Page 1030 - Small Animal Clinical Nutrition 5th Edition

1070 Small Animal Clinical Nutrition

Fiber readily available, nonantigenic form. Monomeric liquid foods
VetBooks.ir It has been recommended that people with IBD eat small are also supplemented with glutamine. In pediatric human
patients, a recent meta-analysis demonstrated that enteral
quantities of soluble or mixed fiber sources (Fiocchi, 1998). In
fact, short-chain fatty acid and butyrate enemas induce clinical
nutritional support was as efficacious as corticosteroid therapy
improvement in people with ulcerative colitis (Harig et al, in acute Crohn’s disease (Henschkel et al, 2000). Parenteral
1989; Breuer et al, 1991). A number of substrates including nutrition does not appear to provide any advantage over
beet pulp, soy fiber, inulin and fructooligosaccharides have been monomeric foods and is not recommended except in those
demonstrated by in vitro fermentation to produce volatile fatty patients unable to tolerate enteral feeding (Hanauer, 1996).
acids that may be beneficial in IBD that involves the distal Complete bowel rest may theoretically worsen GI mucosal
small intestine and colon (Sunvold et al, 1995, 1995a, 1995b; lesions by depriving mucosal epithelial cells of nutrients such
Jamikorn et al, 1999). In addition, these fermentable fibers may as glutamine and short-chain fatty acids (Husain and
serve as prebiotics and foster the growth of beneficial bacterial Korzenik, 1998). Veterinary experience with parenteral feed-
organisms such as Bifidobacterium and Lactobacillus at the ex- ing and monomeric and hydrolysate-based foods in the man-
pense of more pathogenic microbes such as Desulfovibrio and agement of IBD is limited (Marks and LaFlamme, 1998;
Clostridium spp. (Chapter 5). These fibers are usually incorpo- Guilford, 1996a; Hannah et al, 2000). Most often, these ther-
rated at rates of 1 to 5% DM in commercial products. apies have been used in refractory cases in which other thera-
A second approach is to increase dietary fiber content to nor- peutic modalities have failed.
malize intestinal motility, water balance and microflora. Fiber
has several physiologic characteristics that are beneficial in Other Nutritional Factors
managing small bowel diarrhea. Moderate levels (7 to 15% Vitamins
DM) of insoluble fiber (e.g., cellulose) add nondigestible bulk, Adequate intake of water-soluble and fat-soluble vitamins is
which buffers toxins, holds excess water and, perhaps more critical for patients with IBD. In many cases, the limited stores
important, provides intraluminal stimuli to reestablish the of water-soluble vitamins have been depleted by diarrheic loss-
coordinated actions of hormones, neurons, smooth muscle, es and the large fluid flux through the animal. Thiamin defi-
enzyme delivery, digestion and absorption. Fiber can help nor- ciency, in particular, occurs commonly and can profoundly
malize transit time through the small bowel, which means affect appetite. Cobalamin (vitamin B ) deficiency has been
12
slowing a hypermotile state, but also improving a hypomotile recognized in dogs and cats with chronic enteropathies and
state to reestablish normal peristaltic action. However, this level can result in severe metabolic abnormalities including in-
of fiber reduces the energy density and digestibility of a food. creased serum methylmalonic acid and disturbances in serum
amino acid levels (Ruaux et al, 2001). Dogs and cats appear to
Digestibility more susceptible to cobalamin depletion than people because
Feeding highly digestible (fat and digestible [soluble] carbohy- they have a more rapid cobalamin turnover as a consequence
drate at least 90% and protein at least 87%) foods provides sev- of biliary excretion of cobalamin (Simpson et al, 2001;
eral advantages in the management of dogs and cats with IBD. Simpson, 2003). In addition, dogs and cats lack cobalamin
Nutrients from low-residue foods are more completely binding protein TC1, which facilitates long-term cobalamin
absorbed in the proximal gut. Furthermore, these highly storage in people (Simpson, 2003). Hypocobalaminemia typi-
digestible foods are associated with: 1) reduced osmotic diar- cally occurs when specific cobalamin receptors in the ileum are
rhea due to fat and carbohydrate malabsorption, 2) reduced damaged as a consequence of inflammatory disease (Such-
production of intestinal gas due to carbohydrate malabsorption odolski and Steiner, 2003). Deficiency is accelerated by re-
and 3) decreased antigen loads because smaller amounts of pro- duced cobalamin consumption and ongoing GI losses. A
tein are absorbed intact. Ideal foods for IBD patients are free of recent case control study demonstrated that parenteral cobal-
lactose to avoid the complication of lactose intolerance. If fiber- amin supplementation in cats with undetectable serum cobal-
enhanced foods are used, the digestibility will be reduced. amin values (<100 ng/l) normalized serum cobalamin and
Digestibility of protein, fat and carbohydrate of fiber-enhanced methylmalonic acid values and improved clinical indices such
foods should be at least 80, 80 and 90%, respectively. as body weight, vomiting and diarrhea (Ruaux et al, 2005). For
The use of monomeric liquid foods and total parenteral that reason, serum cobalamin should be assessed in patients
nutrition to provide a period of “bowel rest” for people and with chronic small intestinal disease and those with hypo-
animals with IBD is controversial (Griffiths et al, 1995; Ling cobalaminemia (<300 ng/l) should receive weekly subcuta-
and Griffiths, 2000). Bowel rest has been recommended as a neous cobalamin therapy (250 µg in cats and 500 µg in dogs)
means of reducing or eliminating antigenic stimuli while min- for four to six weeks or until serum levels return to the normal
imizing GI secretions. The greatest benefit appears to be for range (Ruaux et al, 2005). Once or twice monthly therapy may
human patients with Crohn’s disease (Lewis and Fisher, 1994; be required for longer term maintenance. Disease of the prox-
Jeejeebhoy, 1995). Placebo controlled trials of monomeric imal small intestine can inhibit absorption of dietary folate,
foods have not been performed in people but response rates in which is present in foods in the polyglutamate form. Folate
clinical practice have been convincing (Ling and Griffiths, absorption requires the jejunal brush border enzyme, folate
2000). Monomeric feedings provide energy and nitrogen in a deconjugase, and specific folate monoglutamate carriers