal antigen transfer are increased in people with atopy and food allergy, and the absorbed dietary antigens can
Common food allergens

The vast majority of allergens are proteins or glycoproteins. Since allergies are abnormal or inappropriate reactions of the immune system against a normal protein, allergies can form to any protein. The majority of common
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food allergens are proteins with a molecular weight between 18 kD and 70 kD.18,19 Smaller proteins are normally too little to elicit an immune reaction, while larger proteins cannot normally access the body across the GI mucosa. The most commonly identified food allergens in dogs and cats are listed in Table 2. The list reflects commonly fed ingredients. Reactions to carbohydrate sources, such as rice, corn, and potato, have been reported but appear to be much less common. Idiosyncratic reactions to food preservatives or additives also are thought to occur, but evidence to support this idea is lacking.1
Table 2. Most commonly identified food allergens in dogs and cats7

Dogs (n=198) Beef (36%) Dairy (28%) Wheat (15%) Egg (10%) Chicken (9.6%) Lamb/Mutton (6.6%) Soy (6%) Cats (n=89) Beef (20%) Dairy (14.6%) Fish (13%) Lamb (6.7%) Poultry (4.5%) Barley/Wheat (4.5%)
Diagnosis of food allergy

The diagnosis of food allergy is based on physical signs, history, veterinary examination, and results of an elimination diet trial with subsequent challenge. Unfortunately, neither serologic nor intradermal testing is effective for diagnosing food allergies.1,8 Food allergies can occur in animals of any age. A history of chronic, non-seasonal pruritus or otitis externa in dogs or cats, or miliary dermatitis or alopecia in cats, may indicate possible food-allergic dermatitis. GI signs may include vomiting, diarrhea, or borborygmus. Large bowel diarrhea appears to be common in food-allergic dogs.6 The presence of concurrent pruritus or otitis and GI signs should always raise suspicion of food
allergy. However, it is necessary to rule out other causes of GI or dermatologic signs that may be confused with food allergies (Table 3). Location and type of skin lesions can help identify or rule out other conditions. For example, lesions predominantly located on the caudal half of the body are more consistent with flea allergy. In nearly 25% of food-allergic dogs, pruritus in the ear region may be the only clinical sign. In pruritic patients, skin cytology should be evaluated for bacterial and Malassezia infections. Unfortunately, medical history does not help differentiate food allergy from atopic disease. The clinical signs of these conditions can be identical, and they may exist concurrently. For patients with GI signs, blood, urine, and feces should be examined to rule out systemic or parasitic causes of vomiting or diarrhea. If food allergy is suspected, a dietary trial (Table 4) using an appropriate elimination diet is required. Most patients with
dermatologic signs respond within four to eight weeks. If only partial improvement is seen, an additional four to six weeks may be needed for maximum resolution.7,20 If concurrent therapy is provided, such as antibiotics or corticosteroids, the trial must be continued for at least three to six weeks after completion of these therapies. If only GI signs are present, a two- to four-week trial is sufficient.5,7 Improvement in dermatologic signs is typically defined in terms of changes in pruritus. Most studies consider a decrease of 50% or more to be a positive response.7,20,21 If the patient responds positively to the elimination diet, a provocative challenge with the prior diet is needed to confirm the diagnosis. Though many will occur within 48 hours, allow up to two weeks to document adverse responses during the challenge period.1 A diagnosis of food allergy is confirmed if the patient improves while on the elimination diet, recrudesces during the challenge, and
17
Table 3. Differential diagnoses for pruritic dogs and cats
Atopy Flea allergy dermatitis Food allergy Drug reaction Lice infestation (pediculosis) Intestinal parasite hypersensitivity Mite infestation (Sarcoptes, Cheyletiella, Demodex, Notoedres, etc.) Malassezia dermatitis Seborrheic skin disease Viral infection Contact dermatitis Primary pyoderma Autoimmune disease
improves again when returned to the elimination diet. If desired, identification of specific protein sources to which the patient is sensitive can be done by challenging with individual ingredients, one at a time, while maintaining the patient on the elimination diet.
Homemade novel protein diets

Homemade diets are considered the gold standard for conducting food-allergy trials.7,8,22 The simplest homemade diets include one protein source and one carbohydrate source to which the patient has not previously been exposed. These are typically provided at a volume ratio of 1:1 for dogs and 2:1 for cats (protein:carbohydrate source). for cats. Lack of prior exposure is important as there is nothing inherently hypoallergenic about any particular protein. Therefore, the patients dietary history must drive the appropriate choice for ingredients to use in the diet. The advantages of homeprepared diets are the ease of addressing the patients specific dietary history, enhanced involvement by the owner, and elimination of any types of additives, though sensitivities to additives
do not appear to be common.1 Some limitations to homeprepared diets typically used for elimination trials include: laborintensive preparation (compared with feeding commercial diets); excessive costs; diet acceptance; the possibility of GI upsets; and nutritional completeness.3,7 Because of nutritional imbalances, home-prepared diets are not recommended for use in growing animals nor for long-term use.1,3,7 Published studies using homemade diets suggest a drop-out rate from 15% to 36%, with the most common reasons being patient refusal, difficult preparation, and development of diarrhea.3,21,23 The proportion of dogs enrolled in the eliminationchallenge tests that were diagnosed as food allergic in these studies averaged 35.7%.
Diet selection
The goal in conducting a dietary trial with an elimination diet is to eliminate any exposure to allergens to which the patient may be sensitive. In addition, because the diet may be fed for an extended period of time, it should also provide complete and balanced nutrition and be palatable and convenient for the owner to feed. Controlled intake during the trial period includes the main meal as well as treats, flavored medications, bits of food used to give medications, and access to any other foods.
Commercial novel protein diets

Another approach for managing food-allergic dogs is feeding a commercial novel protein diet. Such a diet contains a limited number of ingredientsusually a single protein and a single carbohydrate sourceto which the patient has not been previously exposed. Limiting ingredients reduces the odds that the food contains an allergen to which the patient is hypersensitive. As with home-prepared diets, the choice of ingredients for commercial novel protein diets should be based on prior exposure considering both pro-
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Table 4. Conducting a dietary elimination trial to diagnose food allergy
Steps Treat or rule out secondary bacterial or yeast skin infections Key Points If food allergy is suspected, begin elimination diet while initiating treatment for concurrent infections. Continue elimination trial at least three to six weeks after conclusion of antibiotic or other therapy to determine continued response. Select ingredients for novel diet (home-prepared or commercial) based on dietary history of prior exposure, or use a diet with no intact proteins (hydrolyzed diet). Feed diet exclusively during trial. Educate clients about allergies, the benefits of completing a dietary trial, and the importance of feeding the elimination diet exclusively. Educate clients to ensure that patients do not have access to other foods or treats from other pets, children, or neighbors. Most food-responsive gastroenteritis will improve within two to four weeks. Most food allergy dermatitis signs will begin to improve within four to eight weeks, but up to 16 weeks may be needed in some patients. A partial resolution of pruritic signs may indicate concurrent conditions, such as atopy. If clinical signs resolve, feed patient its prior diet for up to two weeks. Return to elimination diet if signs recur. Recurrence of signs and subsequent resolution confirm diagnosis. If client is willing, identify individual ingredients to which the patient is allergic by adding foods or ingredients, one per week, while maintaining patient on the elimination diet. Many patients have multiple allergies, so test a sufficient number of common allergens to identify suitable diets for the patient. If individual allergens are identified, patient can be fed any diet that avoids those allergens. Alternately, hydrolyzed or novel protein diets can be fed. If specific allergens are not known, it may be necessary to try two or more novel protein diets to find one that best suits the patient.
Select appropriate diet
Assure client compliance
Conduct trial for sufficient time
Conduct challenge to confirm diagnosis
Maintain patient on an appropriate diet
tein and carbohydrate sources. While allergies to carbohydrates are uncommon, allergies to the protein contained in these ingredients (e.g., potato, rice, corn, wheat) can occur.5,24,25
Most commercial novel protein diets provide complete and balanced nutrition and they are easy to prepare. Because of this, the proportion of patients completing the elimination
study may be increased.2,5 Commercial novel protein diets are recommended when owners do not wish to cook for their pets, when pets do not tolerate home-prepared diets, and when
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the cost of a home-prepared diet is prohibitive.7 A few published studies have shown that these diets can be used with good success to diagnose food allergy.2,5 However, several studies have documented adverse reactions in 15% to 85% of confirmed food-allergic dogs offered various commercial novel protein diets.8,22,23,26 One study indicated that 22 of 40 dogs reacted only against one of three diets, while an additional eight dogs reacted against two different novel diets.26 Such results confirm the critical importance of a good dietary history prior to selecting a diet for a suspected food-allergic patient. They also are the reason some researchers discourage the use of novel commercial diets during the elimination trial.7,22,26 While there are limitations to using novel protein diets during the diagnostic period, it appears that 84% to 95% of confirmed food-allergic dogs can be maintained on a commercial novel protein diet.22,26 This provides a viable way to control clinical signs while providing complete and balanced nutrition. If the patients specific allergies are not known, it may be necessary to test several novel protein diets until a suitable diet is found. Unfortunately, it is still possible for the patient to develop a hypersensitivityeven to the novel dietat a later time.1
Commercial hydrolyzed protein diets

Another option for elimination diets is to use hydrolyzed proteins. The ability of a protein to induce an immune-mediated hypersensitivity is dependent upon the size and structure of the protein. Most food allergens are glycoproteins that range in size from 18 kD to 70 kD.18,19 Proteins of this size are large enough and have sufficient molecular complexity to allow activated T and B cells to recognize the substance as foreign and initiate a response, yet small enough to pass through mucosal membranes and come in contact with elements of the immune system. Hydrolysis, which reduces the proteins to small polypeptides, can create dietary proteins below this size so that they are not recognized by the immune system; thus rendering the proteins non- or hypo-allergenic. The optimal molecular weight of a protein hydrolysate varies with the type of protein used.7 Soy, an extensively studied dietary protein, contains 21 specific allergens, identified using IgE- or IgG-binding techniques.27,28 The major IgEproducing allergens in soy protein range in size from 20 kD to 78 kD. 27 Thus, if soy protein were hydrolyzed to a molecular weight below 20 kD, these antigens would be destroyed, rendering the protein hypoallergenic. This effect has been confirmed in both in vitro and in vivo studies.19,28-32
In addition to protein hydrolysis, hypoallergenic diets should be formulated using carbohydrate sources containing minimal to no protein to reduce risk of new allergenic responses. While grains are typically considered carbohydrate sources, they also contain varying amounts of intact proteins that could trigger allergic responses. In recent years, a number of diets made with hydrolyzed proteins have been introduced into the marketplace. If these diets could be used even in dogs allergic to the parent (intact) protein, they could be used as elimination diets without consideration of the dietary history. Several studies specifically designed to look at the impact of hydrolyzed protein diets in dogs allergic to the parent protein documented that the reaction to hydrolyzed proteins is significantly reduced.19,30-33 For example, 10 of 12 confirmed chicken-allergic dogs had at least a 50% reduction in CADESI (Canine Atopic Dermatitis Extent and Severity Index) score when fed a chicken hydrolysate diet.32 In two different studies of dogs with confirmed soy or corn allergies, or both, the reaction to a hydrolyzed soy and corn starch diet was significantly reduced versus intact soy or corn, and no different from the reactions to corn- and soy-free control diets.30,33 Multiple hypersensitivities may occur in one-third to one-half of dogs or cats with food-allergies.7
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References
1. Jackson HA. Food allergy in dogs clinical signs and diagnosis. Eur J Comp Anim Pract 2009;19:230-233. 2. Guilford WG, Markwell PJ, Jones BR, et al. Prevalence and causes of food sensitivity in cats with chronic pruritus, vomiting or diarrhea. J Nutr 1998;128:2790S2791S. 3. Loeffler A, Soares-Magalhaes R, Bond R, et al. A retrospective analysis of case series using home-prepared and chicken hydrolysate diets in the diagnosis of adverse food reactions in 181 pruritic dogs. Vet Derm 2006;17:273-279. 4. Picco F, Zini E, Nett C. A prospective study on canine atopic dermatitis and food-induced allergic dermatitis in Switzerland. Vet Derm 2008;119:150-155. 5. Guilford WG, Jones BR, Markwell PJ, et al. Food sensitivity in cats with chronic idiopathic gastrointestinal problems. J Vet Intern Med 2001;15:7-13. 6. Allenspach K, Wieland B, Grone A, et al. Chronic enteropathies in dogs: evaluation of risk factors for negative outcome. J Vet Intern Med 2007;21:700-708. 7. Verlinden A, Hesta M, Millet S, et al. Food allergy in dogs and cats: a review. Crit Rev Food Sci Nutr 2006;46:259-273. 8. Bryan J, Frank L. Food allergy in the cat: a diagnosis by elimination. J Fel Med Surg 2010;12:861-866. 9. Chandra RK. Food hypersensitivity and allergic disease: a selective review. Am J Clin Nutr 1997;66:526S529S. 10. du Pr MF, Samsom JN. Adaptive T-cell responses regulating oral tolerance to protein antigen. Allergy 2010; doi:10.1111 /j.1398-9995.2010.02519. Available at: www.onlinelibrary.wiley.com/ journal/10.1111/(ISSN)1398-9995. Accessed Feb. 16, 2011. 11. Foster AP, Knowles TG, Hotston Moore A, et al. Serum IgE and IgG responses to food antigens in nor-
In one study, most food allergic dogs reacted to two food ingredients while one dog reacted to seven.24 This situation presents a challenge when attempting to develop effective novel protein diets, and becomes less important when a hydrolyzed hypoallergenic diet is used. Furthermore, because the hydrolyzed proteins are truly hypoallergenic, it is less likely that a new allergy will form when these diets are fed longterm. Other advantages of hydrolyzed protein diets are that they can provide complete and balanced nutrition and avoid client concerns about the difficulties in preparing homemade diets. A further advantage of hydrolyzed protein diets is the effect on digestibility. The use of highly digestible proteins has long been recommended for managing food allergies. One of the natural defenses against food allergy is the breakdown of food allergens during digestion. Under normal circumstances, very little intact protein is absorbed. However, if there is increased GI permeability, or digestive function is compromised, larger peptides and proteins may be absorbed intact, contributing to development or exacerbation of food allergy.9,25 Hydrolysis of a protein enhances digestive efficiency. For example, when soy protein hydrolysates were administered to dogs, the small intestinal absorption rate increased three-fold compared
with administration of intact soy protein.34 Thus, feeding hydrolyzed protein diets may avoid aggravation or perpetuation of allergies in animals with compromised GI tracts. Several studies suggest that about 90% of dogs with food allergy will be detected using hydrolysate diets, although a few dogs or cats might have an adverse reaction to the hydrolyzed diets.18,35 (Sousa C, unpublished data 2001) While this falls short of 100%, it compares favorably with home-prepared or commercial novel diets.
Summary
Food allergies may cause dermatological or GI signs, or both. A diagnosis of food allergy is made by performing a dietary elimination trial using an appropriate diet, followed by a food challenge using the patients prior diet or specific food ingredients. Following diagnosis and identification of the offending allergens, dogs and cats can be maintained on diets that exclude the identified antigens or on commercial novel protein or hypoallergenic diets. As the immune system remains primed for an allergic response, it is possible for an allergy to additional proteins to develop over time with recurrence of clinical signs. This risk may be reduced by feeding hydrolyzed protein diets to at-risk patients.
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mal and atopic dogs, and dogs with gastrointestinal disease. Vet Immunol Immunopathol 2003;92:113-124. Veenhof EZ, Rutten VP, van Noort R, et al. Evaluation of T-cell activation in the duodenum of dogs with cutaneous food hypersensitivity. Am J Vet Res 2010;71:441-446. German AJ, Hall EJ, Day MJ. Immune cell populations within the duodenal mucosa of dogs with enteropathies. J Vet Intern Med 2001;15:14-25. Veenhof EZ, Knol EF, Schlotter YM, et al. Characterization of T cell phenotypes, cytokines and transcription factors in the skin of dogs with cutaneous adverse food reactions. Vet Journal 2010. doi:10.1016/i. tvil.2010.02.005. Available at: www.sciencedirect.com/science?_ ob=ArticleURL&_udi=B6WXN4YM7N2N-1&_user=3550545&_ coverDate=03%2F15%2F2010&_ rdoc=1&_fmt=high&_ orig=search&_origin=search&_ sort=d&_docanchor=&view=c&_ acct=C000065267&_version=1&_urlVersion=0&_userid=3550545&md5= 44c2bdacee7020760e91c4a9549c65 7e&searchtype=a. Accessed Feb. 16, 2011. Frischmeyer-Guerrerio PA, Guerrerio AL, Chichester KL, et al. Dendritic cell and T cell responses in children with food allergy. Clin Exp Allergy 2011;41:61-71. Hillier A, Griffin CE. The ACVD task force on canine atopic dermatitis (X): is there a relationship between canine atopic dermatitis and cutaneous adverse food reactions? Vet Immunol Immunopathol 2001;81:227-231. Chalmers SA, Medleau L. An update on atopic dermatitis in dogs. Vet Med 1994;89:326-341. Biourge VC, Fontaine J, Vroom MW. Diagnosis of adverse reactions to food in dogs: efficacy of a soy-isolate hydrolyzate-based diet. J Nutr 2004;134:2062-2064. Puigdemont A, Brazis P, Montserrat S, et al. Immunological responses against hydrolyzed soy protein in dogs with experimentally induced soy hypersensitivity. Am J Vet Res 2006;67:484-488. Chesney CJ. Systematic review of evidence for the prevalence of food sensitivity in dogs. Vet Rec 2001;148:445-448. Proverbio D, Perego R, Spada E, et al. Prevalence of adverse food reactions in 130 dogs in Italy with dermatological signs: a retrospective study. J Sm Anim Pract 2010;51:370-374. Jeffers JG, Shanley KJ, Meyer EK. Diagnostic testing of dogs for food hypersensitivity. J Am Vet Med Assoc 1991;198:245-250. Tapp T, Griffin C, Rosenkrantz W, et al. Comparison of a commercial limited-antigen diet versus homeprepared diets in the diagnosis of canine adverse food reaction. Vet Therapeutics 2003;3:244-251. Kawarai S, Ishihara J, Masuda K, et al. Clinical efficacy of a novel elimination diet composed of a mixture of amino acids and potatoes in dogs with non-seasonal pruritic dermatitis. J Vet Med Sci 2010;72:1413-1421. Roudebush P, Guilford WG, Jackson HA. Adverse reactions to food. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small animal clinical nutrition, 5th ed. Topeka, Kan.: Mark Morris Institute, 2010;609-635. Leistra MHG, Markwell PJ, Willemse T. Evaluation of selected-proteinsource diets for management of dogs with adverse reactions to food. J Am Vet Med Assoc 2001;219:1411-1414. Awazuhara H, Kawai H, Maruchi N. Major allergens in soybean and clinical significance of IgG4 antibodies investigated by IgE- and IgG4-immunoblotting with sera from soybean-sensitive patients. Clin Exp Allergy 1997;27:325-332. Wilson S, Blaschek K, Gonzalez de Mejia E. Allergenic proteins in soybeans: processing and reduction of P34 allergenicity. Nutr Rev 2005;63:47-58. Olson ME, Hardin JA, Buret AG, et al. Hypersensitivity reactions to dietary antigens in atopic dogs. In: Reinhart GA, Carey DP, eds. Recent advances in canine and feline nutrition, Vol III, 2000 Iams Nutrition Symposium Proceedings. Wilmington, Ohio: Orange Frazer Press, 2000:69-77. Beale KM, Laflamme DP. Comparison of a hydrolyzed soy protein diet containing corn starch with a positive and negative control diet in corn- or soy-sensitive dogs, in Proceedings. 16th Annual AAVD and ACVD Meeting 2001;12:237. Serra M, Brazis P, Fondati A, et al. Assessment of IgE binding to native and hydrolyzed soy protein in serum obtained from dogs with experimentally induced soy protein hypersensitivity. Am J Vet Res 2006;67:1895-1900. Ricci R, Hammerberg B, Paps J, et al. A comparison of the clinical manifestations of feeding whole and hydrolyzed chicken to dogs with hypersensitivity to the native protein. Vet Derm 2010;21:358-366. Jackson HA, Jackson MW, Coblentz L, et al. Evaluation of the clinical and allergen specific serum immunoglobulin E responses to oral challenge with cornstarch, corn, soy and a soy hydrolysate diet in dogs with spontaneous food allergy. Vet Derm 2003;14:181-187. Zhao XT, McCamish MA, Miller RH, et al. Intestinal transit and absorption of soy protein in dogs depend on load and degree of protein hydrolysis. J Nutr 1997;127:2350-2356. Olivry T, Bizikova P. A systematic review of the evidence of reduced allergenicity and clinical benefit of food hydrolysates in dogs with cutaneous adverse food reactions. Vet Derm 2010;21:31-40.
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From fat to fitAvoiding six common mistakes while helping pets combat obesity
We veterinarians are all aware that weight problems affect 30% to 40% of our patients. The effects of obesity are far-reaching, predisposing our patients to insulin resistance, type II diabetes, orthopedic disease, and possibly even cancer.1-3 We all know that a pet is not in ideal health if it is not at its ideal weight, but many of us have also discovered how difficult it can be to motivate clients to help their pets lose weight. In this article, I will describe six common mistakes veterinarians make when implementing weight-management programs and explain how best to avoid them.
Joseph Wakshlag, DACVSMR
DVM, PhD, DACVN,
College of Veterinary Medicine Cornell University Ithaca, N.Y.
Mistake #1 Not backing your recommendations with hard science

To drive home the importance of weight loss to my clients, I now discuss the ramifications of obesity and chronic inflammation on the pets body. Although this does not motivate every client to be more interested in his dogs or cats body condition, it may persuade those owners who are on the fence to try a weight-loss program. The pathophysiology of obesity is becoming much clearer. Fat is now recognized as an endocrine organ, since adipose tissue releases local and systemic cytokines (known as adipokines) that are thought to regulate systemic inflammation and food intake.1 A handful of measurable mediators of chronic inflammation and adipokines have been defined in dogs and cats.1 The picture of obesity and chronic inflammation in pets is similar to the evolving human story. When fat from obese animals is examined histologically, apoptotic/necrotic adipocytes are surrounded by inflammatory macrophages. This results in a chronic inflammatory response. This process may stimulate further release of inflammatory mediators from surrounding adipocytes, creating a chronic inflammatory stimulus back and forth between macrophages and adipocytes. There are 40 to 50 identified adipokines released from fat cells. The ones of clinical importance in dogs and cats are adiponectin, leptin, monocyte chemotactic protein-1, and resistin. Adiponectin is the most abundant adipokine in the bloodstream in all species, but it does not circulate as a single monomer only. It circulates and has its best insulin-propagating activity as large polymers of six to 18 bonded monomers. In this form, it is called high-molecularweight (HMW) adiponectin.4 HMW adiponectin is released from adipocytes in lean people and its secretion is severely diminished in obese people, with post-gastric-bypass surgery patients showing increases in serum HMW adiponectin.5 This is important because adiponectin improves insulin signaling; therefore, when obese animals stop secreting it, insulin resistance can ensue.
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Recent results from our data set and now from an Australian group suggest that adiponectin and HMW adiponectin concentrations are not affected during weight loss in dogs.6,7 However, even in obese dogs, it appears that adiponectin is continually secreted at high concentrations into the blood. Could this be part of the reason why insulin resistance in dogs is hard to define in clinical investigations? And is this why type II diabetes is rarely observed in dogs? Further research is needed to elucidate the clinical ramifications of adiponectin secretion in dogs and cats. Table 1 shows results from a recent study examining adipokine concentrations before and after a weight-loss program in dogs. The results show that all of the aforementioned adipokines except for adiponectin decrease after about 25% weight loss in a group of dogs, similar to other reports.8,9 This decrease in inflammatory adipokines corresponds with a drop in the systemic marker of inflammation, the acute phase protein called C-reactive protein (CRP). In obese people, the increased inflammation is associated with an increased risk of heart disease and type II diabetes.10 The chronic health ramifications of this slightly elevated inflammatory response in dogs and cats still need to be investigated. Although there is much left to be studied, we do know that obesity has a multitude of systemic effects and predisposes pets to many problems. We can do a better job of communicating to clients what is definitively known about the short- and long-term health risks of obesity in pets. tion or management. We ask clients to exert a great deal of effort for the health of their pets, and so we should be willing to do the same. Fortunately, the major pet food companies make software that allows us to track our patients progress. This tracking can be entrusted to a technician who is familiar with your weightloss software program. When you dispense the first bag of a therapeutic diet, it is best to have your technician schedule several monthly weigh-in sessions for the animal. These are usually free office visits, but you will find that the client typically buys another bag of food or another item, such as a flea control product or heartworm preventive, which more than justifies the time spent in these cases. Reminder calls before each weigh-in session are a good idea. Time and time again, plans without weigh-in appointments fail because of client noncompliance. If veterinary professionals do not take a longterm interest in these cases, then clients are also less likely to comply or come back for that second bag of weight-loss-formula food, and the battle is lost.
Fortifying food with 150 mg to 500 mg carnitine can improve retention of lean mass during a weightreduction protocol.
Mistake #2 Having a do as I say, not as I do attitude

One of the biggest problems in practice is that we do not invest adequate time in obesity preven-
Mistake #3 Miscalculating the pets maintenance energy requirement

Often the first mistake that veterinarians make when implementing a weight-loss program is incorrectly calculating a
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Table 1. Medians for body weight, body condition score, serum adipokines, and markers of inflammation before and after weight loss
Body Weight (kg) Body Condition Score Leptin (ng/ml) Adiponectin (pg/ml) Resistin (pg/ml) HMW Adiponectin (ng/ml) MCP-1 (ng/ml) CRP (g/ml) Before Weight Loss 43.1 8 18.9 38.1 67.1 52.0 202 10.0 After Weight Loss 33.8 5 6.6 29.5 60.5 54.3 170 5.6 P value P < 0.001 P < 0.001 P < 0.001 P = 1.0 P = 0.003 P = 0.86 P = 0.038 P = 0.005
patients maintenance energy requirement (MER). For animals weighing less than 30 kg, the MER is calculated in kilocalories (kcal) by first using the linear equation to calculate the resting energy requirement (RER):11 RERkcal = 30(BWkg) + 70. Then, to determine the MER, a multiplier is applied to the RER. This multiplier is based on the animals activity level, and it is frequently around 1.5. With this equation, you should use the pets ideal body weight. Other weight-loss equations use current body weight and/or body condition score to calculate the daily caloric amount. For more information on one such method, visit Purinaveterinarydiets.com, or call the Veterinary Resource Center at 1-800-222-VETS (8387). Regardless of the methods used, it is ideal to target between 1-3% weekly weight loss for dogs and between 0.5-2.0% in cats. One common mistake in using this equation is calculating the
RER using the animals current body weight instead of its ideal or goal body weight. You should use the pets ideal body weight. A second error can occur with the activity level multiplier. Using 1.5 as the multiplier is acceptable for young active dogs or indoor/outdoor cats, but it is not appropriate for inactive dogs or indoor cats. Often the multiplier should be less than 1.5, particularly in cases in which a previous weight-loss program was unsuccessful. Recent research suggests that obese, inactive cats should start at their RER (that is, with a multiplier of 1.0), because they are not active enough to have an MER. The multiplier should be closer to 1.0 or 1.2 in the typical inactive, neutered, overweight dog.12,13 Unfortunately, the linear RER equation only works for dogs that weigh less than 30 kg. If used for an obese 50-kg Rottweiler, then the dogs kilocalorie needs would be overestimat-
ed right from the start. For larger dogs, the RER is calculated by plugging the ideal body weight into this exponential equation:13-15 95(BWkg)0.75. Be sure you begin a patients weight-loss program based on correct calculations. Use the pets ideal body weight in your RER calculations and be sure to use an appropriate multiplier to calculate a pets MER.
Mistake #4 Not addressing the pets activity level

The issue of activity level in weight-loss programs for cats and dogs has been hotly debated. I recently completed a study using pedometer technology with dogs and found a very strong correlation between body condition score (BCS) and average daily number of steps (Figure 1).16 This suggests either that obese dogs walk less than thinner dogs or that walking less predisposes dogs to obesity. A second clinical study recently
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Figure 1.
Mistake #5 Not addressing problems with the pets behavior and satiety
Undesirable behaviors, such as begging, breaking into pet food bags, and food protectiveness, can develop or worsen during a weight-loss program. Owners are less likely to comply with your recommendations if they see these negative behaviors develop or worsen. Because of my involvement with a fairly extensive obesity trial and routine obesity clinic work, I feel that switching some pets to a canned therapeutic food or a combination of canned and dry foods can sometimes result in progress. An 8-oz portion of dry kibble has between 225 and 275 kcal for dogs and a half cup of food (4 oz) has 125 to 175 kcal for cats, while a 13-oz can for dogs has 175 to 275 kcal and a 6-oz can for cats has 110 to 130 kcal. Therefore, the cans contain fewer calories but more volume. Clients will appreciate being able to feed the increased quantity, and the canned food is likely to provide more immediate gastric fill, increasing the dogs or cats satiety. Another trick for adding volume to a dogs diet is to substitute green beans for dog food. We have gone as high as 1 cup of green beans per cup of dog food. The owners appreciate the extra volume given, which creates the needed gastric fill.
is true.6 In the second study, we also measured steps taken with a pedometer during a weightloss program, and we found that pedometer readings were virtually unchanged when the dogs average BCS dropped from 8 to 5.5. That is, weight loss did not increase their activity level. This, unfortunately, really points the finger at owners. From our data, we predict that the owners activity and willingness to increase the dogs physical activity may play a role in the success of a canine weight-loss program. Another question is whether active dogs lose weight quicker than less active dogs do. Our study showed that active dogs could eat approximately 5 more
conducted by my laboratory group suggests that the former
This scatter plot shows the relationship of baseline body condition score and average daily steps. Analysis of these values revealed a significant negative nonparametric correlation (P value <0.0001).
kcal/kg of metabolic body weight (not kg of true body weight) during weight loss. Thus, activity does play a role in calorie consumption and weight loss. In our study, active dogs averaged about 5,000 more steps per day than inactive dogs did. This equates to about a 2-mile walk each day.6 It is, without a doubt, more challenging to increase the activity level of cats, especially obese cats. Veterinarians should encourage owners to work at this, and share their own ideas about ways to boost the cats activity level in the home. Although most cats quickly grow bored with the same activities, if owners are willing to be creative, they can pique a cats interest by rotating toys or using laser pointers and treat dispensers.
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2011 Nestl Purina

and other flavonoid supplements to foods. There is some indication that these bioactive molecules can diminish food intake. The exact mechanism of action has yet to be determined, but it is currently thought that flavonoids may act at the level of the hypothalamus to hinder appetite. The most convincing evidence has been in cats, though the long-term effects seem to be less rewarding.18-20 The flavonoids may only be useful for temporarily decreasing appetite. One study showed that eating behaviors returned to normal within a week.20 In the same study, the use of the isoflavone genistein enhanced retention of lean body mass during weight loss, which is intriguing. From a theoretical standpoint, maintaining lean body mass is advantageous since it is more metabolically active and, therefore, helps to burn fat during weight loss. To preserve lean body mass during weight loss, two approaches have been used successfully. Fortifying food with 150 mg to 500 mg carnitine can improve retention of lean mass during a weightreduction protocol.21 Other evidence suggests that a highprotein diet (40% to 50% dry matter) can help retain lean body mass during weight loss.22 Lean body mass retention cannot be achieved by feeding common over-the-counter light foods, which are often moderate When it comes to cats, portion control becomes an issue since every owners -cup can be different. Ask cat owners to use a kitchen scale so they can precisely measure grams of food per feeding. Another trick with cats is to use zucchini to create gastric fill. Cats do not usually appreciate vegetables, but some seem to enjoy the texture of firm, steamed zucchini. Instruct the client to start adding three or four cubes of chopped, steamed zucchini to the regular meal. In some of our cases, cats ate up to 50 g of zucchini each day, and owners claimed that begging behaviors were diminished. ed. Therefore, when clients ask to use an over-the-counter light food, I often supplement the dog food with a human complete multivitamin (one-half tablet per 25 kg body weight for dogs). I do not recommend doing this for cats. A bigger problem with using an over-the-counter light food is the fact that the calorie content of that product is really not known, since most of the caloric information is based on calculations of the guaranteed analysis numbers from the package rather than actual analysis of the food. Also, if the food is higher quality and more digestible than what AAFCO assumes for their calculations then the calculations may also be flawed and can contain more calories in the food than shown on the label. Additionally, the manufacturers calculations are done based on the guaranteed analysis label, which contains minimum protein and minimum fat information. Thus, a food that is labeled as containing 5% fat may really contain 7% fat, meaning that it may contain 10% to 15% more calories than the amount calculated by the manufacturer. This is partly why manufacturers hesitate to label pet foods with kcal per cup or per can, since it is probably a low estimate of the true calories in the food. An emerging area of interest in the therapeutic pet food market is the addition of isoflavones
Mistake #6 Using the wrong food

When choosing a food for a weight-loss program, you need to choose what is optimal for the patient. If you use a light food and restrict the assumed calories to around 60% of the MER at ideal body condition, you can create a subclinical nutrient deficiency since these foods are not designed for calorie restriction.17 Many companies provide around two times the Association of American Feed Control Officials (AAFCO) requirement when adding vitamin and mineral premixes during manufacturing, but some companies stay close to the AAFCO requirements, so there could be subpar vitamin and mineral consumption when the total amount of food is restrict-
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to low in protein and are usually not fortified with carnitine.
and drugs for the management of obese and overweight pets. J Am Vet Med Assoc 2008;233:717-725. 3. Laflamme DP. Understanding and managing obesity in dogs and cats. Vet Clin North Am 2006;36:12831295. 4. Chiarugi P, Fiaschi T. Adiponectin in health and diseases: From metabolic syndrome to tissue regeneration. Expert Opin Ther Targets 2010;14:193-206. 5. Linscheid P, Christ-Crain M, Stoeckli R. Increase in high molecular weight adiponectin by bariatric surgery-induced weight loss. Diab Obes Metab 2008;20:1266-1270. 6. Wakshlag JJ, Bushey JJ, Struble AM, et al. The effects of weight loss on adipokines and markers of chronic inflammation in dogs. Br J Nutr (in press). 7. Rand J. Companion Animal Clinical Sciences, University of Queensland, St. Lucia, QLD 72, Australia: Personal communication, 2011. 8. German AJ, Hervera M, Hunter L, et al. Improvement in insulin resistance and reduction in plasma inflammatory adipokines after weight loss in obese dogs. Domest Anim Endo 2009;37:214-226. 9. Eirmann LA, Freeman LM, Laflamme DP, et al. Comparison of adipokine concentrations and markers of inflammation in obese versus lean dogs. Int J Appl Res Vet Med 2009;7:196-205. 10. Gustafson B. Adipose tissue, inflammation and athelosclerosis. J Atheroscler Thromb 2009;17:332341. 11. Chan DL. Parenteral support. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine, 6th ed. Saunders Elsevier, St. Louis, Mo.: WB Saunders, 2005;587-591. 12. Chen CA, Hill RC, Scott KC, et al. Energy requirements of indoor adult pet cats (abst). 9th Annu Am Acad of Vet Nut Symp 2009;4. 13. Wakshlag JJ, Struble AM, Warren BS, et al. The effects of physical activity on kilocalorie intake during a successful canine weight reduction protocol. J Am Vet Med Assoc (in press). 14. Saker KE, Remillard RL. Performance of a canine weight-loss program in clinical practice. Vet Ther 2005;6:291-302. 15. Kienzle, E. Energy. In: Beitz DC, ed. National Research Council nutrient requirements of dogs and cats. Washington DC: National Academies Press, 2006;28-48 16. Warren BS, Wakshlag JJ, Maley M, et al. Use of pedometers to measure the relationship of dog walking to body condition score in obese and non-obese dogs. Br J Nutr (in press). 17. Linder DE, Freeman LM. Evaluation of calorie density and feeding directions for commercially available diets designed for weight loss in dogs and cats. J Am Vet Med Assoc 2010;236:74-77. 18. Jeusette I, Torre C, Salas A, et al. Effects of consuming diets containing various fats or citrus flavanones on plasma lipid and urinary F2-isoprostane concentrations in overweight cats. Am J Vet Res 2010;71:1039-1044. 19. Cave NJ, Backus RC, Marks SL, et al. Oestradiol and genistein reduce food intake in male and female overweight cats after gonadectomy. N Z Vet J 2007;55:113-119. 20. Cave NJ, Backus RC, Marks SL, et al. Oestradiol, but not genistein, inhibits the rise in food intake following gonadectomy in cats, but genistein is associated with an increase in lean body mass. J Anim Physiol Anim Nutr 2007;91:400-410. 21. Center SA, Harte J, Watrous D, et al. The clinical and metabolic effects of rapid weight loss in obese pet cats and the influence of supplemental oral L-carnitine. J Vet Intern Med 2000;14:598-608. 22. German AJ, Holden SL, Bissot T, et al. A high protein high fiber diet improves weight loss in obese dogs. Vet J 2010;183:294-297.
Conclusion
As a profession we are on the cusp of new and exciting product innovations that will help our patients combat obesity not only with greater success, but also in a healthier way. The adage that calories in must equal calories out is still the key to successful weight loss. But we veterinarians can help ensure the success of our patients weight-loss programs by avoiding the six common mistakes reviewed in this article. In summary, we should back up our recommendations for a weight-loss program with the science at hand, devote adequate time to obesity prevention and management in our practice, ensure the accuracy of the initial calculations on which our caloric recommendations are based, take into account the activity level of our patients, acknowledge that we may need to alter feeding recommendations for some pets to sate them and prevent negative behaviors, and help clients choose the best food for a patients weight-loss program.
References
1. German AJ. The growing problem of obesity in dogs and cats. J Nutr 2006;136:1940S-1946S. 2. Roudebush P, Schoenherr, WD, Delaney SJ. An evidence-based review of the use of therapeutic foods, owner education, exercise,
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2011 Nestle Purina Veterinary Symposium On Companion Animal Medicine

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2011 Nestle Purina Veterinary Symposium On Companion Animal Medicine

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on companion animal medicine

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2011 Nestl Purina

Understanding pet owner behavior to achieve weight loss in companion animals

Health risks associated with obesity

Understanding the problem

2011 Nestl Purina

Understanding pet owner behavior to achieve weight loss in companion animals

keeping dogs and cats more active encourages weight loss.

Identifying the issues

Dietary and environmental management in dogs

2011 Nestl Purina

Understanding pet owner behavior to achieve weight loss in companion animals

Dietary and environmental management in cats

2011 Nestl Purina

Follow up and overcoming pitfalls and lapses in compliance

Understanding pet owner behavior to achieve weight loss in companion animals

Clinical and research experiences with probiotics in cats

Michael R. Lappin, DACVIM

Clinical and research experiences with probiotics in cats

SF68 and immune stimulation in cats

SF68 and immune stimulation in puppies

2011 Nestl Purina

Figure 1. Kitten with conjunctivitis secondary to feline herpesvirus 1 i(FHV-1) nfection.

SF68 and management of feline herpesvirus type 1

Clinical and research experiences with probiotics in cats

SF68 and diarrhea in shelter animals

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Figure 2. Cumulative conjunctivitis scores in FHV-1-infected kittens.

Pathophysiology of food allergy

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Table 1.  Common clinical signs of food allergy in dogs and cats4,7,8,21

Role of the GI tract

Role of the immune system

Factors influencing development of allergic conditions

Common food allergens

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Table 2.  Most commonly identified food allergens in dogs and cats7

Diagnosis of food allergy

Homemade novel protein diets

Commercial novel protein diets

2011 Nestl Purina

Select appropriate diet

Assure client compliance

Conduct trial for sufficient time

Conduct challenge to confirm diagnosis

Maintain patient on an appropriate diet

Commercial hydrolyzed protein diets

2011 Nestl Purina

Joseph Wakshlag, DACVSMR

DVM, PhD, DACVN,

College of Veterinary Medicine Cornell University Ithaca, N.Y.

Mistake #1 Not backing your recommendations with hard science

Mistake #2 Having a do as I say, not as I do attitude

Mistake #3 Miscalculating the pets maintenance energy requirement

2011 Nestl Purina

Mistake #4 Not addressing the pets activity level

conducted by my laboratory group suggests that the former

2011 Nestl Purina

Mistake #6 Using the wrong food

S-ar putea să vă placă și

Table 1. Common clinical signs of food allergy in dogs and cats4,7,8,21

Table 2. Most commonly identified food allergens in dogs and cats7