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Nestlé 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 Nestlè 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 Nestlé 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.

2011 Nestlé Purina
on companion animal medicine

Veterinary Symposium

WHAT’S 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 fit—Avoiding six common mistakes while helping pets combat obesity Joseph Wakshlag, DVM, PhD, DACVN, DACVSMR

1

DACVB Owner.5 Research has found that the risk of health problems was higher in overweight cats—“heavy cats were 2.4 Caloric restriction and maintaining a lean body condition throughout life have been associated with an increase in the median life span of dogs. Considering the behavioral factors in weight loss will improve owner compliance and benefit the pet with better overall health. Horwitz.9 times as likely to be taken to veterinarians because of lameness not associated with cat bite abscesses. DVM. 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. Data published in Australia found 33.8 Naturally. the weight issue is not complicated. and a shorter life span.7 Puppies and kittens that are overweight are more likely to become overweight adults. a reduced quality of life. the owners may conclude the diet or your advice is ineffective. When owners try a weight-loss diet for their pet. obesity can lead to other behavior problems if it causes pain or if it causes anxiety or competition over food resources.Understanding pet owner behavior to achieve weight loss in companion animals Debra F.3 times as likely to develop nonallergic skin conditions. with both the owner and the pet contributing issues and behaviors that make food consump- 2 . Yet the problem goes deeper. Obese cats were also 3. Louis. Veterinary Behavior Consultations St.1.9 times as likely to develop diabetes mellitus. Understanding the problem In most situations.9 times as likely to develop lameness requiring veterinary care. certain chronic disease conditions and medications can also contribute to excessive weight gain. and the pet does not lose weight. and 4. some pet owners seem unable to help their companion animals lose weight. Finally. whereas 7. metabolic diseases. Even with a plethora of weight-loss diets available to them. Mo.2 The prevelance of obesity in cats appears to be similar.”6 Indoor confinement and physical inactivity (often found in cases of obesity) have also been associated with diabetes mellitus. Pet obesity results from overconsumption of food provided. Obesity in companion animals has become a serious medical problem. findings which are likely comparable to those in the USA.3 Overweight animals may experience orthopedic problems. which may even result in aggression.5% of dogs were classed as overweight. 2. Spayed and neutered individuals may be at a higher risk for weight gain because of decreased energy requirements.6% were judged to be obese.

The feeding ecology of felids is different. Dogs tend to eat in a “feast or famine” mode. faster A dog’s food-seeking behavior may not be hunger driven. and special tidbits symbolizes love. Dogs may threaten. They like to show their pet how much they care. vomiting. However.2011 Nestlé Purina on companion animal medicine eating with increased intake may be interpreted as hunger. For many owners feeding their pet is a bonding experience associated with love and caring. if necessary resources. These behaviors could lead to obesity. they may not know how to feed their cat in that manner and maintain weight or achieve weight loss. can be misinterpreted as food seeking. treats. making these behaviors more likely to recur. eating large quantities when food is available since hunting and catching prey is unreliable. Common signs may include an altered consumption rate. Even rubbing behavior. Cats may vocalize to the owner for attention or to play. Acquiring food through a certain behavior is a Pavlovian learned response that is difficult to extinguish. are not adequately provided and spaced within the home. 3 . In life. and providing the pet with delectable food. or very slow eating may be interpreted as dislike of the product provided. food is an important commodity. a cat may overeat or eat very quickly when a food bowl is available. such as food bowls. If they Social factors in food consumption Social factors within the home can have a profound influence on consumptive behavior in dogs and cats. a typical cat greeting behavior. For cats. but the natural foodscavenging behavior of dogs. but owners often assume that the cat is hungry. but the natural food-scavenging behavior of dogs. 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. Even if owners are aware of a cat’s natural tendency. a dog’s food-seeking behavior may not be hunger driven. or tion about more than nutrition. owners of overweight dogs tend to interpret every need of their dog as a request for food.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. especially if the cat follows them into the kitchen. altering the amount consumed or the eating pattern of other dogs. Veterinary Symposium Feeding ecology of dogs and cats Because of the feeding ecology of canids. this reinforces scavenging and begging behavior. Group eating in dogs results in social facilitation of eating and for some dogs an increase in consumption. fight. or intimidate other dogs when food is being prepared and consumed. both can simply be a sign of competition or anxiety about food. 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.10 Additionally.10 receive food. and many owners are unaware that cats would naturally eat multiple small meals daily rather than one or two larger ones.

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. Satiety versus meeting caloric needs Another issue is satiety. Regularly scheduled meals will help create predictability for the pet and may reduce owner overfeeding. the mere presence of the owner may be a signal that food is forthcoming. the animal may not “feel” full. ask owners to identify all sources of food being provided to their pets.) Many owners are unaware that cats would naturally eat multiple small meals daily rather than one or two larger ones. and feeding multiple meals may help with begging behavior. several “if/ then” situations arise that may be obstacles to success. begging and foodseeking behavior may persist. Severe social pressure between household cats may result in increased vomiting. then outcome B occurs. resulting in a classically conditioned response. Alternately. Alternately. For the owner. and the owner may presume that the food is at fault or that there are hairballs. the sensation of fullness. Dietary and environmental management in dogs Feeding set meals rather than free-choice feeding works well for many dogs and is often recommended.Understanding pet owner behavior to achieve weight loss in companion animals other gastrointestinal problems. In a multiple-dog home. certain rec- 4 . Identifying the issues The first step in identifying the behavioral issues underlying a pet’s weight problem is to gather pertinent information about the household routine. For starters. When the pet is fed a food that is highly palatable it may be stimulated to consume more than it needs. Appropriate enrichment and owner-pet activities can be another way to strengthen the human-animal bond. free choice). instead of addressing the underlying social factors. In addition. which may not be achieved or noted by the pet. 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. (For a complete list of questions to ask pet owners. the more difficult it will be to change the behavior. resulting in smaller portions being offered. including all set meals and treats. Learning contingencies Most behavior is influenced by the “if/then” relationship—if I do behavior A. In weight-loss issues. Owners may attempt to switch food without success. several small meals. if it does not “feel” full. keeping dogs and cats more active encourages weight loss. In fact. Although ideally an animal should eat to meet its caloric needs. The stronger the relationship is between the behavior and outcome. if the food has high caloric density per piece. twice daily. All food provided to the pet must be measured using the same measurement tool every meal. a week’s worth of meals can be set up and then dispensed at mealtime. Ask owners to identify the feeding pattern (once daily. the pet’s apparent delight at receiving food is the reward for giving treats or tidbits from the table. Most dogs would prefer to eat at least two meals a day. The owner might be unaware of how to provide bonding and enrichment for the pet without using food. see Table 1.

In some situations. behavior) • Is covered and safe outdoor access available for cats? • Do the owners play with their pet? If yes. does the pet receive tidbits? • If the cat vocalizes when a human enters the kitchen. 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. begging behavior is likely to continue and actually may increase. what type of play and for how long? • Are adequate opportunities and toys provided for enrichment and self-play? Veterinary Symposium ommendations may make compliance easier. etc. why not? (time. treats for coming inside. which makes the dog hopeful that this will occur again. until it finally goes away if no food is given. Therefore. • 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.) • 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. create an acceptable food-sharing plan that includes the approved diet or some low-calorie substitute such as carrots or apples. The best options for doing this are fooddispensing toys. rather than in an accessible garbage can.) • What are the “if/then” situations? • If the dog is around when food is prepared. (See Table 3 for a resource list. etc. countersurfing and garbage-raiding will test the owner’s patience.) If food-seeking behavior and begging occur while human food is being prepared and eaten. pulling on the leash. does food fall on the floor? • If the pet is present during consumption of human food. slowing down the rate of eating and having the dog work for its food can increase satiety and decrease begging. owners are often unable or unwilling to comply with this recom- mendation. raiding other pets’ food. One alternative is to use part of the pet’s 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. Identifying and dealing with this problem is likely to increase compliance overall. These must be used cautiously in a multipledog home since fighting over food-dispensing toys can occur. Explore the feeding behavior Ask pet owners these questions to gain insight on their household routines. If food sharing is a large component of the human-animal bond.) For some dogs. Discussions about how to keep these items away from the dog can help.2011 Nestlé Purina on companion animal medicine Table 1. then the dog should be confined elsewhere during these activities. does it receive food? • If the dog vocalizes at the treat jar. from the table. Many dogs get treats for simply being cute or just coming inside. when they stop feeding the dog from the table. and placing bread in a covered breadbox. These include keeping garbage under the sink. However. These can add up to 5 . (See Table 2. Treats are almost always an issue.

slimmer cats access to food. it is often easy to substitute something else or switch to a low-calorie option. certain environmental changes may help: • Use a timed feeding bowl that opens only at certain times for the cat with the corresponding collar. Therefore. the owner holds up the second one. By calculating the number of treats given each day. prepare food when the dogs are out of the room. the owner is unable or unwilling to walk the dog due to its behavior on a leash. many additional calories over the course of a day. Increasing exercise. opt for free-choice feeding. realistically most will not. it is possible to ask the owners to break each treat in half and decrease the number of treats by 50%. asks the dog to drop the object and when it does. place food bowls on elevated surfaces to allow the more agile. 6 . so placing food bowls in noisy or busy locations may alter feeding patterns and lead to either under. As part of the weight-loss plan. • Once the dog has finished its allotted amount.  Feeding routines for a home with multiple pets Feeding routine in a multiple-dog home • Separate dogs for feeding. • When cats are on different diets or need additional food.Understanding pet owner behavior to achieve weight loss in companion animals Table 2. Once they realize that the size of the treat does not seem to matter to the pet. • If the obese cat is not agile. Most owners have a difficult time getting the dog to drop the ball so that the game can continue. the owner needs to find a way to increase activity levels. such as hide and seek or even basic training or tricks to keep the pet moving. bonding. so that only the cat wearing the corresponding collar can enter. the owner could meet with a veterinary technician to learn how to use these devices for more pleasurable walks. Cats generally will eat multiple small meals a day. • Give each dog its own food bowl. It is often assumed that a dog with a fenced yard will exercise itself. If the dog likes to play with toys. Walks do not need to be long. • Pick up and put away the food bowl until the next feeding time. but once the dog is out of adolescence. Dietary and environmental management in cats The feeding ecology of a cat differs from that of a dog. meaning one cat will not empty the entire bowl. • If possible. Walks are a good alternative. but should be frequent. some say up to 12 to 15. Although we would like owners to stop giving the pet treats. then the owner and the dog can play fetch. Be sure to counsel owners that an increase in exercise does not mean that the dog can increase its intake of food.or overconsumption. This allows cats to eat multiple small meals. When the dog returns with one object. Appropriate control products. • Use an electronic cat door into a room with the selected food. Other games are possible. Owner and pet become conditioned to use food as a bond- ing exercise. provide each cat with its own bowl in a separate spot for feeding times. Replacing this bonding exercise with another is crucial to success. This can be overcome by using two objects. Feeding routine in a multiple-cat home • Provide multiple feeding stations throughout the home. let it out of its confinement area. preferably in different rooms. this is simply not so. can be used to address leash-walking problems. and play is critical. Cats often like privacy when they eat. the new object is thrown. • If free-choice feeding is not possible. • If anxious or excited behavior is a component of the feeding routine. In many situations. such as head halters or no-pull body harnesses.

owners using Diet C and the measuring cup recorded higher hunger scores than those for Diet A or B.com)  Busy Buddy.) Owners should realize that when active play wanes after a short time. 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. Kibble Nibble.11 Cats in the study were fed either Diet A. an existing commercial dry high-fiber ration fed with a measuring cup. (See Table 2.2011 Nestlé Purina on companion animal medicine The type of food and the way food is provided seem to influence weight loss in cats. A randomized.) Owners may not be aware of social issues because aggression between cats is often not overt. pet owners are often isolated from other pet owners. so opportunities to share experiences through a structured program such as Project Pet Slim 7 . In addition. or Diet C. a novel dry high-fiber ration. Because social issues can have a profound effect on food consumption in cats.purinapetgear.cannyco. Some cats enjoy interactive play with their owners and the use of toys can greatly enhance this activity. But when you explain to the owner that the dog has lost 10% of its total body weight. (See Table 3. Twist ‘n Treat.12 Adding climbing towers and placing food bowls in outof-the-way places can increase activity. then distributing Veterinary Symposium Table 3. blocking. Explaining the weight loss as a percentage of body weight sometimes helps. For example. However. removal of the toy and substitution with another would restimulate play activity. Follow up and overcoming pitfalls and lapses in compliance Owners often get discouraged because weight loss is slow.premier. pre-prepared portions of dry and moist food. owners using Diet C and the measuring cup were most dissatisfied. Some cats will use food-dispensing toys and can have at least one meal a day provided in this manner. Owners noted an increase in activity in the cats with all diets. If that rarely occurs.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.kongcompany.com) The Gratifier. which can intimidate a cat from approaching the food bowl.premier.com) Kong and Kong Wobbler Premier Pet Products (www.us) Halti Training Head Collar (most pet supply stores) Premier Pet Products (www. the significance of the achievement is more likely to become clear. Diet B.  Resources Food-dispensing toys for dogs and cats Kong Products (www. but may consist of staring. Moreover. environmental placement of food is very important. One pound of weight lost by a dog can equal 5 pounds lost by a person. Exercise and increased activity can aid in weight loss in cats. and Linkables for dogs Funkitty Twist ‘n Treat and Egg-Cersizer for cats Purina Pet Gear (www. It often is illuminating to ask when the owner sees all the cats in one place. and mild chasing. single-blind study in 2009 investigated the effect of dietary strategies and diet composition on weight loss in cats. Mean weight loss was similar among the groups. 5 pounds lost in a 50-pound dog can seem like a small amount to the owner. Kitty Treat Ball Control products for dogs and cats Canny Collar (www.

10. Object play in adult domestic cats: the roles of habituation and disinhibition. Enhanced compliance can occur by offering the owner pre-prepared pet food. et al. Pride C. Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus. Effects of feeding regimens on a bodyweight. 4th ed. Effective weight-loss plans are achievable using the proper diet. Servet E. behavioral interventions for both the owner and the pet. McGreevy PD. Donoghue S. Burkholder WJ. and good coaching and follow up. Remillard RL. owner education. Toll PW.79:263-271. Colliard L. Evidence exists that weightloss programs that include regular follow up improve compliance and results. J Feline Med Surg 2010 Feb. 2000. et al. Small animal clinical nutrition. Thatcher CD. composition and condition score in cats following ovariohysterectomy. 9. Bradshaw JWS. Slingerland LI. App Anim Behav Sci 2002. exercise and drugs for the management of obese and overweight pets. 7.216:1089-1091.212:1725-1731. et al.233:717-725. J Am Vet Med Assoc 2000. Kienzle E. References 1.12(2):104-12. At that time. J Nutr 2006. Topeka. Robinson IH. Bissot T. Planting EA. Thomson PC.13 Not only can follow-up visits be used to weigh the pet. Vet Rec 2005. et al. 6. 2. Associations between body condition and disease in cats J Am Vet Med Assoc 1998.136(suppl):1947S-1950S.179:247–253. but they are an opportunity to discuss what behaviors are troublesome and interfering with compliance. and control devices for walking the dog. Lawler DF.Understanding pet owner behavior to achieve weight loss in companion animals Down (projectpetslimdown.401-430. 3. 12. Obesity. 5. J Feline Med Surg 2009. Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Watson TGD. Fazilova VV. 13. et al. Roudebush P. Schoenherr WD. J Am Vet Med Assoc 2008.12(suppl):128. et al. Comparisons of the feeding behavior and the human-animal relationship in owners of normal and obese dogs. Kan.220:1315-1320.156:695-707. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. J Nutr 1998. Lemuet B. Effects of diet restriction on life span and age-related changes in dogs. Scarlett JM. Harperd EJ. play items. Muir P. Vet J 2009. J Am Vet Med Assoc 2002. HumanAnimal Relationship of Owners of Normal and Overweight Cats. Hall SL.11:135-140.: Mark Morris Institute. J Small Anim Pract 2001. In: Hand MS. 8. An evidence-based review of the use of therapeutic foods. Paragon BM. 11. Impellizeri JA. Delaney SJ. et al. Ballam JM. Berglert R. Kienzle E. Stack MT. Mandernack A. Kealy RD. Vidal S. Bergler R. 8 . Prevalence and risk factors of obesity in an urban population of healthy cats. eds.42:433-438. Novel dietary strategies can improve the outcome of weight loss programmes in obese client-owned cats. Tetrick MA.com) can help increase compliance. fooddispensing toys. 4. the technician can offer alternate solutions that may help the owner keep on track with the treatment plan.

 Prevention of respiratory tract infections (common cold. and 7. Helicobacter pylori infection.  Beneficial effects on microbial aberrancies. DACVIM DVM. 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.3-5 Michael R. The proposed mechanisms of action include competition for essential nutrients or receptor sites. PhD. In a recent review of human studies involving probiotics. more rigorously controlled multicenter studies should be performed.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. 6. Lappin. it was stated that “wellestablished probiotic effects include:2 1. influenza) and other infectious diseases as well as treatment of urogenital infections. such as Clostridium difficile diarrhea and hospital-acquired pneumonia. but very few in small animals. 4. College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins. All mechanisms of immune modulation have not been characterized and it is likely these effects vary by the probiotic.  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. inflammation.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. is minimal and that larger.” Infectious diseases are very common in small animals. Colo. so the potential beneficial effects of probiotics could impact veterinary practice significantly. or bacterial overgrowth.1 There have been many studies of the effects of probiotics on the health of people. and production of inhibitory substances.  Reduction of the concentration of cancer-promoting enzymes and/or putrefactive (bacterial) metabolites in the gut. 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.  Prevention and alleviation of unspecific and irregular complaints of the gastrointestinal tracts in healthy people. natural killer cell activity.  Normalization of passing stool and stool consistency in subjects suffering from obstipation or an irritable colon. 9 . 5. 3. 2. and both specific and nonspecific immunoglobulin production. binding with pathogenic bacteria. and other complaints in connection with inflammatory diseases of the gastrointestinal tract.  Prevention or alleviation of allergies and atopic diseases in infants.

Body weight and fecal scores were not statistically different between the two groups. Cellular immune responses were assessed via flow cytometry and whole blood proliferation assays. E. and saliva were estimated using a commercial ELISA or radial immunodiffusion assay. a commercial FVRCP modified-live vaccine was administered subcutaneously and the kittens were followed until 27 weeks of age. In addition. the majority of diets claiming to contain probiotics generally did not meet the label claim when evaluated. Blood. In one dog study. a similar collaborative study with Nestlé Purina PetCare was performed in healthy kittens. and FHV-1-specific cell-mediated immune responses. 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. feline calicivirus (FCV). CD8. and feline panleukopenia virus (FPV).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. and urinalyses were performed to detect adverse events induced by the probiotic. Feces from seven of nine treatment SF68 and immune stimulation in cats After publication of the puppy study. the source of the probiotic should also be considered. and B cells. 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. 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. FCV-specific IgG. but not fed the probiotic. and feces were collected from all cats throughout the study. humoral immune responses to feline herpesvirus type 1 (FHV-1). FHV-1-specific IgA. it was hypothesized that feeding E. as well as FHV-1 specific IgG and IgA levels in saliva using adaptations of previously published ELISA methods. At 9 and 12 weeks of age. and body weight was measured weekly. in a recent study in Canada. Other tests included randomly amplified polymorphic DNA (RAPD)-PCR on feces. lymphocyte proliferation in response to concanavalin A and FHV-1 antigens was assessed. RAPD-PCR was done to determine if viable E.Clinical and research experiences with probiotics in cats 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. faecium SF68 to kittens would enhance nonspecific immune responses. saliva. 10 . In addition. For example. Antigen-specific humoral immune responses were estimated by measuring FHV-1-specific IgG. serum biochemical panels. Total IgG and IgA concentrations in sera. Twenty 6-week-old specificpathogen-free kittens were divided into two groups. and an increased percentage of circulating B lymphocytes when compared with puppies in the control group. fecal extracts. CD44. Lymphocytes were stained for expression of CD4.9 In that study. one group was fed SF68 daily and the other group was fed a placebo. The attitudes and behavior of the kittens were monitored daily throughout the study. increased CDV-specific IgG and IgA serum concentrations. It was believed that SF68 prevented the decline in antibody titers observed in the control group by maintaining high levels of antibodies.8 A number of findings suggested that the probiotic had an immune-modulating effect. Complete blood counts. Starting at 7 weeks of age. The puppies supplemented with SF68 had increased serum and fecal total IgA concentrations.7 This bacterium is now the probiotic in the Nestlé Purina PetCare Company product named FortiFlora™. respectively. and FPV-specific IgG in sera. extracts from samples taken at 9 and 27 weeks of age were analyzed for total IgA and total IgG. MHC Class II.

it could not be determined whether a Th1 or Th2 response predominated. fecal. SF68 and management of feline herpesvirus type 1 The results of this study prompted a follow-up study on FHV-1. Therefore. There were no significant differences in serum. FCV.10 This virus is extremely common in cats and frequently results in recurrent ocular and respiratory clinical signs (see Figure 1). Th2 cells produce interleukin-4. and 27 weeks of age. However. There is no known drug therapy that consistently eliminates the carrier state. Veterinary Symposium Figure 1. At 21 and 27 weeks of age. The CD4+ T lymphocytes of kittens in this study were not additionally characterized via cytokine production profiles or additional cell surface marker characterization. 12 cats with chronic FHV-1 infection were administered either SF68 or a placebo. the treatment group’s serum mean FPV-specific IgG levels were numerically greater than those of the placebo group. analyzed for FHV-1 shedding. After an 11 . In this study. at 27 weeks of age. the increase in CD4+ T lymphocytes may have been nonspecific as the cells appeared to be unprimed. 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. The cats were then monitored for clinical signs of disease. which stimulates IgE production by B cells (humoral immunity). these differences in FHV-1 antibody levels did not reach statistical significance. SF68 DNA was not amplified from feces of any treated cat one week after stopping supplementation (Week 28). the treatment group had a significantly higher percentage of gated lymphocytes positive for CD4 than the placebo group. and FCVspecific IgG levels in serum were similar between the groups. the mean levels of FHV1-specific IgA in serum and saliva were numerically greater in the treatment group when compared with the placebo group. 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. and evaluated for FHV-1-specific humoral and cell-mediated immune responses and fecal microbiome stability. Kitten with conjunctivitis secondary to feline herpesvirus 1 i(FHV-1) nfection. Two major subsets of CD4+ T cells are the Th1 and Th2 subsets. 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 mean FHV-1-specific serum IgG levels were numerically greater in the treatment group when compared with the placebo group at 15. At 15 weeks of age.2011 Nestlé Purina on companion animal medicine cats were positive for SF68 at some point during the study. whereas feces from all control cats were negative for SF68 throughout the study. Moreover. or saliva IgG or IgA concentrations between the two groups. However. and FHV-1 antibody titers. 21. Th1 cells stimulate cell-mediated immune functions (cell-mediated immunity). but the differences were not statistically significant. No FHV-1-specific IgG was detected in saliva. Furthermore. and vaccination does not provide sterilizing immunity. In this study. Complete blood counts and biochemical profiles were within normal limits for the age group for all cats at all time points. either the sample size or the duration of this study may have precluded detection of statistical differences between the groups in regards to FPV.

but those fed SF68 had fewer episodes of conjunctivitis than the placebo group during the supplementation period.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. flat. 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. with no texture Occurs as puddles Leaves residue when picked up equilibration period. mice administered SF68 and then infected with Giardia intestinalis shed fewer trophozoites and Giardia antigen than the placebo group. suggesting that administration of the probiotic lessened morbidity from chronic FHV-1 infection (see Figure 2). The study 12 . Ideally. stools should be firm but not hard. The SF68 was well tolerated by all cats. but decreased in cats fed the placebo. Upper respiratory signs of disease were not exacerbated by the induced stress. pliable and segmented. when compared with untreated mice.11 In addition. SF68 and diarrhea in shelter animals In previous research. This work prompted a study on diarrhea in cats and dogs housed in an animal shelter. indicating a more stable microbiome in cats fed SF68. and easy to pick up (Score 2). in a healthy animal. as well as increased anti-Giardia intestinal IgA and serum IgG. Fecal microbial diversity was maintained throughout the study in cats given SF68. supplemented mice had increased CD4+ cells in Peyer’s patches and the spleen. mild stress was induced over time by changing the housing of the cats from cages to gang housing repeatedly over a five-month period.Clinical and research experiences with probiotics in cats Table 1. 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.

7% for the placebo group. Isakow W. Adv Biochem Eng Biotechnol 2008. Am J Clin 13 . Knorr R.14:168-175. These results suggest that administering SF68 to cats housed in shelters may reduce the number of days with diarrhea. J Feline Med Surg 2009. Otherwise.11:650-654. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: A systematic review. Morrow LE. Summary Controlled studies evaluating the use of probiotics in cats is limited and inconclusive. Lappin MR. management of the rooms was identical. Can Med Assoc J 2005. Moroni M. Effect of supplementation with Enterococcus faecium (SF68) on immune functions in cats. Czarnecki-Maulden GL. Chest 2007. Curr Opin Pul Med 2008. et al. Probiotics. the percentage of cats with diarrhea of two or more days was 7. and oocysts and immunofluorescent antibody testing for Cryptosporidium oocysts and Giardia cysts. Since this was a shortterm study. Scorza V. and synbioticsapproaching a definition. Curr Ther Res 1979. Veterinary Symposium 35 30 25 20 15 10 5 0 Percent conjunctivitis P<0. 5. Biological properties of SF68. J Vet Int Med 2011. Benyacoub J. 8. one of the investigators would score the feces in each animal’s cage using the Purina Fecal Scoring System for Dogs and Cats (see Table 1). Before the room was cleaned each morning. Cavadini C. in press. a new approach for the treatment of diarrhoeal disease. Costa V.2011 Nestlé Purina on companion animal medicine SF68 Placebo Nutr 2001. However. this effect was likely from the probiotic’s influences on intestinal flora rather than its systemic immune-enhancing effects. Cavadini C.8:229-238. Probiotics for the prevention of nosocomial pneumonia: Current evidence and opinions. 9.173:167-170. Animals in one room were supplemented daily with FortiFlora and animals in the alternate room were supplemented daily with placebo. Bacteriological evaluation of dog and cat diets that claim to contain probiotics. Schrezenmeir J. Probiotics. Lappin MR. Diarrhea prevalence rates were low for all dogs in the study and so statistical differences were not detected. J Nutr 2005. J Nutr 2003. McNabb B. 7. dogs and cats were divided into groups and housed in separate rooms (two groups of dogs and two groups of cats). and synbiotics.111:1-66. Cumulative conjunctivitis scores in FHV-1-infected kittens. 3. De Vrese M. Can Vet J 2003. Effect of Enterococcus faecium SF68 supplementation on diarrhea in cats housed in a northern Colorado animal shelter. Probiotics for preventing and treating nosocomial infections: Review of current evidence and recommendations.133:1158-1162. Further research is ongoing in this area. et al. et al. 4. in press. The testing at CSU included microscopic examination for parasite eggs. 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. Kollef MH. Satyaraj E.7% for the probiotic group and 20. Pilot study to evaluate the effect of oral supplementation of Enterococcus faecium SF68 on cats with latent feline herpesvirus 1. Supplementation of food with Enterococcus faecium (SF68) stimulates immune functions in young dogs. Benyacoub J. Arroyo L. However. Enterococcus faecium SF68 enhances the immune response to Giardia intestinalis in mice. 12.73:361S-364S. Vet Therap 2007. prebiotics. et al. Isakow W. Lewenstein A. Perez PF.135:1171-1176. Frigerio G. 11. Veir JV. cysts. Dendukuri N. The cats and dogs were all fed a standardized diet by species. Scherezenmeir J. 6. Weese JS. References 1. Bybee SN.0001 Supplementation/stress period Figure 2. McGregor M. de Vrese M. et al. prebiotics.132:286-294.26:967-974. 10. Veir JK.44:212-216. Rochat F. 2. there is evidence that SF68 is well tolerated and may have various clinical applications.

or both. Other forms of adverse reactions to foods can include food intoxication or food poisoning. the majority of dogs and cats with food allergies manifest dermatologic signs.When pieces are better than the whole: Hydrolyzed protein diets Clinical signs of food allergy in dogs and cats Dottie Laflamme. biological reactions to the toxins or infectious agents in foods. 259 allergic dogs were identified. 45% exhibited dermatologic signs. Similarly. According to veterinary dermatologists. Louis. 29% were diagnosed as food allergic based on elimination and challenge testing. Mo. 65 were identified as food responsive. rather than to normal foods. but in only 10% of the atopic dogs. while 183 were considered atopic. veterinary gastroenterologists recognize that a large percentage of patients with GI signs have some form of food allergy or intolerance. while food intolerance is considered to be an idiosyncratic reaction. or both. Food allergy is immune-mediated. which are abnormal responses to normal foods or ingredients.5. GI signs. Unlike food allergy or intolerance. 32% expressed GI signs. DACVN Senior Research Scientist Nestlé Purina PetCare Research St. and borborygmus. Food allergy and food intolerance imply abnormal reactions to a normal food or ingredient. food poisoning refers to normal. Similarly. identified 22 (17%) cats that were confirmed food allergic by elimination and subsequent challenge testing. PhD. although 15% to 50% are now recognized to also have GI signs. diarrhea. III. and both food allergy and atopic dermatitis commonly occur together.1-4 Moreover.2 Pathophysiology of food allergy The exact mechanisms behind food allergy are not fully known. Dermatologic signs of food allergy (Table 1) are similar to those of atopic dermatitis. Concurrent GI signs occurred in 31% of the food-responsive dogs. and 23% exhibited both signs.2-4 In a study of 418. although only 20% of these were confirmed by challenge to be food allergic.1 GI signs can include vomiting.2 Among the cats confirmed to be food allergic. It appears that patients expressing both dermatologic and GI signs are more likely to be diagnosed as food allergic.6 In one study of 70 cats with chronic GI signs.422 dogs in Switzerland. and IV hypersensitivity reac- 14 . another study demonstrated that 50% of dogs with chronic GI signs were food responsive.5 An additional 20% of cats in the study showed a positive response to diet but did not relapse upon challenge.2.4 Of these. 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%). Food allergy may manifest with dermatologic or gastrointestinal (GI) signs. but are thought to involve type I. DVM.6 Another study evaluating 128 cats with either pruritus.

10 Two major subsets of CD4+ T cells are the Th1 and Th2 subsets. Under normal circumstances. This allows the immune system to develop an appropriate recognition and response to that particular antigen—either to develop a tolerance to a food protein or to mount a defense against an invading organism.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. toxic substances. immunoglobulins (Ig). and antigens.10 This function is facilitated by micro- fold cells (M cells) located on the Peyer’s patches. which is the largest immunologic organ in the body. hypersensitivity may develop. Although type I and III reactions are mediated by IgE or IgG and type IV is a T-cellmediated reaction. such as with increased mucosal permeability. M cells take up antigens from the intestinal lumen and present them directly to lymphocytes within the Peyer’s patch.  Common clinical signs of food allergy in dogs and cats4. neck. 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. which stimulates IgE production by B 15 .8. It must balance this protective function with the need to absorb and tolerate normal dietary antigens. Veterinary Symposium Table 1.7. whereas Th2 cells produce interleukin (IL)-4. only trace amounts of intact proteins and large peptides can make it past the mucosal barrier. Complete digestion of proteins destroys the antigenic factors.7. These proteins are removed by the reticuloendothelial cells of the liver and the mesenteric lymph nodes. The primary means of defense against inappropriate allergic responses to dietary antigens include an effective mucosal barrier. and the cells involved. other cells play a role in these reactions.9 A critical role is played by the GALT in the development of tolerance to food proteins. Th1 cells stimulate cell-mediated immune functions and inhibit IgE synthesis. When excessive antigens are absorbed. 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. and oral tolerance developed by the gut-associated lymphoid tissue (GALT).2011 Nestlé Purina on companion animal medicine tions. which are distinguishable on the basis of their expressed cytokines. Interaction between food antigens and the immune system begins in the GI tract. efficient digestion of proteins.8 The offending allergens are usually proteins or glycoproteins that can interact with the body’s immune system and lead to a hypersensitivity reaction.7. 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.

thus. As the GI mucosa is a primary barrier to prevent absorption of potential allergenic proteins. Nonallergenic factors. and up to 30% of patients with cutaneous manifestations also develop GI signs. Another factor that may influence the manifestation of clinical signs is the pruritic threshold. or it may be a result of compromised GI mucosa. significant changes occurred within the skin of dogs with cutaneous adverse food reactions. and tumor necrosis factor-α (TNF-α) production and a reduced Th1-Th2 ratio associated with increased Th2 cells are found in atopic and food-allergic people. suggesting a continuing “pre-activated immune status” in dogs with food allergies. a pruritic dog with concurrent atopy and food allergy may drop below the pruritic threshold by effective control of only one of these conditions. thus increasing the risk of sensitization or allergic response.9 This may also be true in cats and dogs based on breed and familial predisposition.9 Heredity is a major predisposing factor in allergic conditions in people. The majority of common 16 .16 This may be because of an underlying immune (Th1/Th2) imbalance. who have ongoing activation of Th2 cells with increased release of inflammatory cytokines. allergies can form to any protein. IL-13.13 These changes included a pronounced CD8+ T cell-dependent inflammatory response. transforming growth factor-β (TGF-β).14 This is consistent with results from food-allergic children. A proper balance between these cell types is necessary for normal immune function. For example.When pieces are better than the whole: Hydrolyzed protein diets cells. a breach in this barrier increases the likelihood of allergens entering the body and contacting the GALT. Immunoglobulin and T-cell responses appear to differ between food allergy and atopy. IL-6. and increased expression of IL-4. Increased IL-4.12. food allergy often manifests with primary GI signs. and a number of immunopathologies have been associated with an exaggerated Th1 or Th2 response.15 contribute to clinical signs of allergy.17 Factors influencing development of allergic conditions The likelihood of an individual patient developing sensitivity to food depends on permeability of the gut. This appears to be associated with clinical or subclinical intestinal inflammation. it is likely that some degree of GI compromise exists in dogs and cats with food allergies. and others play an important role in maintaining the Th1-Th2 ratio and promoting allergen tolerance. It may relate to the concept of “summation. 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.14 These changes remained even after clinical resolution of signs. at least in dogs.10 GI permeability and transmucosal antigen transfer are increased in people with atopy and food allergy. the presence of allergy to other foods or inhalants.9.11 Though no differences were found in the T-cell status of the GI tract between normal dogs and food-allergic dogs. Current evidence suggests that dogs with cutaneous food allergy may be predisposed to developing atopic dermatitis. In cats and dogs. The percentage with subclinical GI involvement is unknown. but the mode of inheritance is unknown. and the absorbed dietary antigens can Common food allergens The vast majority of allergens are proteins or glycoproteins. and other genes suggestive of a Th2-skewed immune status. and hot weather. can also contribute to pruritus via nonimmunologic means and must be considered in the diagnosis and management of pruritic pets. dry skin. and other factors. Since allergies are abnormal or inappropriate reactions of the immune system against a normal protein. such as stress.” which suggests that multiple allergies or nonallergenic pruritic stimuli are additive in effect. which refers to the variation in response to a given allergen. The likelihood of an infant developing atopy or food allergy is 37% if one parent is atopic and 62% if both parents are affected. The cytokines IL-10.

to four-week trial is sufficient. it is necessary to rule out other causes of GI or dermatologic signs that may be confused with food allergies (Table 3). Unfortunately.5%) Barley/Wheat (4. A history of chronic. urine. lesions predominantly located on the caudal half of the body are more consistent with flea allergy. may indicate possible food-allergic dermatitis. and results of an elimination diet trial with subsequent challenge. Unfortunately. GI signs may include vomiting. If food allergy is suspected. history.19 Smaller proteins are normally too little to elicit an immune reaction.5.6%) Fish (13%) Lamb (6. Location and type of skin lesions can help identify or rule out other conditions. diarrhea. but evidence to support this idea is lacking. and feces should be examined to rule out systemic or parasitic causes of vomiting or diarrhea. For patients with GI signs. skin cytology should be evaluated for bacterial and Malassezia infections. If only GI signs are present.20 If concurrent therapy is provided. Reactions to carbohydrate sources.1 A diagnosis of food allergy is confirmed if the patient improves while on the elimination diet. The clinical signs of these conditions can be identical. Most patients with dermatologic signs respond within four to eight weeks. Idiosyncratic reactions to food preservatives or additives also are thought to occur. The most commonly identified food allergens in dogs and cats are listed in Table 2. corn. However. For example.8 Food allergies can occur in animals of any age.7 Improvement in dermatologic signs is typically defined in terms of changes in pruritus. In nearly 25% of food-allergic dogs.7.2011 Nestlé Purina on companion animal medicine food allergens are proteins with a molecular weight between 18 kD and 70 kD.5%) Diagnosis of food allergy The diagnosis of food allergy is based on physical signs.6 The presence of concurrent pruritus or otitis and GI signs should always raise suspicion of food allergy.6%) Lamb/Mutton (6. and potato. an additional four to six weeks may be needed for maximum resolution. have been reported but appear to be much less common. medical history does not help differentiate food allergy from atopic disease. or borborygmus. blood.18. recrudesces during the challenge.1 Veterinary Symposium Table 2. such as antibiotics or corticosteroids. while larger proteins cannot normally access the body across the GI mucosa. a dietary trial (Table 4) using an appropriate elimination diet is required.7. pruritus in the ear region may be the only clinical sign.21 If the patient responds positively to the elimination diet.7%) Poultry (4.6%) Soy (6%) Cats (n=89) Beef (20%) Dairy (14. or miliary dermatitis or alopecia in cats. The list reflects commonly fed ingredients. neither serologic nor intradermal testing is effective for diagnosing food allergies.20. Though many will occur within 48 hours. Large bowel diarrhea appears to be common in food-allergic dogs. allow up to two weeks to document adverse responses during the challenge period. and they may exist concurrently. a provocative challenge with the prior diet is needed to confirm the diagnosis. a two. the trial must be continued for at least three to six weeks after completion of these therapies. non-seasonal pruritus or otitis externa in dogs or cats.  Most commonly identified food allergens in dogs and cats7 Dogs (n=198) Beef (36%) Dairy (28%) Wheat (15%) Egg (10%) Chicken (9. veterinary examination. and 17 . such as rice. Most studies consider a decrease of 50% or more to be a positive response. In pruritic patients.1. If only partial improvement is seen.

Cheyletiella.21. and elimination of any types of additives. bits of food used to give medications.22 The simplest homemade diets include one protein source and one carbohydrate source to which the patient has not previously been exposed. difficult preparation. The advantages of homeprepared diets are the ease of addressing the patient’s specific dietary history. Homemade novel protein diets Homemade diets are considered the gold standard for conducting food-allergy trials.7 Published studies using homemade diets suggest a drop-out rate from 15% to 36%. Controlled intake during the trial period includes the main meal as well as treats. etc. excessive costs.When pieces are better than the whole: Hydrolyzed protein diets Table 3. while maintaining the patient on the elimination diet. the choice of ingredients for commercial novel protein diets should be based on prior exposure considering both pro- 18 . 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. one at a time. and nutritional completeness. and access to any other foods. it should also provide complete and balanced nutrition and be palatable and convenient for the owner to feed. These are typically provided at a volume ratio of 1:1 for dogs and 2:1 for cats (protein:carbohydrate source). with the most common reasons being patient refusal.3. Such a diet contains a limited number of ingredients—usually a single protein and a single carbohydrate source—to which the patient has not been previously exposed. identification of specific protein sources to which the patient is sensitive can be done by challenging with individual ingredients.  Differential diagnoses for pruritic dogs and cats Atopy Flea allergy dermatitis Food allergy Drug reaction Lice infestation (pediculosis) Intestinal parasite hypersensitivity Mite infestation (Sarcoptes. As with home-prepared diets.23 The proportion of dogs enrolled in the eliminationchallenge tests that were diagnosed as food allergic in these studies averaged 35. Commercial novel protein diets Another approach for managing food-allergic dogs is feeding a commercial novel protein diet. enhanced involvement by the owner. diet acceptance.3. In addition.7.1.7 Because of nutritional imbalances. and development of diarrhea. though sensitivities to additives do not appear to be common. for cats. Lack of prior exposure is important as there is nothing inherently hypoallergenic about any particular protein.3. Limiting ingredients reduces the odds that the food contains an allergen to which the patient is hypersensitive. If desired.7%. Notoedres. flavored medications.8. because the diet may be fed for an extended period of time. Therefore.1 Some limitations to homeprepared diets typically used for elimination trials include: laborintensive preparation (compared with feeding commercial diets). the possibility of GI upsets. the patient’s dietary history must drive the appropriate choice for ingredients to use in the diet.) Malassezia dermatitis Seborrheic skin disease Viral infection Contact dermatitis Primary pyoderma Autoimmune disease improves again when returned to the elimination diet. Demodex. home-prepared diets are not recommended for use in growing animals nor for long-term use.

Select ingredients for novel diet (home-prepared or commercial) based on dietary history of prior exposure. one per week. the benefits of completing a dietary trial. patient can be fed any diet that avoids those allergens. identify individual ingredients to which the patient is allergic by adding foods or ingredients. feed patient its prior diet for up to two weeks. A partial resolution of pruritic signs may indicate concurrent conditions. but up to 16 weeks may be needed in some patients.2. hydrolyzed or novel protein diets can be fed. such as atopy. wheat) can occur.24.25 Most commercial novel protein diets provide complete and balanced nutrition and they are easy to prepare. so test a sufficient number of common allergens to identify suitable diets for the patient. Alternately.. Most food allergy dermatitis signs will begin to improve within four to eight weeks.g. Return to elimination diet if signs recur. while maintaining patient on the elimination diet. Veterinary Symposium 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.  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. and when 19 . and the importance of feeding the elimination diet exclusively.5. While allergies to carbohydrates are uncommon. or neighbors. or use a diet with no intact proteins (hydrolyzed diet). Educate clients about allergies. allergies to the protein contained in these ingredients (e. Continue elimination trial at least three to six weeks after conclusion of antibiotic or other therapy to determine continued response.2011 Nestlé Purina on companion animal medicine Table 4. Most food-responsive gastroenteritis will improve within two to four weeks. Recurrence of signs and subsequent resolution confirm diagnosis.5 Commercial novel protein diets are recommended when owners do not wish to cook for their pets. corn. If individual allergens are identified. Many patients have multiple allergies. begin elimination diet while initiating treatment for concurrent infections. rice. the proportion of patients completing the elimination study may be increased. it may be necessary to try two or more novel protein diets to find one that best suits the patient. children. If specific allergens are not known. Feed diet exclusively during trial. If client is willing. Because of this. when pets do not tolerate home-prepared diets. Educate clients to ensure that patients do not have access to other foods or treats from other pets. If clinical signs resolve. potato.

yet small enough to pass through mucosal membranes and come in contact with elements of the immune system.2. rendering the protein hypoallergenic. or both.26 While there are limitations to using novel protein diets during the diagnostic period.8.7 20 .30-33 For example. it may be necessary to test several novel protein diets until a suitable diet is found.32 In two different studies of dogs with confirmed soy or corn allergies. Hydrolysis. They also are the reason some researchers discourage the use of novel commercial diets during the elimination trial. it is still possible for the patient to develop a hypersensitivity—even to the novel diet—at a later time. these antigens would be destroyed. 27 Thus. they also contain varying amounts of intact proteins that could trigger allergic responses.22. while an additional eight dogs reacted against two different novel diets.or hypo-allergenic. While grains are typically considered carbohydrate sources. it appears that 84% to 95% of confirmed food-allergic dogs can be maintained on a commercial novel protein diet. can create dietary proteins below this size so that they are not recognized by the immune system. contains 21 specific allergens. identified using IgE. Unfortunately.7.26 This provides a viable way to control clinical signs while providing complete and balanced nutrition. 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.22.19 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. a number of diets made with hydrolyzed proteins have been introduced into the marketplace. In recent years.23. they could be used as elimination diets without consideration of the dietary history. the reaction to a hydrolyzed soy and corn starch diet was significantly reduced versus intact soy or corn.and soy-free control diets.7 A few published studies have shown that these diets can be used with good success to diagnose food allergy.28 The major IgEproducing allergens in soy protein range in size from 20 kD to 78 kD. hypoallergenic diets should be formulated using carbohydrate sources containing minimal to no protein to reduce risk of new allergenic responses. This effect has been confirmed in both in vitro and in vivo studies. The ability of a protein to induce an immune-mediated hypersensitivity is dependent upon the size and structure of the protein.or IgG-binding techniques.26 One study indicated that 22 of 40 dogs reacted only against one of three diets. If these diets could be used even in dogs allergic to the parent (intact) protein. which reduces the proteins to small polypeptides.27.19. The optimal molecular weight of a protein hydrolysate varies with the type of protein used. if soy protein were hydrolyzed to a molecular weight below 20 kD.30. 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.33 Multiple hypersensitivities may occur in one-third to one-half of dogs or cats with food-allergies.28-32 In addition to protein hydrolysis.19.5 However. thus rendering the proteins non.22.When pieces are better than the whole: Hydrolyzed protein diets the cost of a home-prepared diet is prohibitive.7 Soy. If the patient’s specific allergies are not known.1 Commercial hydrolyzed protein diets Another option for elimination diets is to use hydrolyzed proteins. several studies have documented adverse reactions in 15% to 85% of confirmed food-allergic dogs offered various commercial novel protein diets. and no different from the reactions to corn.18. an extensively studied dietary protein. Most food allergens are glycoproteins that range in size from 18 kD to 70 kD.26 Such results confirm the critical importance of a good dietary history prior to selecting a diet for a suspected food-allergic patient.

One of the natural defenses against food allergy is the breakdown of food allergens during digestion. it is possible for an allergy to additional proteins to develop over time with recurrence of clinical signs.2010. when soy protein hydrolysates were administered to dogs. et al. unpublished data 2001) While this falls short of 100%. This risk may be reduced by feeding hydrolyzed protein diets to at-risk patients.onlinelibrary. 4. Accessed Feb. if there is increased GI permeability.02519. A diagnosis of food allergy is made by performing a dietary elimination trial using an appropriate diet.19:230-233. Serum IgE and IgG responses to food antigens in nor- Veterinary Symposium In one study. contributing to development or exacerbation of food allergy.com/ journal/10. For example. Food allergy in dogs and cats: a review. et al. et al. Wieland B. As the immune system remains “primed” for an allergic response. Hesta M. 2011.17:273-279. J Vet Intern Med 2001. J Nutr 1998. J Fel Med Surg 2010. A further advantage of hydrolyzed protein diets is the effect on digestibility. Vet Derm 2008.1398-9995.24 This situation presents a challenge when attempting to develop effective novel protein diets. Foster AP. Jones BR. Following diagnosis and identification of the offending allergens. the small intestinal absorption rate increased three-fold compared with administration of intact soy protein. The use of highly digestible proteins has long been recommended for managing food allergies. Summary Food allergies may cause dermatological or GI signs. Eur J Comp Anim Pract 2009. larger peptides and proteins may be absorbed intact. Guilford WG. or both.15:7-13. Available at: www. J Vet Intern Med 2007.2011 Nestlé Purina on companion animal medicine References 1. very little intact protein is absorbed. Soares-Magalhaes R. 10.12:861-866. Verlinden A. most food allergic dogs reacted to two food ingredients while one dog reacted to seven. Markwell PJ. Prevalence and causes of food sensitivity in cats with chronic pruritus.66:526S–529S. Picco F. A prospective study on canine atopic dermatitis and food-induced allergic dermatitis in Switzerland. et al. Chronic enteropathies in dogs: evaluation of risk factors for negative outcome.128:2790S–2791S. doi:10. Frank L. Knowles TG. Millet S. and becomes less important when a hydrolyzed hypoallergenic diet is used. 5. Loeffler A. Crit Rev Food Sci Nutr 2006. Food allergy in dogs— clinical signs and diagnosis. 7. et al. 8.21:700-708.46:259-273. 11. Under normal circumstances. However. or digestive function is compromised. dogs and cats can be maintained on diets that exclude the identified antigens or on commercial novel protein or hypoallergenic diets.1111 /j. Chandra RK. 16. Adaptive T-cell responses regulating oral tolerance to protein antigen. Markwell PJ.25 Hydrolysis of a protein enhances digestive efficiency. du Pré MF.1111/(ISSN)1398-9995. Grone A. Vet Derm 2006. 3. 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.9. A retrospective analysis of case series using home-prepared and chicken hydrolysate diets in the diagnosis of adverse food reactions in 181 pruritic dogs. Bryan J. Food hypersensitivity and allergic disease: a selective review. Allenspach K. feeding hydrolyzed protein diets may avoid aggravation or perpetuation of allergies in animals with compromised GI tracts. Food sensitivity in cats with chronic idiopathic gastrointestinal problems. Nett C.wiley. it is less likely that a new allergy will form when these diets are fed longterm. Several studies suggest that about 90% of dogs with food allergy will be detected using hydrolysate diets. Zini E.119:150-155. although a few dogs or cats might have an adverse reaction to the hydrolyzed diets. Allergy 2010. Guilford WG. et al. vomiting or diarrhea. Hotston Moore A. 9. Food allergy in the cat: a diagnosis by elimination. 6. Jackson HA. 21 . followed by a food challenge using the patient’s prior diet or specific food ingredients. Samsom JN.34 Thus. 2. because the hydrolyzed proteins are truly hypoallergenic. Bond R. it compares favorably with home-prepared or commercial novel diets. Jones BR.18.35 (Sousa C. Am J Clin Nutr 1997. Furthermore.

20. 28. Jackson HA. 13. van Noort R. In: Reinhart GA. Clin Exp Allergy 1997. Griffin C. 31. Wilmington. Vol III. Frischmeyer-Guerrerio PA. Vet Journal 2010. Vroom MW. German AJ. Day MJ. 5th ed. Hillier A. Allergenic proteins in soybeans: processing and reduction of P34 allergenicity. Major allergens in soybean and clinical significance of IgG4 antibodies investigated by IgE. corn. Thatcher CD.609-635. J Vet Med Sci 2010. 24. Maruchi N. Vet Rec 2001. Systematic review of evidence for the prevalence of food sensitivity in dogs. 12. Veenhof EZ.63:47-58. eds. Veenhof EZ. 25. Clinical efficacy of a novel elimination diet composed of a mixture of amino acids and potatoes in dogs with non-seasonal pruritic dermatitis. Vet Immunol Immunopathol 2003. Rosenkrantz W.: Mark Morris Institute. Awazuhara H. et al.67:484-488. Accessed Feb. Immune cell populations within the duodenal mucosa of dogs with enteropathies.3:244-251.89:326-341. Gonzalez de Mejia E. Brazis P. Laflamme DP. Topeka.or soy-sensitive dogs. Chichester KL. Zhao XT. eds. Wilson S. 18. Jeffers JG. Proverbio D. et al.21:31-40. Fondati A.134:2062-2064. 2000:69-77. A systematic review of the evidence of reduced allergenicity and clinical benefit of food hydrolysates in dogs with cutaneous adverse food reactions. Jackson HA. et al. Evaluation of selected-proteinsource diets for management of dogs with adverse reactions to food. Biourge VC.When pieces are better than the whole: Hydrolyzed protein diets mal and atopic dogs. Am J Vet Res 2006. Ohio: Orange Frazer Press. Paps J. Rutten VP. Hypersensitivity reactions to dietary antigens in atopic dogs.2010.81:227-231. A comparison of the clinical manifestations of feeding whole and hydrolyzed chicken to dogs with hypersensitivity to the native protein. Immunological responses against hydrolyzed soy protein in dogs with experimentally induced soy hypersensitivity. 22 .12:237. 27. Remillard RL. J Nutr 2004. Evaluation of T-cell activation in the duodenum of dogs with cutaneous food hypersensitivity. J Am Vet Med Assoc 2001. Characterization of T cell phenotypes.and IgG4-immunoblotting with sera from soybean-sensitive patients.148:445-448.sciencedirect. Hardin JA.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. et al. 35. Meyer EK. 21. In: Hand MS. Blaschek K. Fontaine J. Dendritic cell and T cell responses in children with food allergy. Shanley KJ. Vet Derm 2010. Willemse T. Chalmers SA. Olivry T. et al. 29. Small animal clinical nutrition.15:14-25. tvil.14:181-187. Hammerberg B. 19. Diagnosis of adverse reactions to food in dogs: efficacy of a soy-isolate hydrolyzate-based diet. et al. and dogs with gastrointestinal disease. Bizikova P.198:245-250. Intestinal transit and absorption of soy protein in dogs depend on load and degree of protein hydrolysis. 33. Assessment of IgE binding to native and hydrolyzed soy protein in serum obtained from dogs with experimentally induced soy protein hypersensitivity. Roudebush P.005. Puigdemont A. Schlotter YM. Leistra MHG. Vet Therapeutics 2003.71:441-446. cytokines and transcription factors in the skin of dogs with cutaneous adverse food reactions. Olson ME. Prevalence of adverse food reactions in 130 dogs in Italy with dermatological signs: a retrospective study. Montserrat S. Miller RH. Am J Vet Res 2006.02. et al. 23. Comparison of a hydrolyzed soy protein diet containing corn starch with a positive and negative control diet in corn. Kawarai S. Clin Exp Allergy 2011. Hall EJ. Vet Med 1994. Available at: www. 16. doi:10. 14.219:1411-1414. Markwell PJ.41:61-71. Guilford WG. 2000 Iams Nutrition Symposium Proceedings. 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. Kan. Adverse reactions to food. et al.1016/i. 16. Brazis P. Spada E. Vet Derm 2010. 15. Medleau L. Vet Derm 2003. Coblentz L. Recent advances in canine and feline nutrition. 26. Knol EF. Nutr Rev 2005. Beale KM. et al. Griffin CE. Evaluation of the clinical and allergen specific serum immunoglobulin E responses to oral challenge with cornstarch. Diagnostic testing of dogs for food hypersensitivity. Perego R.92:113-124. J Nutr 1997. 16th Annual AAVD and ACVD Meeting 2001. Masuda K. Tapp T. J Sm Anim Pract 2010. 34. J Am Vet Med Assoc 1991.51:370-374. Comparison of a commercial limited-antigen diet versus homeprepared diets in the diagnosis of canine adverse food reaction. et al. Am J Vet Res 2010.67:1895-1900. Kawai H. soy and a soy hydrolysate diet in dogs with spontaneous food allergy. An update on atopic dermatitis in dogs. Ishihara J. in Proceedings. 30. Chesney CJ.72:1413-1421. Buret AG.21:358-366. et al. Carey DP. 2011. Ricci R. et al. et al. Serra M. 32. 2010. J Vet Intern Med 2001.27:325-332. 17. McCamish MA.127:2350-2356. 22. Guerrerio AL. Jackson MW.

Y. type II diabetes. In this form. and possibly even cancer. PhD. predisposing our patients to insulin resistance. It circulates and has its best insulin-propagating activity as large polymers of six to 18 bonded monomers. since adipose tissue releases local and systemic cytokines (known as adipokines) that are thought to regulate systemic inflammation and food intake. DACVSMR DVM. when obese animals stop secreting it. Adiponectin is the most abundant adipokine in the bloodstream in all species. it may persuade those owners who are on the fence to try a weight-loss program.1-3 We all know that a pet is not in ideal health if it is not at its ideal weight. This results in a chronic inflammatory response. Fat is now recognized as an endocrine organ. I will describe six common mistakes veterinarians make when implementing weight-management programs and explain how best to avoid them. In this article.5 This is important because adiponectin improves insulin signaling. monocyte chemotactic protein-1. College of Veterinary Medicine Cornell University Ithaca.1 A handful of measurable mediators of chronic inflammation and adipokines have been defined in dogs and cats. The pathophysiology of obesity is becoming much clearer. insulin resistance can ensue. DACVN. orthopedic disease. 23 . but it does not circulate as a single monomer only. The effects of obesity are far-reaching. There are 40 to 50 identified adipokines released from fat cells. but many of us have also discovered how difficult it can be to motivate clients to help their pets lose weight.From fat to fit—Avoiding six common mistakes while helping pets combat obesity We veterinarians are all aware that weight problems affect 30% to 40% of our patients. Although this does not motivate every client to be more interested in his dog’s or cat’s body condition. therefore. N.1 The picture of obesity and chronic inflammation in pets is similar to the evolving human story. I now discuss the ramifications of obesity and chronic inflammation on the pet’s body.4 HMW adiponectin is released from adipocytes in lean people and its secretion is severely diminished in obese people. Mistake #1 — Not backing your recommendations with hard science To drive home the importance of weight loss to my clients. and resistin. creating a chronic inflammatory stimulus back and forth between macrophages and adipocytes. The ones of clinical importance in dogs and cats are adiponectin. Joseph Wakshlag. apoptotic/necrotic adipocytes are surrounded by inflammatory macrophages. with post-gastric-bypass surgery patients showing increases in serum HMW adiponectin. leptin. This process may stimulate further release of inflammatory mediators from surrounding adipocytes. it is called high-molecularweight (HMW) adiponectin. When fat from obese animals is examined histologically.

9 This decrease in inflammatory adipokines corresponds with a drop in the systemic marker of inflammation.and long-term health risks of obesity in pets. Fortifying food with 150 mg to 500 mg carnitine can improve retention of lean mass during a weightreduction protocol.8. then clients are also less likely to comply or come back for that second bag of weight-loss-formula food.10 The chronic health ramifications of this slightly elevated inflammatory response in dogs and cats still need to be investigated. the increased inflammation is associated with an increased risk of heart disease and type II diabetes. tion or management. we do know that obesity has a multitude of systemic effects and predisposes pets to many problems. Table 1 shows results from a recent study examining adipokine concentrations before and after a weight-loss program in dogs. Fortunately. Mistake #2 — Having a “do as I say.From fat to fit—Avoiding six common mistakes while helping pets combat obesity 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. and so we should be willing to do the same.7 However. the acute phase protein called C-reactive protein (CRP). In obese people. the major pet food companies make software that allows us to track our patients’ progress. plans without weigh-in appointments fail because of client noncompliance. and the battle is lost. similar to other reports. it is best to have your technician schedule several monthly weigh-in sessions for the animal. Although there is much left to be studied. but you will find that the client typically buys another bag of food or another item. Time and time again.6. We ask clients to exert a great deal of effort for the health of their pets. We can do a better job of communicating to clients what is definitively known about the short. These are usually free office visits. This tracking can be entrusted to a technician who is familiar with your weightloss software program. If veterinary professionals do not take a longterm interest in these cases. 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 pet’s maintenance energy requirement Often the first mistake that veterinarians make when implementing a weight-loss program is incorrectly calculating a 24 . Reminder calls before each weigh-in session are a good idea. even in obese dogs. such as a flea control product or heartworm preventive. 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. it appears that adiponectin is continually secreted at high concentrations into the blood. which more than justifies the time spent in these cases. When you dispense the first bag of a therapeutic diet. The results show that all of the aforementioned adipokines except for adiponectin decrease after about 25% weight loss in a group of dogs.

Recent research suggests that obese.6 29.1 52. One common mistake in using this equation is calculating the RER using the animal’s current body weight instead of its ideal or goal body weight.0% in cats.16 This suggests either that obese dogs walk less than thinner dogs or that walking less predisposes dogs to obesity. overweight dog. because they are not active enough to have an MER. a multiplier is applied to the RER.0).2 in the typical inactive. For more information on one such method. and it is frequently around 1.12. Often the multiplier should be less than 1. inactive cats should start at their RER (that is.003 P = 0. For larger dogs. A second clinical study recently 25 . to determine the MER.0 P = 0. particularly in cases in which a previous weight-loss program was unsuccessful. You should use the pet’s ideal body weight.5. A second error can occur with the activity level multiplier.005 Veterinary Symposium patient’s maintenance energy requirement (MER). 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 (μg/ml) Before Weight Loss 43.0 or 1. Using 1.13 Unfortunately. you should use the pet’s ideal body weight.9 38. Other weight-loss equations use current body weight and/or body condition score to calculate the daily caloric amount. Regardless of the methods used. it is ideal to target between 1-3% weekly weight loss for dogs and between 0. the linear RER equation only works for dogs that weigh less than 30 kg.3 170 5.5. neutered.1 8 18.6 P value P < 0.038 P = 0. the MER is calculated in kilocalories (kcal) by first using the linear equation to calculate the resting energy requirement (RER):11 RERkcal = 30(BWkg) + 70.001 P = 1.5-2.001 P < 0. For animals weighing less than 30 kg. body condition score. Be sure you begin a patient’s weight-loss program based on correct calculations.86 P = 0. This multiplier is based on the animal’s activity level. The multiplier should be closer to 1. visit Purinaveterinarydiets. but it is not appropriate for inactive dogs or indoor cats.5 as the multiplier is acceptable for young active dogs or indoor/outdoor cats.8 5 6.1 67.5 60. Then. Mistake #4 — Not addressing the pet’s activity level The issue of activity level in weight-loss programs for cats and dogs has been hotly debated.com. the RER is calculated by plugging the ideal body weight into this exponential equation:13-15 95(BWkg)0.2011 Nestlé Purina on companion animal medicine Table 1.5 54. If used for an obese 50-kg Rottweiler.001 P < 0.0 After Weight Loss 33. Use the pet’s ideal body weight in your RER calculations and be sure to use an appropriate multiplier to calculate a pet’s MER.  Medians for body weight. 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). serum adipokines. with a multiplier of 1. then the dog’s kilocalorie needs would be overestimat- ed right from the start.75. With this equation.0 202 10. or call the Veterinary Resource Center at 1-800-222-VETS (8387).

Analysis of these values revealed a significant negative nonparametric correlation (P value <0. The owners appreciate the extra volume given. 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.6 It is. Another trick for adding volume to a dog’s diet is to substitute green beans for dog food. the cans contain fewer calories but more volume. 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. and share their own ideas about ways to boost the cat’s activity level in the home. breaking into pet food bags. weight loss did not increase their activity level. Another question is whether active dogs lose weight quicker than less active dogs do.From fat to fit—Avoiding six common mistakes while helping pets combat obesity Figure 1. which creates the needed gastric fill. increasing the dog’s or cat’s satiety.5.000 more steps per day than inactive dogs did. Veterinarians should encourage owners to work at this. kcal/kg of metabolic body weight (not kg of true body weight) during weight loss. I feel that switching 
 some pets to a canned therapeutic food or a combination of canned and dry foods can sometimes result in progress. unfortunately. Thus. Mistake #5 — Not addressing problems with the pet’s behavior and satiety Undesirable behaviors.0001). Clients will appreciate being able to feed the increased quantity. really points the finger at owners. active dogs averaged about 5. and food protectiveness. That is. This. and we found that pedometer readings were virtually unchanged when the dogs’ average BCS dropped from 8 to 5. they can pique a cat’s interest by rotating toys or using laser pointers and treat dispensers. This equates to about a 2-mile walk each day. Therefore. Although most cats quickly grow bored with the same activities. if owners are willing to be creative.6 In the second study. without a doubt. while a 13-oz can for dogs has 175 to 275 kcal and a 6-oz can for cats has 110 to 130 kcal. such as begging. we predict that the owner’s activity and willingness to increase the dog’s physical activity may play a role in the success of a canine weight-loss program. we also measured steps taken with a pedometer during a weightloss program. In our study. is true. activity does play a role in calorie consumption and weight loss. Because of my involvement with a fairly extensive obesity trial and routine obesity clinic work. From our data. Owners are less likely to comply with your recommendations if they see these negative behaviors develop or worsen. We have gone as high as 1 cup of green beans per cup of dog food. 26 . and the canned food is likely to provide more immediate gastric fill. can develop or worsen during a weight-loss program. more challenging to increase the activity level of cats. especially obese cats.

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.20 In the same study. Thus. but it is currently thought that flavonoids may act at the level of the hypothalamus to hinder appetite. a food that is labeled as containing 5% fat may really contain 7% fat. you can create a subclinical nutrient deficiency since these foods are not designed for calorie restriction. which is intriguing. helps to burn fat during weight loss. cats ate up to 50 g of zucchini each day. An emerging area of interest in the therapeutic pet food market is the addition of isoflavones Veterinary Symposium Mistake #6 — Using the wrong food When choosing a food for a weight-loss program. Therefore. The exact mechanism of action has yet to be determined.21 Other evidence suggests that a highprotein diet (40% to 50% dry matter) can help retain lean body mass during weight loss. 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. From a theoretical standpoint.18-20 The flavonoids may only be useful for temporarily decreasing appetite. and owners claimed that begging behaviors were diminished. One study showed that eating behaviors returned to normal within a week. If you use a “light” food and restrict the assumed calories to around 60% of the MER at ideal body condition. In some of our cases. but some seem to enjoy the texture of firm. To preserve lean body mass during weight loss. which are often moderate When it comes to cats. two approaches have been used successfully. portion control becomes an issue since every owner’s ¼-cup can be different. Another trick with cats is to use zucchini to create gastric fill. since it is probably a low estimate of the true calories in the food. Ask cat owners to use a kitchen scale so they can precisely measure grams of food per feeding. steamed zucchini. maintaining lean body mass is advantageous since it is more metabolically active and. ed. when clients ask to use an over-the-counter light food.22 Lean body mass retention cannot be achieved by feeding common over-the-counter light foods. Additionally. I do not recommend doing this for cats. Fortifying food with 150 mg to 500 mg carnitine can improve retention of lean mass during a weightreduction protocol. Also. which contains minimum protein and minimum fat information.2011 Nestlé Purina on companion animal medicine and other flavonoid supplements to foods. This is partly why manufacturers hesitate to label pet foods with kcal per cup or per can. therefore. you need to choose what is optimal for the patient. so there could be subpar vitamin and mineral consumption when the total amount of food is restrict- 27 . steamed zucchini to the regular meal. I often supplement the dog food with a human complete multivitamin (one-half tablet per 25 kg body weight for dogs). the manufacturer’s calculations are done based on the guaranteed analysis label. 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. the use of the isoflavone genistein enhanced retention of lean body mass during weight loss. The most convincing evidence has been in cats. but some companies stay close to the AAFCO requirements.17 Many companies provide around two times the Association of American Feed Control Officials (AAFCO) requirement when adding vitamin and mineral premixes during manufacturing. Instruct the client to start adding three or four cubes of chopped. though the long-term effects seem to be less rewarding. Cats do not usually appreciate vegetables. meaning that it may contain 10% to 15% more calories than the amount calculated by the manufacturer. There is some indication that these bioactive molecules can diminish food intake.

4. 6. Roudebush P. et al. Schoenherr. J Nutr 2006. 17. Energy requirements of indoor adult pet cats (abst). An evidence-based review of the use of therapeutic foods. Hill RC. Comparison of adipokine concentrations and markers of inflammation in obese versus lean dogs. St. but not genistein. Warren BS.183:294-297. inflammation and athelosclerosis. 18. Fiaschi T. 28 . Cave NJ. 15. 2.14:193-206.233:717-725. Marks SL. Vet J 2010. J Am Vet Med Assoc (in press). J Am Vet Med Assoc 2008. 11. Adipose tissue. German AJ. Bushey JJ. 6th ed. 2006. QLD 72. Wakshlag JJ. E. Saunders Elsevier. Bissot T. Vet Clin North Am 2006. Energy. ensure the accuracy of the initial calculations on which our caloric recommendations are based. 2005. et al. et al. Laflamme DP. 19. Stoeckli R. 9. The clinical and metabolic effects of rapid weight loss in obese pet cats and the influence of supplemental oral L-carnitine. Christ-Crain M.236:74-77. Br J Nutr (in press). J Am Vet Med Assoc 2010. Evaluation of calorie density and feeding directions for commercially available diets designed for weight loss in dogs and cats. et al. References 1. Wakshlag JJ. Backus RC. J Atheroscler Thromb 2009. Maley M. Marks SL. Hunter L. Mo. St. Expert Opin Ther Targets 2010. German AJ. et al. Domest Anim Endo 2009. WD. Feldman EC. Vet Ther 2005. Parenteral support.37:214-226. Lucia. 13. Rand J. Linder DE. Oestradiol. 4. Struble AM. Eirmann LA. Center SA. 22. Hervera M. Kienzle. et al. J Anim Physiol Anim Nutr 2007. Adiponectin in health and diseases: From metabolic syndrome to tissue regeneration. 10. Chan DL. Chiarugi P. 20. 2011. Watrous D. Increase in high molecular weight adiponectin by bariatric surgery-induced weight loss. Harte J. The growing problem of obesity in dogs and cats.6:291-302. Remillard RL. Improvement in insulin resistance and reduction in plasma inflammatory adipokines after weight loss in obese dogs. A high protein high fiber diet improves weight loss in obese dogs. Gustafson B. et al. Laflamme DP. et al. and drugs for the management of obese and overweight pets. Backus RC. Saker KE.71:1039-1044. Am J Vet Res 2010. J Vet Intern Med 2000. et al. Use of pedometers to measure the relationship of dog walking to body condition score in obese and non-obese dogs.7:196-205. 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. devote adequate time to obesity prevention and management in our practice. Struble AM. 3. Br J Nutr (in press). et al. Diab Obes Metab 2008. The adage that “calories in must equal calories out” is still the key to successful weight loss. 14.17:332341. ed. Understanding and managing obesity in dogs and cats. Cave NJ. but genistein is associated with an increase in lean body mass. but also in a healthier way. Freeman LM. Salas A. In: Beitz DC. Textbook of veterinary internal medicine. and help clients choose the best food for a patient’s weight-loss program. Louis. acknowledge that we may need to alter feeding recommendations for some pets to sate them and prevent negative behaviors. 7. German AJ. Scott KC. The effects of weight loss on adipokines and markers of chronic inflammation in dogs.587-591. Australia: Personal communication.136:1940S-1946S. But we veterinarians can help ensure the success of our patients’ weight-loss programs by avoiding the six common mistakes reviewed in this article.14:598-608. inhibits the rise in food intake following gonadectomy in cats. University of Queensland. 8.91:400-410.From fat to fit—Avoiding six common mistakes while helping pets combat obesity to low in protein and are usually not fortified with carnitine. National Research Council nutrient requirements of dogs and cats. Washington DC: National Academies Press. The effects of physical activity on kilocalorie intake during a successful canine weight reduction protocol. Oestradiol and genistein reduce food intake in male and female overweight cats after gonadectomy. In summary. et al. Holden SL. eds. take into account the activity level of our patients. Int J Appl Res Vet Med 2009. In: Ettinger SJ. 9th Annu Am Acad of Vet Nut Symp 2009. owner education. Wakshlag JJ. Performance of a canine weight-loss program in clinical practice. 5. Chen CA. 12. we should back up our recommendations for a weight-loss program with the science at hand. Effects of consuming diets containing various fats or citrus flavanones on plasma lipid and urinary F2-isoprostane concentrations in overweight cats. Delaney SJ.: WB Saunders. Jeusette I. Companion Animal Clinical Sciences.55:113-119. N Z Vet J 2007. Linscheid P.20:1266-1270.36:12831295. exercise. Warren BS. Torre C. Freeman LM. 21.28-48 16.