Nutritional Assessments in Practice: What, Why and How

In veterinary medicine, it has been widely accepted that there are 4 vital assessments to be made on every patient; that of temperature, pulse, respiration and pain. Within the last few years, following publication of the Nutritional Assessment Guidelines for Dogs and Cats by the American Animal Hospital Association in 2010 and a similar, more Global Nutrition Assessment Guidelines by the World Small Animal Veterinary Association Global Nutrition Committee (WSAVA-GNC) in 2011, a new paradigm has evolved that nutritional assessment is the new (5th) vital assessment that should be made on our animal patients.

We all have heard "we are what we eat". And that holds true for our animal patients as well. Especially with the growing popularity of new and boutique diets and alternate diets now in vogue, nutritional assessment is of growing importance for the profession in terms of nutritional adequacy, life stage, and even for disease treatment and prevention. With the plethora of commercial and alternate diets available to the consumer, it is impossible for the practitioner to have enough information about each and every one. In addition, research in North America has shown the majority of clients come in expecting some form of nutritional advice, but less than 15% of them perceive they received any. These guidelines, and the tools developed by the WSVA GNC, provide veterinarians and their teams helpful tools to more confidently and consistently advise on and assess nutrition.

So, this is how it works in an everyday practice. First, you perform a screening evaluation. This includes information you obtain from the history and a physical exam and should include these additional assessments, as well as what is part of your normal physical exam.

 Weight today and previously

 Body condition score (BCS)

 Muscle condition score (MCS)

 Diet:

 Brand: Home-made, commercial

 Dry kibble, canned, semi-moist, raw, other

 Frequency of feeding and amounts

 Treats

 Supplements

 Medications (include aspirin products)

 History of vomiting or diarrhea or other

 Temperature, pulse, respiration, pain

 Any abnormal physical finding

From this screening evaluation, if all is acceptable, you are almost done with your nutritional assessment and only need to comment on the food (good, adequate, inappropriate or unknown) and what your recommendations might be as far as diet (no change, change to XXX, or refer to nutritionist or toolkit on how to select an appropriate diet.)

If your screening evaluation is normal, that is it! You are done!

If, on the other hand, there are abnormalities in the history, diet, or physical exam... a more extended evaluation is triggered, as would be for any exam.

In the extended evaluation, you will examine:

 Animal/patient factors

 Food intake changes

 Vomit or diarrhea

 Medical condition

 Laboratory abnormalities

 Physical exam

 Dietary factors

 Calories and nutrients

 Balance

 Contamination or spoilage

 Change in kibble shape or content

 Treats

 Feeding and environmental factors

 Feeding location and frequency

 Access to food

 Toys

 Inter-pet interactions

Then, your overall assessment
Your overall plans/treatments/recommendations
Case example(s)

Implementation: How you integrate into a busy practice

 Create awareness within the practice team and education of the entire healthcare team

 Obtain buy-in for best patient care

 Create templates: SOAP sheets or paperless

 Reassess and modify as needed. Continuously update.

Barriers to implementation

 Lack of knowledge and acceptance of the practice team

 Client perceptions

 Time commitments

Reported, evidence-based factors contributing to the successful and unsuccessful delivery of prescribed enteral nutrition and recommendations.

Tools you can use and comments on application and relevance:

1.  Body Condition Score charts for dogs and cats

2.  BCS Video How to...

3.  Caloric Requirements for dogs and cats

4.  Muscle Condition Score chart for dogs and cats

5.  Nutritional Assessment Checklist

6.  Short Diet History Form

7.  Tips on Implementing the Guidelines

8.  Feeding Guide for Hospitalized Patients

9.  Feeding and Monitoring Chart for Hospitalized Patients

10.  Nutritional Assessment and Management of the Critical Care Patient

11.  Savvy Pet-Owners Guide to Nutrition on the Internet

12.  Selecting the Best Food for Your Pet

References

1.  WSAVA Global Nutrition Committee Guidelines 2011.

2.  WSAVA Global Nutrition Committee Toolkit 2015.