Dietary patterns of cats with cardiac disease

SMALL ANIMALS/
EXOTIC

Danielle S. Torin, ba; Lisa M. Freeman, dvm, phd, dacvn; John E. Rush, dvm, ms, dacvim, dacvecc

Objective—To determine nutrient intake and dietary patterns in cats with cardiac disease.
Design—Prospective study.
Animals—95 cats with congenital cardiac disease or primary cardiomyopathy.
Procedures—Owners completed a standardized telephone questionnaire regarding their
cat’s diet and a 24-hour food recall to determine daily intake of calories, fat, protein, sodium,
magnesium, and potassium.
Results—Of the 95 cats, 18 (19%) had a history of congestive heart failure and 73 (77%)
had no clinical signs of cardiac disease. Fifty-five percent (52/95) of cats had concurrent
disease. Inappetance was reported in 38% (36/95) of all cats and in 72% (68/95) of cats
with a history of congestive heart failure. Most (57% [54/95]) cats received treats or table
scraps on a regular basis. Approximately half the cats were receiving orally administered
medications, supplements, or both. Only 34% (32/68) of owners used food to administer
medications to cats. Cats consumed more than the Association of American Feed Control
Officials (AAFCO) minimums for protein, sodium, potassium, and magnesium, and nearly
all cats consumed more than the AAFCO minimum for fat. Daily nutrient intake was variable
for all of the nutrients assessed.
Conclusions and Clinical Relevance—Dietary intake in cats with cardiac disease was
variable, but results for dietary supplement use, food use for medication administration,
and treat feeding were different from those found in a similar study of dogs with cardiac
disease. This information may be useful for treating and designing nutritional studies for
cats with cardiac disease. (J Am Vet Med Assoc 2007;230:862–867)

N utritional management holds promise as a tool for

prevention and treatment of cardiac disease. Cardiac
disease is 1 of the 10 most common diseases of cats and
affects > 20% of cats in certain populations.1-3 Nutritional
alterations, such as inappetance, weight loss, and nu-
trient deficiencies or excesses, are thought to be com-
mon in cats with cardiac disease, whether as a result of
preexisting conditions, inappropriate diet, concurrent
disease, or the medical treatment itself.4,5 Although
the causes of most feline cardiac diseases have not yet
been identified, it has been established that nutritional
deficits can precipitate disease. A classic example is
taurine-deficiency–induced dilated cardiomyopathy in
cats.6 In 1987, evidence of the connection between tau-
rine and dilated cardiomyopathy was published, com-
mercial cat foods were subsequently reformulated with
higher concentrations of taurine, and the prevalence
of the condition decreased dramatically.5,6 In other in-
stances, changes in nutritional status may occur sub-
sequent to the onset of cardiac disease, as occurs with
the retention of sodium, chloride, and water in animals
with CHF. Inappetance and cardiac cachexia are also
common in animals with CHF.7-9
A number of dietary modifications have been recom-
mended for treatment of cardiac disease, and additional
research may provide more options for supplementa-
tion.4,5 Sodium restriction to reduce fluid accumulation
is one of the most common recommendations, particu-
larly for animals with CHF, although optimal doses of
From the Department of Clinical Sciences, Cummings School of
Veterinary Medicine, Tufts University, North Grafton, MA 01536.
Supported by the Morris Animal Foundation.
Address correspondence to Dr. Freeman.
CHF
Abbreviations
Congestive heart failure
AAFCO Association of American Feed Control
Officials
sodium and the ideal time to institute various degrees
of sodium restriction are not yet known. Cats with car-
diomyopathy and arterial thromboembolism have low-
er plasma concentrations of vitamins B6, B12, and folate
than healthy cats, suggesting that the effects of B vi-
tamin supplementation warrant further evaluation.10,a
Fish oil, which contains high concentrations of omega-
3 fatty acids, has certain beneficial effects in dogs with
cardiac disease.8,11 Other suggested dietary modifica-
tions include supplementation with taurine, arginine,
coenzyme Q10, and l-carnitine.5
Inappetance is also an important consideration in
the evaluation and treatment of animals with cardiac
disease. In a study7 of dogs with dilated cardiomyopathy
or chronic valvular disease, 34% of dogs had a present
or past history of inappetance. Another study9 of dogs
that had been euthanatized because of CHF revealed
that 84% of the dogs had been inappetant and that inap-
petance was one of the most important factors contrib-
uting to owners’ decisions to euthanize the dogs. The
prevalence of inappetance in cats with cardiac disease is
unknown at present. Because inappetance impacts both
quality of life and client decisions regarding treatment,
this information may be useful in the optimal manage-
ment of cats with cardiac disease.
A 2003 study7 of dogs with cardiac disease revealed
wide variation in nutrient intake. Most dogs had a daily

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protein intake greater than the AAFCO minimum (5.1
g/100 kcal), but 20% of the dogs evaluated had an in-
take less than the AAFCO minimum. Ninety-nine per-
cent of dogs in that study7 consumed more than the
AAFCO minimum of sodium, and many had very high
sodium intake. In addition to this wide variation in nu-
trient intake, most (61%) dogs in the study also had
concurrent disease that could affect the choice of diet.
Although these results provided useful information for
making recommendations for individual dogs and for
designing nutritional studies, the situation may be dif-
ferent in cats. Cats are obligate carnivores with differ-
ent nutritional requirements and metabolic pathways;
they require higher concentrations of dietary protein,
niacin, and vitamin B6 than dogs, and they also require
exogenous sources of taurine, arachidonic acid, and
vitamins A and D.12 To ascertain the effects of dietary
modification in cats with cardiac disease, randomized,
double-blinded, placebo-controlled studies are needed.
However, the typical dietary patterns and nutritional
intake of cats with cardiac disease are unknown, mak-
ing it difficult to plan research trials in which baseline
nutrient intake is modified or dietary supplementation
is instituted. Knowledge pertaining to nutrition needs
is also needed to aid clinicians in making dietary rec-
ommendations for cats with cardiac disease. Lastly, this
information could be used to identify topics for client
education regarding optimal dietary management. The
purposes of the present study were to characterize the
dietary patterns and intake of key nutrients of cats with
cardiac disease and assess the prevalence of inappetance
in these cats.
Materials and Methods
Eligible cats were identified from the Cardiology
Service database at the Tufts Cummings School of Vet-
erinary Medicine Foster Hospital for Small Animals.
Cats with congenital cardiac disease or primary car-
diomyopathy (ie, hypertrophic, dilated, restrictive, or
unclassified cardiomyopathy), as established by the at-
tending cardiologist, were eligible. Cats with primary
bradyarrhythmia or systemic hypertension were ex-
cluded from the study. Cats with hyperthyroidism were
also excluded from the study, unless the hyperthyroid-
ism was controlled (with medical management, surgery,
or treatment with iodine 131). Eligibility was limited
to cats in which the diagnosis was rendered from June
2004 through May 2006 to ensure that no more than 2
years had passed between the time of diagnosis and ad-
ministration of the questionnaire to owners. To ensure
that all cats were medically stable and that all dietary
adjustments made immediately subsequent to diagno-
sis had been completed, cats whose records were dated
in the most recent end of the 2004 to 2006 interval had
to have had the diagnosis for at least 1 month to be
included. Cats were subcategorized into congenital dis-
ease versus cardiomyopathy groups and into CHF ver-
sus no CHF groups for purposes of comparison. than cats with congenital cardiac disease (median age,
Medical records of each cat were reviewed, and infor-
mation pertaining to signalment, weight, and body con-
dition score (on a scale of 1 to 9, where 1 = emaciated, 5
= ideal, and 9 = obese)13 was collected. Age was recorded
at the time of administration of the questionnaire, but
JAVMA, Vol 230, No. 6, March 15, 2007 Scientific Reports: Original Study 863
body weight and body condition score were obtained
from records for the last hospital visit. Date of diagnosis;
SMALL ANIMALS/
type of cardiac disease; presence of CHF, murmurs, or
EXOTIC
arrhythmias; and concurrent diseases or disorders were
also recorded. Owners of eligible cats were contacted via
telephone and asked to complete a standardized ques-
tionnaire, a process that typically lasted from 10 to 20
minutes. Questions were asked regarding cats’ medi-
cations, diet history, concurrent diseases, and past or
present inappetance. For the purposes of the study, inap-
petance was defined as partial or complete loss of appe-
tite, as determined by the owner. Owners were asked to
recall everything the cat had consumed during the past
24 hours, including dry, canned, and semimoist com-
mercial cat food; homemade diets; nutritional supple-
ments; treats; food used for medicine administration;
and any other food sources. For cats in which a precise
dietary intake could be obtained from the owner, intake
of calories, fat, protein, sodium, magnesium, and potas-
sium was determined from the 24-hour food recall and
manufacturer’s information for commercial cat foods and
treats. The USDA Nutrient Database for Standard Ref-
erence, USDA-Agricultural Research Service Nutrient
Data Laboratory, was used in conjunction with the 24-
hour food recall to provide nutritional information for
noncommercial foods. Nutrient intake was determined
in units of total grams (or milligrams) per kilogram of
body weight, grams (or milligrams) per day, and grams
(or milligrams) per 100 kcal.
Statistical analysis—Distributions of data were
examined graphically. Normally distributed data are
presented as mean ± SD; skewed data are presented as
median and range. χ2 Analysis was used to compare dif-
ferences in categoric variables between cats with con-
genital and acquired disease and between cats with and
without CHF. Independent t tests were used to com-
pare continuous variables between the same subgroups.
Statistical analyses were performed with a commercial
statistical software package.b Values of P < 0.05 were
considered significant.
Results
Owners of 141 eligible cats were contacted; the
owners of 15 eligible cats could not be reached, even
after multiple attempts. Thirty-seven cats had died, 2
cats had run away, and 7 owners declined to partici-
pate, leaving 95 cats included in the study. The un-
derlying diseases in these cats included hypertrophic
cardiomyopathy (n = 73), congenital cardiac defects
(16), intermediate or restrictive cardiomyopathy (4),
arrhythmogenic right ventricular cardiomyopathy (1),
and dilated cardiomyopathy (1). Median age at the time
of study was 6.8 years (range, 1.1 to 16.6 years). Cats
with acquired cardiac disease (eg, cardiomyopathies;
median age, 7.9 years [range, 2.0 to 16.6 years]) were
significantly (P < 0.001) older at the time of the study
2.2 years [range, 1.1 to 14.8 years]). Seventy-three cats
were male (72 neutered), and 22 were female (16 neu-
tered). There was a significant (P = 0.03) difference in
sex distribution between cats with acquired cardiac dis-
ease (64 male and 15 female) and cats with congenital
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 cardiac disease (9 male and 7 female). The most com- At the time of the questionnaire, all cats were be-
SMALL ANIMALS/

mon breed represented was the domestic shorthair (n = ing fed commercial cat foods. One cat was consuming
55). Other breeds represented were domestic longhair a homemade diet in addition to commercial cat food.
EXOTIC

(n = 20); Maine Coon (6); Persian (3); Himalayan (3);
Ragdoll (2); Bengal (2); and 1 each of Burmese, Devon
Rex, Siamese, and Sphynx. Mean body weight was 5.2 ±
1.4 kg (11.4 ± 3.1 lb). Cats with congenital cardiac dis-
ease (4.0 ± 1.1 kg [8.8 ± 2.4 lb]) weighed significantly
(P < 0.001) less than cats with acquired disease (5.4 ±
1.4 kg [11.9 ± 3.1 lb), and cats with CHF (4.4 ± 1.3
kg [9.7 ± 2.6 lb]) weighed significantly (P = 0.01) less
than cats without CHF (5.4 ± 1.4 kg). Body condition
scores were available for 69 of 95 cats; mean score was
6 ± 1. Forty-eight of the 69 (70%) cats for which body
condition scores were available had a body condition
score from 4 to 6. Cats with CHF (score, 4 ± 1) had
a significantly (P = 0.002) lower body condition score
than cats without CHF (score, 6 ± 1).
The most common clinical problem at the time of
initial examination was CHF (n = 17). One cat initially
had syncope, and another cat had arterial thromboembo-
lism. Seventy-six cats had no clinical signs at the time of
the initial diagnosis of cardiac disease, and 73 of those cats
remained free of clinical signs at the time the telephone
questionnaire was administered. Of the 3 cats that had no
clinical signs at the time of diagnosis but developed clini-
cal signs later, 1 developed CHF, 1 developed syncope, and
1 had arterial thromboembolism. Therefore, 18 cats had a
history of developing clinical signs of CHF (eg, pulmonary
edema [n = 8], pleural effusion [6], or both [4]) since diag-
nosis. Thirty-seven cats were receiving medications, includ-
ing atenolol (n = 19), enalapril (18), furosemide (9), aspirin
(6), clopidogrel (4), digoxin (2), dalteparin (2), hydrochlo-
rothiazide-spironolactone (2), and diltiazem (1). Several
cats were receiving multiple medications. Many cats (n =
53 [56%]) had concurrent disease, most commonly feline
lower urinary tract disorder (n = 16), diabetes mellitus (5),
asthma (4), gastrointestinal tract disease (3), dental disease
(3), renal disease (3), and hyperthyroidism (3). Some cats
had multiple concurrent diseases.
Dietary recommendations were discussed with 19
owners at the time of initial diagnosis, according to infor-
mation from the medical record (n = 19) or owner (17).
However, only 8 owners changed their cat’s diet during the
course of disease (eg, changed to a lower-sodium diet or
cardiac diet or decreased the amount of food fed). Thirty-
six owners reported that their cat was inappetant at the
time of diagnosis, since the time of diagnosis, or both
(including inappetance noticed at the time of administra-
tion of the questionnaire). Cats with a history of CHF (n =
13/18) were significantly (P = 0.001) more likely than cats
without CHF (23/77) to have been inappetant.
Table 1—Summary of dietary intake (median [range]) of nutrients of concern in 21 cats with cardiac
disease.
Diets were a combination of dry and canned cat food
(n = 52), a combination of dry and semimoist pouch
food (1), dry cat food (34), canned cat food (7), and
a combination of dry food and a homemade raw-food
diet (1). One cat was consuming a commercial cardiac
food as part of the diet, but no cats were eating a com-
mercial cardiac food as the major portion of their diet
at the time of the questionnaire. However, 4 owners had
changed to diets containing a low sodium concentra-
tion specifically for this reason. Thirty-one cats were
consuming therapeutic diets for concurrent diseases
(eg, lower urinary tract disease, diabetes mellitus, and
gastrointestinal tract disease).
Thirty-one (33%) cats received treats or table food on
a daily basis, and 54 (57%) cats received treats or table
food at least once per week. These included commercial
cat treats and foods intended for humans. Dietary supple-
ments were given to 12 (13%) cats. The most commonly
administered supplements were fish oil (n = 3), carnitine
(2), potassium (2), coenzyme Q10 (2), and multivitamins
(2). Several cats were receiving > 1 supplement. Of the 47
cats that received orally administered medications, dietary
supplements, or both, 16 (34%) received the medications
in either human or pet foods. These included canned cat
food (n = 8), foods intended for humans (5 total; cheese
[2], baby food [2], and butter [1]), a homemade raw-food
diet (1), and flavored pill pockets (1).c In 1 cat, owners
used a compounded veterinary chew that incorporated
the medication within the treat.
Food intake was quantified by owners of 21 (22%)
cats. Most owners who fed dry food provided it on an
ad libitum basis. Other owners fed precise amounts but
distributed the food among multiple cats and were not
sure how much any given cat consumed. There was a
higher proportion of male cats (P = 0.02) in those 21
cats with precise intake, compared with the 74 cats for
which intake could not be quantified, but no other dif-
ferences between the 2 groups were detected. There was
considerable variation in nutrient intake, in both total
calories and individual nutrients, whether assessed on
the basis of total daily intake, intake per kilogram of
body weight, or on a caloric basis (ie, per 100 kcal;
Table 1). All cats except 1 consumed more than the
AAFCO minimum value for fat (2.25 g/100 kcal). All
cats had a daily intake above the AAFCO minimum
value for protein (6.5 g/100 kcal), sodium (50 mg/100
kcal), potassium (150 mg/100 kcal), and magnesium
(10 mg/100 kcal; Figure 1). Fourteen cats were eating
< 100 mg/100 kcal of sodium/d.

Nutrient Total per day Per kg of body weight Per 100 kcal
Calories 205 (144–489) 41 (22–93) NA
Protein (g) 20.2 (12.7–40.7) 3.9 (2.2–7.7) 9.4 (7.6–14.5)
Fat (g) 9.4 (4.0–25.9) 1.9 (0.9–4.9) 4.6 (2.1–7.6)
Sodium (mg) 193 (129–626) 37 (27–148) 95 (66–289)
Potassium (mg) 451 (266–914) 83 (46–194) 203 (158–287)
Magnesium (mg) 40 (25–114) 8 (4–22) 19 (13–29)
NA = Not applicable.

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Figure 1—Box-and-whisker plots depicting daily intake of protein and fat (left panel) and sodium, potassium, and magnesium (right
panel) in 21 cats with cardiac disease. Each box represents the central 50% of the values. The horizontal line in each box represents
the median, and the whiskers indicate the range (ie, median ± 1.5 X interquartile range). Asterisks represent outliers. Arrows indicate
the minimum AAFCO value for each nutrient.
Discussion
Intake of nutrients for cats with cardiac disease
in the present study was variable. Although median
nutrient intake for many nutrients was similar to
that found in a study7 of nutrient intake in dogs with
cardiac disease, the variability of intake for cats ap-
peared to be less than in dogs. In addition, all cats in
the present study consumed certain nutrients of con-
cern (ie, protein, sodium, potassium, and magnesium)
in amounts greater than the AAFCO-recommended
minimum. This was in contrast to the previous study7
mentioned in dogs in which 20% and 49% of dogs had
a daily protein and potassium intake, respectively, less
than the AAFCO minimum value. All cats for which
precise dietary intake information was available con-
sumed more sodium than the AAFCO minimum of 50
mg/100 kcal, and the median amount of sodium con-
sumed was nearly twice the AAFCO minimum value.
The highest sodium intake for cats in the present study
was 289 mg/100 kcal, which was still lower than the
highest intake (384 mg/100 kcal) for dogs with cardi-
ac disease in a similar study.7 Although an ideal intake
of sodium has not yet been established for cats with
cardiac disease, high sodium intake is likely not desir-
able in cats with CHF. Recommended sodium intake
in animals with subclinical cardiac disease is contro-
versial because severe sodium restriction can activate
the renin-angiotensin-aldosterone system.14,15 Recom-
mendations for maintaining dietary sodium content
< 100 mg/100 kcal have been made by some authors.5
Fourteen of the 21 cats in the present study with a
precise dietary intake were consuming less than this
quantity of sodium. Nonetheless, additional research
is needed to determine optimal sodium intake in cats
with various types and stages of cardiac disease.
In a similar study7 of dietary patterns in dogs with
cardiac disease, 92% of dogs received treats or table
JAVMA, Vol 230, No. 6, March 15, 2007 Scientific Reports: Original Study 865
SMALL ANIMALS/
EXOTIC
food on a daily basis. Although most (57%) cats in
the present study received treats or table food at least
once weekly, only 33% received treats or table food on
a daily basis. The percentage of cats receiving treats
and table food was lower than in dogs, but clinicians
should consider the type and amount of these foods
veterinary patients receive because they contribute to
overall nutrient intake. A number of cats in the present
study received table food that was high in sodium (eg,
deli meat) on a regular basis, which could have affected
their cardiac disease or medical treatment.
Dietary supplements were administered to 13% of
the cats in this study. In a similar study7 in dogs, 31%
of dogs received supplements. This difference between
dogs and cats is similar to findings in a recent study2 of
pets, in which significantly fewer cats received dietary
supplements than dogs. This may be the result of great-
er difficulty administering pills to cats or to a perceived
lower need for cats to receive dietary supplementation.
The most commonly used supplements in cats in the
present study were n-3 fatty acids, carnitine, potassium,
coenzyme Q10, and multivitamins. Efficacy for most
dietary supplements has not been established. Interest-
ingly, some of the dietary supplements administered to
cats in the present study (eg, carnitine and coenzyme
Q10) have been primarily recommended for dogs with
dilated cardiomyopathy, and little evidence exists for
benefit to cats with cardiac disease. It is important that
clinicians inquire what dietary supplements owners are
administering to their cat because supplements may in-
teract with cardiac or other medications.
In cats that received orally administered medica-
tions, dietary supplements, or both, 34% of these agents
were administered in food. Given the difficulty associ-
ated with administering oral medications to cats, this
percentage was surprisingly low and was lower than
that reported in a study7 of dogs with cardiac disease,
in which 57% of dogs received pills in food. Addition-
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 ally, canned cat food and human foods were used by
SMALL ANIMALS/
owners in similar proportions in the present study for
administration of medications or supplements to cats.
EXOTIC
In contrast, a study7 of dogs with cardiac disease re-
vealed that when food was used to administer medica-
tions, most dog owners used human foods, which often
were high in sodium.
The finding that 56% of cats in the present study
had concurrent disease supports the theory that there
is no single diet best suited for all cats with cardiac
disease and that diets should be tailored for individual
cats on the basis of clinical signs, laboratory values, and
concurrent diseases rather than only on the basis of the
cardiac condition. The most common concurrent con-
ditions were feline lower urinary tract disease, diabetes
mellitus, and asthma. For some of these diseases, dietary
modification is considered to be advantageous, but the
modifications may or may not contradict the goals of
nutritional management for cardiac disease; therefore,
addressing multiple concerns may be necessary in cats
with cardiac disease. For example, some diets for cats
with lower urinary tract disease are designed to have
high sodium content. Only 1 cat in the present study
was consuming a commercial food labeled for cats with
cardiac disease as part of its diet. Two owners changed
their cat’s diet to a food designed for cats with cardiac
disease but switched back to a non–cardiac-disease food
because of concerns about palatability. However, some
owners were feeding low-sodium diets on the basis of
discussions with the cardiologist. Dietary modifications
for the cat’s cardiac disease were a topic of conversation
between owners and the attending veterinarian in 20%
of the sample population. However, most cats had no
clinical signs at either the time of initial evaluation or
the time of administration of the questionnaire, and it is
possible that the attending veterinarian did not feel that
adjustments in diet were warranted.
Thirty-eight percent of cats had a present or past his-
tory of inappetance. Because owners were asked to re-
count episodes of inappetance from memory, it is probable
that some cats with loss of appetite were not accounted
for in the questionnaire; therefore, this percentage may
be an underestimate. Additionally, 78% of owners could
not quantify their cat’s food intake, so minor changes in
appetite may have gone unnoticed. However, it is also
probable that cats that were inappetant for reasons other
than cardiac disease were included in the questionnaire,
particularly since 77% of cats remained free of clinical
signs at the time the questionnaire was administered.
Some cats that were inappetant at the time of diagnosis
were initially examined for other medical causes (such
as feline lower urinary tract disease). In those instances,
cardiac disease was secondarily diagnosed following inci-
dental auscultation of a cardiac murmur, arrhythmia, or
gallop. However, the frequent occurrence of inappetance
is an important finding because it can be an indicator of
general health and may impact quality of life.
Only 22% of owners were able to quantify their cat’s
dietary intake. Given the importance of nutrient intake
and body weight in feline health management, the fact
that three fourths of owners did not know how much
their cat was eating is an important finding that can af-
fect how clinicians make nutritional recommendations.
866 Scientific Reports: Original Study JAVMA, Vol 230, No. 6, March 15, 2007
This study was limited by a number of factors.
Precise dietary information was only available for 22%
of cats. However, no significant differences were found
between this subset and the remainder of the study
population with the exception that the subset group
contained significantly more male cats. Information
regarding diet history and occurrence of inappetance
was obtained from owners and was thus dependent on
their memories. Body condition scores were not avail-
able for all cats, and not all body weights and body
condition scores were obtained close to the time the
questionnaire was administered. Additionally, a 24-
hour diet recall was used to assess dietary intake. This
method was chosen because the ease with which it
can be administered made owner participation more
feasible. A single 24-hour period may not fully rep-
resent an individual cat’s dietary intake because of
daily variation in feeding. However, the information
obtained from a 24-hour diet recall has good reliabil-
ity from interviewer to interviewer, has good repeat-
ability, is more objective than a diet history, and can
provide dependable mean group intake values.16 In
addition, it is important to acknowledge that we made
comparisons with AAFCO cat food nutrient profiles
because they are the standard that is used at present
by the pet food industry. The AAFCO minimums are
not absolute requirements but rather are allowances
because AAFCO also considers variation in nutrient
availability of ingredients. National Research Council
requirements were not chosen because minimal re-
quirements, adequate intake, or safe upper-limit data
were not available for all 5 key nutrients (protein, fat,
sodium, potassium, and magnesium).17 Recommended
allowances for these 5 nutrients were available from
the National Research Council, but values are either
identical or similar to the AAFCO minimum values.17
Additional studies are needed to determine wheth-
er the results obtained in the present study are appli-
cable to other patient populations. Nevertheless, this
information may be useful in providing control or base-
line information for nutritional intervention studies,
improving client education, and identifying areas in
which cats with cardiac disease may benefit from nutri-
tional modification.
a. Hohenhaus AE, Simantov R, Fox PR, et al. Evaluation of plasma
homocysteine and B vitamin concentration in cardiomyopathic
cats with congestive heart failure and arterial thromboembolism
(abstr). Compend Contin Educ Pract Vet 1999;22:89.
b. Systat, version 10.0, SPSS, Chicago, Ill.
c. Pill Pockets Inc, Raleigh, NC.
References
1. Cote E, Manning AM, Emerson D, et al. Assessment of the prev-
alence of heart murmurs in overtly healthy cats. J Am Vet Med
Assoc 2004;225:384–388.
2. Freeman LM, Abood SK, Fascetti AJ, et al. Disease prevalence
among dogs and cats in the United States and Australia and
proportions of dogs and cats that receive therapeutic diets or
dietary supplements. J Am Vet Med Assoc 2006;229:531–534.
3. Lund EM, Armstrong PJ, Kirk CA, et al. Health status and
population characteristics of dogs and cats examined at private
veterinary practices in the United States. J Am Vet Med Assoc
1999;214:1336–1341.
4. Roudebush P, Keene BW, Mizelle HL. Cardiovascular disease. In:
Unauthenticated | Downloaded 07/28/23 08:09 PM UTC
 Hand HS, Thatcher CD, Remillard RL, et al, eds. Small animal
clinical nutrition. 4th ed. Marceline, Mo: Walsworth Publishing
Co, 2000;529–562.
5. Freeman LM, Rush JE. Nutritional management of cardiac dis-
ease. In: Ettinger SJ, ed. Textbook of veterinary internal medicine.
6th ed. St Louis: Elsevier Publishers BV, 2005;579–583.
6. Pion PD, Kittleson MD, Rogers QR. Myocardial failure in cats
associated with low plasma taurine: a reversible cardiomyopa-
thy. Science 1987;237:764–768.
7. Freeman LM, Rush JE, Cahalane AK, et al. Evaluation of di-
etary patterns in dogs with cardiac disease. J Am Vet Med Assoc
2003;223:1301–1305.
8. Freeman LM, Rush JE, Kehayias JJ, et al. Nutritional alterations
and the effect of fish oil supplementation in dogs with heart
failure. J Vet Intern Med 1998;16:440–448.
9. Mallery KF, Freeman LM, Harpster NK, et al. Factors contribut-
ing to the decision for euthanasia of dogs with congestive heart
failure. J Am Vet Med Assoc 1999;214:1201–1204.
10. McMichael MA, Freeman LM, Selhub J, et al. Plasma homocys-
teine, B vitamins, and amino acid concentrations in cats with
cardiomyopathy and arterial thromboembolism. J Vet Intern Med
2000;14:507–512.
JAVMA, Vol 230, No. 6, March 15, 2007 Scientific Reports: Original Study 867
11. Smith CE, Freeman LM, Rush JE, et al. Omega-3 fatty acids in
Boxer dogs with arrhythmogenic right ventricular cardiomy-
SMALL ANIMALS/
opathy. J Vet Intern Med 2007;in press.
12. Kirk CA, Debraekeleer J, Armstrong PJ. Normal cats. In: Hand
EXOTIC
HS, Thatcher CD, Remillard RL, et al. Small animal clinical
nutrition. 4th ed. Marceline, Mo: Walsworth Publishing Co,
2000;291–347.
13. Laflamme D. Development and validation of a body condition
score system for cats: a clinical tool. Feline Pract 1997;25:
13–17.
14. Pedersen HD. Effects of mild mitral valve insufficiency, sodium
intake, and place of blood sampling on the renin-angiotensin
system in dogs. Acta Vet Scand 1996;37:109–118.
15. Freeman LM, Rush JE, Markwell PJ. Effects of dietary modifica-
tion in dogs with early chronic valvular disease. J Vet Intern Med
2006;20:1116–1126.
16. Dwyer J. Dietary assessment. In: Shills ME, Olson JA, Shike M,
et al, eds. Modern nutrition in health and disease. 9th ed. Balti-
more: The Williams & Wilkins Co, 1999;937–959.
17. National Research Council. Nutrient requirements of dogs
and cats. Washington, DC: National Academies Press, 2006;
366–367.
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