When the nutritional assessment indicates a patient may benefit from consuming a purpose-formulated therapeutic diet, the clinician needs to focus on specific nutrients of concern (Table 8). When a patient has a single disease condition and no additional nuanced feeding or diet requirements, it may be adequate to simply choose a therapeutic diet designed for the disease. In diseases in which diagnostics and staging affect nutrients of concern (e.g., CKD) or when patients have multiple disease conditions and/or additional feeding or diet requirements, consider all nutrients of concern before selecting a diet. Otherwise, it is easy to overlook a nutrient of concern and inhibit or negate the treatment plan for the patient’s condition. For example, if a dog receiving a low-fat diet to manage chronic pancreatitis is diagnosed with CKD, a dietary change to address the CKD may result in recurrent pancreatitis symptoms if both disease conditions are not considered.
Adverse food reaction >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Cutaneous adverse food reaction |
- Limited antigen diet
- Novel/hydrolyzed protein
- Limited ingredients
|
- Ingredients impact success of treatment
- Noningredients may also impact success (e.g., additives, Food intolerance Maillard production reaction)
|
| Food intolerance |
| Food-responsive chronic enteropathy |
Inflammatory skin condition >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
- Non-food-related skin condition
|
- High n-3 fatty acids (consider n-6:n-3 ratio)
- High vitamin A
- High vitamin E
- High zinc
- Added antioxidants
|
- Individual diseases may require different supplements and doses
|
Osteoarthritis >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
|
- High EPA/DHA
- Added glucosamine
- Added chondroitin
- Added antioxidants
- Low energy density if overweight/obese
|
- Additional supplementation may be required to achieve optimal dose
- High n-3 fatty acid supplementation may result in gastrointestinal disturbance
|
Neurologic conditions >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Cognitive dysfunction |
- Added lipoic acid
- Added carnitine
- High EPA/DHA
- Added antioxidants
|
- Synergistic effects of nutrients when combined
|
| Idiopathic epilepsy |
- High medium-chain triglycerides
|
|
| Anxiety |
- Added L-tryptophan
- Added hydrolyzed casein
- Added antioxidants
- Modified fiber
|
|
Cardiovascular disease >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Degenerative valve disease |
- Controlled sodium
- High EPA/DHA
- Avoid low protein
|
- Supplement potassium as required
- Maintain optimal body and muscle condition
|
| Hypertrophic cardiomyopathy |
| Dilated cardiomyopathy |
- Controlled sodium
- High EPA/DHA
- Avoid low protein
- Added taurine
- Added carnitine
|
|
Urolithiasis >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Calcium oxalate |
- Low oxalate ingredients
- Controlled calcium with appropriate calcium to phosphorus ratio
- Avoid vitamin C supplementation
- Low relative supersaturation
- Added water
|
- Many of these nutrients of concern can be incorporated into other diets but may be difficult to identify unless specifically labeled for this use
- Aim for USG ≤1.020 (dogs) or ≤1.035 (cats)
- Struve urolithiasis in dogs is typically infection related and special diet may not be required long term
|
| Struvite |
- Controlled magnesium
- Controlled phosphorus
- Controlled protein
- Target acidic urine pH
- Added water
|
| Urate |
- Low purines
- Does not necessarily mean low protein
- Target alkaline urine pH
- Added water
|
| Cystine |
- Controlled cystine
- Controlled methionine
- Target alkaline urine pH
- Added water
|
Lower urinary tract disease >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Matrix-crystalline plugs |
- Based on mineral content of the plug
- Added water
|
- Many of these nutrients of concern can be incorporated into other diets but may be difficult to identify unless specifically labeled for this use
- Aim for USG ≤1.020 (dogs) or ≤1.035 (cats)
- Struve urolithiasis in dogs is typically infection related and special diet may not be required long term
|
| Feline idiopathic cystitis |
- Added antioxidants
- High EPA/DHA
- Added water
- Low energy density if overweight/obese
|
Pancreatic disease >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Diabetes mellitus |
- High soluble and insoluble fiber
- Low carbohydrate (cats)
- High protein (unless contraindicated,
|
Gastrointestinal >
| Specific Conditions |
Nutrients of Concern |
Notes |
|
| Acute vomiting, diarrhea |
- Highly digestible
- Low to moderate fat
|
- Difficult to identify digestibility unless specifically labeled for this use
|
| Chronic enteropathy |
- Limited antigen diet
- ± modified fiber
- ± low fat
|
- Assess serum cobalamin and folate and supplement if indicated
|
| Intestinal dysbiosis |
|
- Assess serum cobalamin and supplement if indicated
|
| Fiber-responsive colitis |
- Moderate to high fiber
- Mixed fiber types
|
- Fiber can be separately supplemented
|
| Large bowel diarrhea |
| Constipation |
- Moderate to high fiber
- Mixed fiber types
- Low energy density if overweight/obese
- Increased water
|
- Investigate underlying causes (e.g., hypercalcemia, hypokalemia, obesity)
|
| Obstipation |
- Highly digestible
- Low energy density if overweight/obese
|
- Difficult to identify digestibility unless specifically labeled for this use
- Caution with high-fiber weight loss diets
|
Other endocrine >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
|
| Hyperlipidemia |
|
- Consider EPA/DHA supplementation
|
| Feline idiopathic hypercalcemia |
- Controlled calcium
- Avoid excess vitamin D
- Avoid excess vitamin A
- ± increased fiber
|
|
|
| Hyperthyroid |
|
- Impossible to achieve necessary level of iodine restriction without specific formulation and production procedures
- Specific nutritional modification not required if hyperthyroidism is managed by other means
|
Liver disease >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
|
| Encephalopathic |
|
- Low protein
- ± B12 supplementation
|
| Copper-associated hepatopathy |
Portosystemic shunt |
|
- Only specifically designed low-copper diets are below AAFCO minimums
|
| Chronic hepatitis |
| Secondary to other diseases (neoplasia, inflammation, fibrosis) |
| Hepatic lipidosis |
- High energy density
- High protein
- Mixed fiber types
|
- Supplement with carnitine
|
|
| Cholestatic |
- High protein
- Mixed fiber types
- Low-fat
|
- Consider vitamin E supplementation
|
| Post-operative liver |
- High protein
- Mixed fiber types
- Low-fat
|
- Consider vitamin E supplementation
|
|
| Hepatic fibrosis or cirrhosis |
- High protein
- Mixed fiber types
- Low-fat
|
- Consider vitamin E supplementation
|
Kidney >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| Protein-losing nephropathy |
- 25–50% protein reduction from current intake
- Meet essential amino acid requirements
- High EPA/DHA
- Low phosphorus if azotemic
|
- Protein recommendations will depend upon the degree of proteinuria
- Many medications used to address proteinuria and hypertension may exacerbate hyperkalemia, and reducing dietary potassium intake may help
|
| Acute kidney injury |
|
- Consider as a critical care disease category when hypercatabolic
|
| Chronic kidney disease |
- Low phosphorus
- ± potassium supplementation
- High EPA/DHA
- Increased energy density to maintain body and muscle condition (unless obese)
- Excess protein
|
- Many medications used to address proteinuria and hypertension may exacerbate hyperkalemia, and reducing dietary potassium intake may help
- Consider vitamin D supplementation • Protein intake can vary based on staging, presence of uremia, and proteinuria
|
Obesity >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
|
- High protein
- Moderate to high fiber
- Low energy density
- Increased nutrient to calorie ratio
- Moderate to low fat
|
- Restriction below RER is not recommended with over-the-counter products
|
Dental disease >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
| |
- Mechanical action or masking flavor for
- Plaque or tartar reduction and/or prevention
- Control of bad breath odor
|
- Mechanical brushing and dental prophylaxis are most effective
|
Critical care >
|
Specific Conditions
|
Nutrients of Concern
|
Notes
|
|
- Highly digestible
- Increased energy density
- High fat
- Added antioxidants
- Texture more amenable to tube feeding slurry use
|
- Difficult to identify digestibility unless specifically labeled for this use
|