Incorporating nutritional assessment into patient care is critical for maintaining pets’ health and their response to disease and injury.
The positive impact of nutrition on health and recovery from disease or injury is well established. The World Small Animal Veterinary Association ( WSAVA) has established an initiative for nutritional assessment to be the “5th vital sign” or 5th vital assessment (V5 or 5VA) after temperature, pulse, respiration and pain assessment.
Incorporating the screening evaluation as described in these guidelines as the fifth vital assessment in the standard physical examination requires little additional time and no cost.
Incorporating nutritional assessment and recommendations into the care of small animals also helps develop the partnership between the owner and veterinary healthcare team. Surveys show that owners have a strong desire to have information on nutrition and diet provided by the veterinary healthcare team.
The American Animal Hospital Association (AAHA) has set up Global Nutrition Guidelines for Nutritional Evaluation which have been published in the Journal of Small Animal Practice. Following the launch of the WSAVA’s guidelines in 2011, its global nutrition committee (GNC) developed a suite of “tools”.
These include practical aids for the veterinary healthcare team for making nutritional assessment and recommendations, and include a diet history form, hospitalised patient feeding guide, body condition score charts, muscle condition score chart and calorie recommendations for adult dogs and cats, and a nutritional assessment check sheet, which is filled out both by the owner and the health care team (Figure 1).
In addition, there are educational materials for pet owners on the website, including using information about nutrition which is on the internet, and picking the right diet. While some of the educational materials for owners on picking a diet are currently somewhat oriented to North America, they provide useful information and will be updated to include European regulations and advice.
The tools are designed to help the veterinary healthcare team address nutrition and to advance the role of the team as the expert source of nutrition information.
What is a nutritional assessment?
Nutritional assessment includes consideration of animal-specific factors, dietspecific factors, feeding management, and environmental factors. Animal-specific factors include age, lifestage, activity and nutrient-sensitive disorders requiring specific dietary management (e.g. chronic kidney disease).
Diet-specific factors include the safety and appropriateness of the diet and include nutrient imbalances, spoilage, and contamination. The feeding of an unbalanced homemade diet or a poor quality commercial diet would be considered.
Feeding factors include the frequency, timing, location and method of feeding. Information on feeding management includes over- or underfeeding, feeding of treats, scavenging and hunting. Environmental factors include the pet’s housing, presence of other animals, access to the outdoors, and environmental enrichment.
The nutritional assessment has two parts: firstly, a screening evaluation and if areas of concern are found there, an extended evaluation may be warranted.
The screening evaluation should be performed for every pet at every visit as a part of routine history taking and physical examination. It includes a diet history, body weight, body condition score (BCS), muscle condition score, and evaluation of the coat and teeth.
The nine-point body condition scale is used by the WSAVA (Figure 2). Body condition is determined using a combination of the visual appearance and palpation of the pet, e.g. is there a waist apparent and palpation of the amount of fat cover over the ribs. A video for doing canine BCS is available on the WSAVA website.
The BSC evaluates body fat, and it is possible for a pet to be overweight but still have muscle loss, especially in diabetic and other ill pets or the elderly. Muscle mass scoring systems are based on palpation of skeletal muscle over the skull, scapulae, spine and pelvis (Figure 3). Acute and chronic disease may cause loss of muscle mass disproportionate to the loss of fat due to the cytokine and neurohormonal effects on metabolism.
Dietary and feeding management plan
Following the nutritional assessment, the owner should be provided with a dietary recommendation and feeding management plan which should be written on a discharge sheet along with other any instructions, e.g. for medictions.
This can be from the WSAVA Nutritional Assessment Check sheet, or a short section on a disc sheet recommending what, how much and how often to feed. If no change is recommended, the owners should be advised that the current diet is adequate, to reinforce good habits!
The nutritional recommendation depends upon whether the animal is healthy or ill and if it is to be hospitalised. Some factors that need to be considered include the animal’s energy needs, protein requirements, and special dietary needs for disease, nutrient losses via diarrhoea, urine (proteinuria or glucosuria) and drains.
Calorie requirements for cats or dogs (Figure 4) can vary up to 50% from the estimated amount, but the estimated amount should be calculated as a starting point. Average maintenance or daily energy requirements (DER or MER, which are equivalent) for adult dogs and cats may be found on the WSAVA GNC Toolkit.
Working or agility-type dogs often need more than these estimates and the adult calculations shouldn’t be used for reproducing bitches and queens or for puppies and kittens as they have much higher needs. The owner’s requirements should also be considered, e.g. if they work full time, feeding multiple times per day may not be feasible. Where treats and snacks are part of the owner’s relationship with the pet, they should be taken into account and advice given for appropriate treats.
Asking an owner to completely stop feeding treats may result in poor compliance; it is better to accept that treat giving will happen and give advice which will work for the owner.
In summary, a nutritional evaluation and diet recommendation should be made for every pet at every veterinary visit, and the WSAVA Toolkit should help make this a practical and profitable way to improve pet health.
References and recommended reading
Baldwin, K., Bartges, J., Buffington, T. et al (2010) AAHA Nutritional assessment guidelines for dogs and cats. J Am Hosp Assoc 46: 2,285-2,296.
Brunetto, M. A., Gomes, M. O. S., Andre, M. R. et al (2010) Effects of nutritional support on hospital outcome in dogs and cats. J Vet Emerg Crit Care 20 (2): 224-231.
Burkholder, W. J. (2000) Use of body condition scores in clinical assessment of the provision of optimal nutrition. J Am Vet Med Assoc 217 (5): 650-654.
German, A. J. and Morgan, L. E. (2008) How often do veterinarians assess the bodyweight and body condition of dogs? Vet Rec 163 (17): 503-505.
Laflamme, D. (1997) Development and validation of a body condition score system for cats: a clinical tool. Feline Practice 25: 13-18.
Laflamme, D. (1997) Development and validation of a body condition score system for dogs. Canine Practice 22 (4): 10-15.
Michel, K. E. (2009) Using a diet history to improve adherence to dietary recommendations. Comp for Cont Ed 31 (1): 55-58.
Michel, K. E., Anderson, W., Cupp, C. et al (2009) Validation of a subjective muscle mass scoring system for cats. J Anim Physol Anim Nutr 93: 806.
Mitsuhashi1, Y., Chamberlin, A. J., Bigley, K. E. and Bauer, J. E. (2011) Maintenance energy requirement determination of cats after spaying. Br J Nutr 106 Suppl 1 (0): S135-138.
Sindgerland, L. I., Fazilova, V. V., Plantinga, E. A. et al (2009) Indoor confinement and physical activity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes. Vet J 179: 247253.
Vogt, A. H., Rodan, I., Brown, M. et al (2010) AAFP-AAHA feline lifestage guidelines. J Feline Med Surg 12: 43-54.
WSAVA Nutritional Assessment Guidelines Task Force Members (2011) WSAVA Nutritional Assessment Guidelines. J Small Anim Pract 52 (7): 385-396.