Out-of-the-blue diet and nutrition queries: Pick your battles carefully

One look at the shelves in any pet store can overwhelm you with the sheer number of brands and dietary options available to pet owners. Practically speaking, there is no way to keep up with new products while also taking the critical step of staying on top of all the recalls. However, you can simplify your nutritional assessment of a client's questions or statements concerning pet food products by asking just three questions.

GETTY IMAGES1. Does the product claim to be nutritionally complete and balanced?

Yes-You are done on this point because the diet is sufficient for long-term feeding.

No-Help the client find a food that claims to be complete and balanced according to AAFCO or National Research Council.

2. Would this particular nutrient profile harm my patient?

Yes-Explain why the nutrient content is inappropriate for this pet.

No-The diet is appropriate for this pet. 

3. Is this a food safety issue?

Yes-Explain that the product is on the recall list and make a recommendation on how to monitor the pet.

No-The diet is apparently safe to feed. However, you may want to voice your own opinion if the diet contains raw meat, eggs or bones.

Let's look at these questions one at a time.

Question 1: Is the product claim complete and balanced? 

Let the American Association of Feed Control Officials (AAFCO) statement become your new best friend. Why? This statement lets you know right off the bat whether the food is nutritionally complete and balanced and can be fed as a sole source of nutrition. An AAFCO statement is required on every pet food label sold in the United States, except if the food is made or sold only in Arkansas or Nevada or is clearly labeled as a treat, snack or supplement. 

The AAFCO statement is the most important preliminary piece of information on the label (not the ingredient list) when assessing the diet for a particular patient. You will see one of three types of statements on a pet food label: 

1. Nutritionally complete and balanced (or perfect, scientific, 100% nutritious)-this diet is known or shown to be nutritionally complete. 

2. For supplemental or intermittent feeding only-this diet is assumed or known to be nutritionally incomplete as a sole source of nutrition for an extended period of time. Specific clinical signs associated with deficiency or toxicity and the timing of their appearance cannot be predicted but depend on the first limiting nutrient and magnitude of the variance from the recommended level. A routine serum chemistry profile or complete blood count does not test for specific nutritional imbalances.

3. Feed under the supervision or direction of a veterinarian-this is seen on therapeutic dietary products. Many have passed AAFCO protocol feeding trials but use a veterinarian-only label.

However, you only need to distinguish between option 1 and 2: Is the diet nutritionally complete and balanced, or not? If it is, you're done on question 1 and the food is sufficient for feeding as a sole source of nutrition. If not, you need to explain this to the pet owner, which should not be too difficult: “There is no guarantee the diet contains all the nutrients known to be essential to a dog or cat.”

Exception-homemade diets. The AAFCO statement cannot help you here. A pet owner survey has shown that 21% of dog owner and 15% of cat owners feed human food or a homemade diet.1 Home-prepared diets do not carry any nutritional adequacy statement because they are not sold as a product-only as a recipe. Recipes are readily available from a variety of sources and so-called “experts.” A quick Google search will give your client myriad recipes, but only veterinarians and nutritionists are held accountable for their recommendations. Keep in mind that 95% of 200 homemade diet recipes published or located online were found to be nutritionally inadequate.2

Two additional major areas of concern with homemade diets: 

1. Is the nutrient profile appropriate for the pet's species, life stage and body weight or body condition score? 

2. Does the client make the recipe according to original instructions, and keep doing so? 

Each of these problems has been documented to cause malnutrition in pets.3-7

Checking the nutritional adequacy of recipes is not a simple task and beyond the skill set of and time available to most practitioners to do correctly because software, formulation skills, nutritional knowledge and access to ingredients databases are required. Therefore, practitioners should be willing to: 

> Briefly assess the recipe for five key nutrient sources and refer if needed8:

-Protein source-The diet should contain 25 to 30 percent cooked skeletal meat for dogs (one part meat to two or three parts grain) and 35 to 50 percent cooked skeletal or organ meat for cats. 

-Carbohydrate source-Optimal grain-to-meat ratios should be at least 2:1 to 3:1 for dog foods and 1:1 to 2:1 for cat foods. Cooked corn, rice, wheat, potato or barley are more than 85 percent digested by both dogs and cats.9,10

-Fat source-Only 1 percent is needed to meet the essential fatty acid requirement; an animal source is best. 

-Calcium source-A specific calcium supplement (with little or no phosphorus) is essential. 

-Multivitamin and trace mineral source-This cannot be met with “whole” foods such as fruits and vegetables because pets can simply not consume enough vegetable material to meet the stated recommendations. Synthetic supplements are required to ensure a complete diet. 

> Offer known nutritionally adequate recipes. Resources are available online at balanceit.com, cuisine-a-crocs.com and petdiets.com. You can also seek advice from a veterinary nutritionist at acvn.org or aavn.org.

Diet drift. Once the homemade diet has been documented as nutritionally sound, it is important that the recipe specifics be maintained in the medical record and reviewed on a regular basis with the owner (i.e. control diet drift). Food substitutions are usually possible, but first consult the author of the recipe. 

Boarded veterinary nutritionists, like other veterinary specialists, have advanced training and can be of particular assistance with homemade diets. Checking and correcting nutritional imbalances are generally not difficult for nutritionists; hence, most recipes can be complete and balanced if the owner insists on feeding a particular food. 

What about feeding raw meat or eggs?

Two health issues are at stake here: 

1. Nutritional integrity-raw food diets have several names but can be grouped by source:

• Homemade, which are usually not complete or balanced2; these diets should be checked by a nutritionist.

• Commercial-very few are sold as “complete and balanced”; most are “for supplemental or intermittent feeding” 

2. Food safety-There are now several consensus statements that cannot be ignored12:

• American Animal Hospital Association: Raw protein diet, available at aaha.org/professional/resources; AAHA's statement has been subsequently endorsed by The American Association of Feline Practitioners and the National Association of State Public Health Veterinarians

• American Veterinary Medical Association: Raw or undercooked animal-source protein in cat and dog diets, available at www.avma.org/kb/policies

• California Veterinary Medical Association: Policy on raw or undercooked animal-source protein in cat and dog diets, available at cvma.net.

Question 2:Would this nutrient profile harm my patient? 

If a diet is nutritionally complete and balanced, embedded in the AAFCO complete and balanced statement on the label will be the species and life stage. Match up the information with your patient: 

> Species-Canine or feline must be named. Some products are sold as one for both (e.g. foods sold for “all dog and cat life stages”).

> Life stage-There are only three life stage claims possible: 1) growth-gestation-lactation, 2) adult or maintenance, and 3) all life stages 

The latter claim sounds very convenient, but these diets are designed for growth. The most common mismatch is an owner feeding an “all life stage” food to a middle-aged, neutered dog of an obese-prone breed or an indoor, middle-aged, neutered cat with a body condition score greater than 6/9. In these cases, the nutrient profile (fat and calorie content) is not appropriate for the patient. Be sure to help owners determine whether such products are inappropriate for their pets and help them select a more appropriate product to maintain a healthier weight and improve longevity.11

Question 3: Is this a food safety issue? 

Once the nutritional adequacy statement has been checked on a particular product, it is unlikely to change unless recalled for a formulation error or potential contaminate. If this occurs, it should appear on the FDA pet food recall list. Pet food product recalls are now required within 24 hours of a possible or known problem (Food Safety and Modernization Act, 2012) and listed on the recall list. 

Name dropping a familiar pet food or manufacturer does not preclude formulation errors. There were more than 30 recalls in 2013, and some of the products were from major pet food companies. Also beware of companies that claim to never have had a recall as they may not be testing their products. 

Conclusion

Nutritional counseling should be an important part of every wellness visit. The good news is that it doesn't have to be a long or difficult discussion, and veterinarians can be a reliable and trusted nutritional authority for clients. One easy action step is to train your technical staff to ask about diet when gathering a history and then use online product websites to determine the answers to these three questions for you even before you go in the room so you will be prepared to give your client the best recommendations. 

See the three simple questions outlined in this article in action by turning the page and working through two case examples. 

GETTY IMAGES

CASE EXAMPLE #1: Not much information in the product name 

Client: “I am interested in that new highly sustainable diet called the New Age Professional

Earthworm Formula. What do you think?” 

You: “Does the product claim to be nutritionally complete and balanced?” 

Client: “Yes, it claims to be complete and balanced according to AAFCO.” 

Excellent! Let's move to question 2.

Would this particular nutrient profile harm my patient? 

You: “What is the species and life stage in the AAFCO statement?” 

Client: “Well it mentions maintenance adult dogs.” 

The client has a 4-year-old neutered healthy dog with a body condition score of 5/9. All A-OK. Time for the final question.

Is this a food safety issue? 

You: “How is this product sold-kibble, canned, raw, freeze-dried, frozen or dehydrated?” 

Client: “It's a new canned food.” 

You pull up the FDA Pet Food Recall list from your browser's favorites, and seeing that it is not listed, you would have to conclude that the product is worthy of a food trial. You could suggest the dog try the diet for 30 days, making clear that with any changes in the dog's appetite, activity, attitude, gastrointestinal function or habits or weight, you would like her to contact you. 

CASE EXAMPLE #2: Lifestyle issues versus nutritional issues

Client: “I have been feeding a diet that uses all-natural organic ingredients with nothing from China and no GMO corn, wheat or gluten, but I forgot the name of it, so let me find it on my phone.” 

You: “Does the product claim to be nutritionally complete and balanced?” 

Client: “Yes, it says it's complete and balanced according to AAFCO.” 

Great! On to question 2.

Would this particular nutrient profile harm my patient? 

You: “What is the species and life stage in the AAFCO statement?” 

Client: “Well it says for all life stages of the cat.” 

You see the client has a 14-year-old neutered cat with a body condition score of 8/9 and a history of being at an International Renal Interest Society (IRIS) Stage 2 for chronic kidney disease. Warning flags of a mismatch are raised. The diet may not be a great choice for this pet. Let's check question 3.

Is this a food safety issue?

You: “How is this product sold-kibble, canned, raw, freeze-dried, frozen or dehydrated?” 

Client: “It's a dry food.” 

You have a technician check the FDA Pet Food Recall list and do not find it on the list, so question 2 remains to be discussed:

• The claims of natural organic ingredients and nothing from China and no GMO corn, wheat or gluten are lifestyle issues that do not affect the nutrient profile of the product.

• The mismatch here is feeding a cat food designed for growing kittens to an older overweight IRIS stage 2 adult cat: The protein and phosphorous concentrations for feline growth exceed those recommended for feline renal disease. In addition, the high fat and caloric density are not appropriate for a body condition score > 6/9. It's best to help the client select a different diet.

Rebecca Remillard, PhD, DVM, DACVN 

Veterinary Nutritional Consultations, Inc. 

Hollister, North Carolina

References

1. 2011-2012 APPA National Pet Owner Survey 2011-2012. Greenwich, Connecticut: American Pet Products Association, Inc., 2011;p84 (canine), p188 (feline).

2. Stockman J, Fascetti AJ, Kass PH, et al. Evaluation of recipes for home-prepared maintenance diets for dogs. J Am Vet Med Assoc 2013;242(11):1500-1505. 

3. Streiff EL, Zwischenberger B, Butterwick RF, et al. A comparison of the nutritional adequacy of home-prepared and commercial diets for dogs. J Nutr 2002;132(suppl):1698S-1700S. 

4. Roudebush P, Cowell CS. Results of a hypoallergenic diet survey of veterinarians in North America with a nutritional evaluation of homemade diet prescriptions. Vet Dermatol 1992;3(1):23-28. 

5. Niza, MMR, Vilela CL, Ferreria LMA. Feline pansteatitis revisited: hazards of unbalanced home-made diets. J Feline Med Surg 2003;5(5):271-277. 

6. Polizopoulou ZS, Kazakos G, Patsikas MN, et al. Hypervitamoinosis A in the cat: a case report and review of the literature. J Feline Med Surg 2005;7(6):363-368. 

7. de Fornel-Thibaud P, Blanchard G, Escoffier-Chateau L, et al. Unusual case of osteopenia associated with nutritional calcium and vitamin D deficiency in an adult dog. J Am Anim Hosp Assoc 2007;43(1):52-60. 

8. Remillard RL, Paragon, BM, Crane SW, et al. Making pet foods at home. In: Hand MS, Thatcher CD, Remillard RL, et al, eds. Small animal clinical nutrition. 4th ed. Topeka, Kansas: Mark Morris Institute, 2000;164-181.

9. de-Oliveira LD, Carciofi AC, Oliveira MC, et al. Effect of six carbohydrate sources on diet digestibility and postprandial glucose and insulin responses in cats. J Anim Sci 2008;86(9):2237-2246.

10. Carciofi AC, Takakura FS, de-Oliveira LD, et al. Effects of six carbohydrate sources on dog diet digestibility and post-prandial glucose and insulin response. J Anim Physiol Anim Nutr (Berl) 2008;92(3):326-336.

11. Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc 2002;220(9):1315-1320. 

12. Freeman LM, Chandler ML, Hamper BA, et al. Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats. J Am Vet Med Assoc 2013;243(11):1549-1558.