Page 922 - Small Animal Clinical Nutrition 5th Edition

954 Small Animal Clinical Nutrition

Table 46-19. Comparison of key nutritional factors in selected commercial veterinary therapeutic foods for reducing the recurrence of
VetBooks.ir Moist foods** Mg (%) P (%) Ca (%) Protein (%) Na (%) Urinary pH Total omega 3 (%)
feline idiopathic cystitis, struvite disease (uroliths or urethral plugs) and/or calcium oxalate uroliths in cats.*

Recommended levels
Hill’s Prescription Diet c/d Multicare 0.07-0.14 0.5-0.9 0.6-1.0 32-45 0.3-0.6 6.2-6.4 0.35-1.0
with Chicken Feline 0.052 0.68 0.72 43.8 0.32 6.35 0.96
Hill’s Prescription Diet c/d Multicare
with Seafood Feline 0.054 0.71 0.62 44.8 0.33 6.4 0.62
Medi-Cal Urinary SO na 1.20 1.20 43.5 1.1 6.4 na
Purina Veterinary Diets UR Urinary St/Ox
Feline Formula 0.07 0.97 0.96 50.6 0.62 6.0-6.4 na
Royal Canin Veterinary Diet Urinary SO in gel 0.10 1.36 1.02 41.3 1.02 6.0-6.3 na
Dry foods Mg (%) P (%) Ca (%) Protein (%) Na (%) Urinary pH Total omega 3 (%)
Recommended levels 0.07-0.14 0.5-0.9 0.6-1.0 32-45 0.3-0.6 6.2-6.4 0.35-1.0
Hill’s Prescription Diet c/d Multicare Feline 0.06 0.65 0.74 36.1 0.35 6.3 0.65
Hill’s Prescription Diet c/d Multicare
with Chicken Feline 0.06 0.65 0.76 34.6 0.33 6.3 0.64
Purina Veterinary Diets UR Urinary St/Ox
Feline Formula 0.07 1.08 1.1 44.9 1.17 6.0-6.4 na
Key: Mg = magnesium, P = phosphorus, Ca = calcium, Na = sodium, total omega 3 = total omega-3 fatty acids, na = not available from
manufacturer.
*Nutrients expressed on a dry matter basis unless otherwise stated.
**In general, it is recommended that moist foods be fed to cats with lower urinary tract disorders, especially those with feline idiopathic
cystitis or calcium oxalate uroliths.

Fiber
Table 46-20. Descriptions of grades used to classify evidence
supporting treatments for cats with lower urinary tract diseases.* The role of dietary fiber has not been carefully evaluated in cats
with lower urinary tract disorders. In an epidemiologic study of
Grade Description of evidence cats with uroliths, those fed high-fiber foods (0.71 to 11.57
I At least one properly designed, randomized, controlled
clinical study performed in patients of the target g/100 kcal) were 2.12 times more likely to develop struvite
species uroliths than cats fed low-fiber foods (0.06 to 0.30 g/100 kcal)
II Evidence from properly designed, randomized, con- (Lekcharoensuk et al, 2001a). In the same study there was no
trolled studies in animals of the target species with
spontaneous disease in a laboratory or research ani- association between dietary fiber and development of calcium
mal colony setting oxalate uroliths. Dietary fiber may bind calcium in the small
III Appropriately controlled studies without randomization intestine, preventing its absorption.There are anecdotal reports
Appropriately designed case-control epidemiologic
studies that feeding foods with increased fiber helps control hypercal-
Studies using models of disease or simulations in the cemia in cats with concomitant calcium oxalate uroliths
target species (McClain et al, 1999).
Dramatic results from uncontrolled studies
Case series
IV Studies conducted in other species
Reports of expert committees
Descriptive studies FEEDING PLANS
Case reports
Pathophysiologic justification/rationale Successful management of cats with various lower urinary tract
Opinions of respected experts diseases requires a multifaceted approach and effective commu-
nication between health care team members and owners. Nu-
*Adapted from Roudebush P, Allen TA, Dodd CE, et al.
Application of evidence-based medicine to veterinary clinical tritional management plays a key role in the treatment of
nutrition. Journal of the American Veterinary Medical Association patients with FIC, struvite disease (uroliths and urethral plugs)
2004; 224: 1765-1771.
and calcium oxalate uroliths. Environmental enrichment (e.g.,
stress reduction, litter box management) also should be imple-
mented in patients with FIC and may be helpful for cats with
other lower urinary tract disorders.For cats with persistent clin-
quent hypercalciuria and increased risk for oxalate uroliths.The ical signs, especially periuria, behavioral modification may also
minimum recommended allowance for vitamin D for adult cats be needed to correcting the underlying medical disorder. Fi-
is 280 IU/kg food (DM; for a food with 4 kcal ME/g DM) nally, other treatments such as pain management may be need-
(NRC, 2006).However,cats at risk for calcium oxalate urolithi- ed for some cats, especially during acute episodes.
asis and those with hypercalcemia associated with calcium Feeding plans for cats with various lower urinary tract dis-
oxalate urolithiasis should be fed foods that do not exceed 2,000 eases continue the iterative process and include the following
IU/kg of food. Dietary supplements containing vitamin D steps: 1) assess and select the food, 2) assess and determine the
should not be fed to at-risk cats. feeding method and 3) reassess and modify the feeding plan, as