Abstract

The importance of nutrition in health and well-being has long been recognized in animal health and production. As small animal nutritional knowledge has expanded over the last 50 years, the ability to enhance our patients' and pets' "quality and quantity of life" obligates us to help promote optimal nutrition. The first steps in determining good nutrition are to provide regular nutritional assessments and appropriate dietary recommendations based on individual needs. The WSAVA Nutritional Assessment Guidelines Task Force has promoted a global initiative to standardize the evaluation of five vital signs, including a nutritional assessment, as part of every physical examination.¹ The five vital assessments (5VA) are derived from AAHA standards and include temperature, pulse, respiration, pain and nutrition.^1,2 Providing specific guidelines for nutritional assessment, nutritional risk factors, diet evaluation and feeding management will help veterinarians develop sound nutritional recommendations for their patients.

Why WSAVA and 5VA?

Good nutrition is well recognized but often underutilized as a factor contributing to good health, disease resistance, and longevity in companion animals. Health and nutrition are largely composed of 3 key factors: genetics, environment and nutrition. The WSAVA mission to advance the availability of quality veterinary medicine across the globe has resulted in published guidelines emphasizing the value of a nutritional assessment as part of a routine physical examination. Nutritional evaluation was added to the 4 critical vital assessment factors and as such represents the 5th vital assessment (5VA).

The specific goals of the WSAVA guidelines are to provide:

1.  Awareness of the importance of nutritional assessment in dogs and cats

2.  Guidelines for nutritional evaluation of dogs and cats to promote optimal health and response to disease

3.  Evidence and tools to support recommendations

By standardizing assessment tools and guidelines all veterinarians will be better able to provide sound nutritional recommendations using evidence-based information.

WSAVA Guidelines

The Guidelines emphasize 2 critical standards for nutritional assessment during routine physical examinations:

1.  Perform a screening nutritional assessment as the 5th vital assessment (5VA)

2.  Implement the assessment at every visit in every patient

The nutritional assessment is an iterative process that stresses a 3 prong approach developed by the American College of Veterinary Nutrition (ACVN).³ This process stresses initial assessment and ongoing reassessment of animal-specific factors, diet-specific factors and feeding management/environment.

The nutritional assessment may be performed in 2 levels where a screening evaluation is performed to identify nutritional risk factors that may require a more detailed examination. It is not simply enough to establish a diet meets the nutrient requirements established by regulatory or advisory bodies such as the National Research Council (NRC)⁴ of the US National Academy of Sciences, Federation of Pet Food Industry (FEDIAF), or Association of American Feed Control Officials(AAFCO).^5,6 Assuring a diet is complete and balanced for the species intended is indeed an important component of the nutritional assessment. However, determining it is the best option for a specific dog or cat requires a broader evaluation of animal-, diet-, and feeding-factors to determine nutrition risk.

Animal-Specific Factors

Animal factors include age, breed, reproductive status, altered physiology or disease, lifestyle, and activity levels. Disease risks associated with certain breed, age and gender may also be considered.

Diet-Specific Factors

Diet factors include both the nutritional adequacy of the food, nutritional balance, form of food (dry, canned), quality of the food, specific ingredients. It may include less factors such as the source of food and factors that may affect food safety (nutrient imbalances, spoilage, contamination, etc). Assuring the correct food is provided for a disease state is also important. For example, cat foods marketed for urinary tract health are often inappropriate for managing cats with chronic renal insufficiency due to the increased dietary acids and elevated sodium levels in some urinary diets.⁷ Owners may not differentiate between bladder health and kidney health when reading urinary tract health claims.

Feeding Management and Environmental Factors

Factors that include details of feeding method and environment should be determined as part of the history. Factors such as food amounts, feeding times, access to other foods, treats, foraging behavior, food competition, and the like all contribute to the development of a nutritional overview.

Nutritional Screening

A screening is to be performed on every animal. The nutritional screening consists of a basic nutritional history, body condition scoring (BCS), muscle condition scoring, evaluation of weight change and a physical exam. Identification of potential risk factors (Table 1) should prompt an extended evaluation.

Table 1. Nutritional screening risk factors.

 History

 Altered gastrointestinal function (e.g., vomiting, diarrhea,

 nausea, flatulence, constipation)

 Previous or ongoing medical conditions / disease

 Currently receiving medications and/or dietary supplements

 Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar)

 Snacks, treats, table food > 10% of total calories

 Inadequate or inappropriate housing

 Physical Examination

 Body condition score

 9-pt scale: any score less than 4 or greater than 5

 Muscle condition score: Mild, moderate, or marked muscle wasting

 Unexplained weight change

 Dental abnormalities or disease

 Poor skin or hair coat

 New medical conditions/disease

Extended Evaluation

Perform an extended evaluation when one or more nutritional risk factors are noted. A detailed nutritional history, additional diagnostics and complete diet evaluation should be performed. Charts and instructions for BCS, muscle condition, diet history, and food evaluation can be found in the published guidelines.¹

Nutritional Plans and Monitoring

A nutritional assessment is just the first step. Developing a rational nutritional plan for individual animals is the ultimate goal. Reassessment will allow modifications to the plan as an animal's physiology, diet, and environment change over time. Follow up visits foster ongoing client education, compliance and communication for the benefit of the pets health. By preventing obesity, managing disease or altered physiology, optimizing growth or reproduction should help to meet the goals of improved quality and quantity of life.

References

1.  http://onlinelibrary.wiley.com/doi/10.1111/j.1748-5827.2011.01079.x/pdf (VIN editor: the original link http://www.wsava.org/PDF/Misc?WSAVA_GlobalNutritionalAssessment Guidelines_2011.pdf was edited because it could not be accessed on 11/17/11)

2.  https://www.aahanet.org/Library/NutritionalAsmt.aspx (VIN editor: the original link http://www.aahanet.org/resources/Nutritional Guidelines.aspx was edited because it could not be accessed on 11/17/11)

3.  Thatcher CD, Hand MS, Remillard RL. Small animal clinical nutrition: An iterative process. In: Hand MS, Thatcher CD, Remillard RL, et al. Small Animal Clinical Nutrition, 5th ed. Marceline, Missouri: Wadsworth Publishing Company;2010:3–21.

4.  National Research Council. 2006. Nutrient requirements of dogs and cats. Washington, D.C.: National Academies Press.

5.  Association of American Feed Control Officials. 2010. Official Publication. Oxford.

6.  European Pet Food Industry Federation (FEDIAF). Nutritional guidelines for cats and dogs. http://www.fediaf.org/self-regulation/nutrition

7.  Kirk CA, Jewell DE, Lowry S. Effect of sodium chloride on selected parameters in cats. Vet Ther 2006;7(4):333–346.