Page 1124 - Small Animal Clinical Nutrition 5th Edition

1170 Small Animal Clinical Nutrition

energy (ME/g) (18.4 kJ ME/g) (dry matter [DM]) are well tol-
VetBooks.ir lipidosis or cholangitis.* erated by most cats and result in clinical improvement when fed
Table 68-7. Key nutritional factors for cats with hepatic
in appropriate amounts. Energy density recommendations for
Factors
Energy density (kcal/g) Recommended levels cats with cholangitis are similar to those outlined for cats with
≥4.4
hepatic lipidosis. Achieving this level of energy density typical-
Energy density (kJ/g) ≥18.4 ly requires at least 25% DM dietary fat.
Protein (%) 30 to 45
Arginine (%) 1.5 to 2.0 Providing adequate daily energy intake is also important in
Taurine (%) ≥0.3 managing dogs and cats with chronic hepatitis, portal hyper-
Potassium (%) 0.8 to 1.0 tension and PSS and dogs with copper-associated hepatotoxi-
L-carnitine (%) ≥0.02
cosis. An adequate supply of energy is needed to allow protein
*Nutrients expressed on a dry matter basis. synthesis and prevent tissue catabolism that generates ammo-
nia. Foods for patients with these diseases should provide at
least 4.0 and 4.2 kcal ME/g DM (16.7 and 17.6 kJ ME/g), for
dogs and cats, respectively.
Table 68-8. Key nutritional factors for dogs and cats with The role of dietary fat in patients with hepatic disease has not
hepatobiliary disease.* been specifically determined. Dietary lipids are beneficial be-
cause they have a protein-sparing effect, reduce carbohydrate
Factors Dogs Cats
Energy density (kcal/g) ≥4.0 ≥4.2 intolerance, augment fat-soluble vitamin absorption, enhance
Energy density (kJ/g) ≥16.7 ≥17.6 palatability and are an important source of energy and essential
Protein (%) 15-20** 30-35**
Arginine (%) – 1.5 to 2.0 fatty acids.
Taurine (%) ≥0.1 ≥0.3 A minor decrease in fat digestibility (i.e., from 92 to 85%)
Sodium (%) 0.08 to 0.25 0.07 to 0.3 was found in dogs with experimentally created PSS (Laflamme
Copper (mg/kg) ≤5 –
Zinc (mg/kg) >200 >200 et al, 1993). Other studies showed that dogs with experimental
Iron (mg/kg) 80 to 140 80 to 140 shunts tolerate foods containing 20 to 25% DM fat (Center,
Vitamin E (IU/kg) ≥400 ≥500 1996b). Clinically significant impaired fat digestion may occur
Vitamin C (mg/kg) ≥100 100 to 200
in animals with severe biliary disease with subtotal or total bil-
*Nutrients expressed on a dry matter basis. iary obstruction.
**For liver disease patients with signs of hepatic There appears to be no reason for routinely restricting dietary
encephalopathy, dry matter dietary protein levels should be
limited to 10 to 15% for dogs and 25 to 30% for cats until fat in dogs and cats with liver disease. One of two different sit-
signs resolve. uations may be occurring if steatorrhea is a problem in patients
with hepatobiliary disease. First, the patient may have concur-
rent disease that is contributing to fat malassimilation, such as
exocrine pancreatic insufficiency. Second, the patient may have
subtotal or total biliary duct obstruction.
clinical experience. The key nutritional factors discussed below Medium-chain triglycerides (MCT; i.e., carbon chain lengths
support a common nutrient profile that will benefit most liver <12) have theoretical advantages over long-chain triglycerides
disease patients. However, it should be noted that due to the (LCT) for the treatment of GI and some forms of hepatobiliary
wide range of hepatobiliary diseases and their differing severi- disease (Guilford, 1996). MCT may be more easily hydrolyzed
ty,one nutrient profile might not always be ideal for all patients. and absorbed than LCT; however, these advantages have yet to
The following section will discuss these key nutritional factors be proved. Caloric supplementation with MCT is useful for
in more detail and outline specific recommendations for the malnourished human cirrhotic patients with steatorrhea and
most common hepatobiliary disorders. Tables 68-7 (feline hep- those with advanced cholestatic hepatic disease (Munoz, 1991).
atic lipidosis and cholangitis) and 68-8 (canine and feline hepa- Controlled clinical trials using MCT in animals with cirrhotic
tobiliary diseases) summarize these key nutritional factors. or cholestatic liver disease have not been reported.
The inflammatory component of hepatic disease may be
Energy attenuated by omega-3 (n-3) fatty acid supplementation. How-
Provision of adequate daily energy intake is the cornerstone of ever, the specific amounts to include in foods and the optimal
successful medical management of cats with hepatic lipidosis ratio of omega-6 (n-6) to omega-3 fatty acids have not been
(Biourge et al, 1990, 1994a; Center, 1996c; Biourge, 1997; determined. Some veterinary therapeutic foods for liver disease
Marks et al, 1994a). An adequate supply of energy is needed to: are enhanced with omega-3 fatty acids (Remillard and Saker,
1) prevent catabolism of amino acids for energy, 2) inhibit 2005).
peripheral lipolysis and 3) avoid excess energy consumption,
which will promote hepatic triglyceride accumulation. Cats Protein and Amino Acids
with hepatic lipidosis are often fed commercial veterinary ther- Dietary protein and the amino acids arginine and taurine are
apeutic products via assisted-feeding techniques (Chapter 25). important in cats with hepatic lipidosis. Cats are less efficient
Foods with energy densities of at least 4.4 kcal metabolizable in sparing protein during fasting than other animals. As such,