Dietary Management of Gastrointestinal Disease. Animal Diet Feeding Method Clinical Nutrition...
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Dietary Management of Gastrointestinal Disease
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Animal
Diet Feeding
Method
Clinical Nutrition Assessment
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Dietary Management - GI Disease
GI Functions Diet types Acute GI disease Chronic GI disease
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Dietary Management - GI Disease
Digestion and absorption
Water regulation Immune monitoring Hormone production Enteric nervous
system Waste elimination
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Diet Types
Highly digestible Fiber enhanced Hypoallergenic Fat restricted Gluten-free Lactose-free
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Highly Digestible
Diet digestibility is a function of:– Ingredients– Processing– Meal size– Animal’s GI
function
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Highly Digestible
Starch Digestibility in Dogs
Corn Rice Barley Oats
Walker, et.al., 1993. J. Animal Sci.
100
75
50
0
25
99.4 99.5 98.8 98.5
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Nutrient profile (dog)– Increased digestibility >
90%– Moderate protein < 30%– Moderate fat < 15%– Low fiber < 1%
Highly Digestible
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Nutrient profile (cat)– Increased digestibility >
90%– Moderate protein < 35%– Moderate fat < 25%– Low fiber < 1%
Highly Digestible
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Diet Types
Highly digestible Fiber enhanced
- High → Low
- Soluble vs insoluble
- Fermentable vs poorly fermentable
Hypoallergenic Fat restricted Gluten-free Lactose-free
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Fiber-enhanced
Fiber– Complex carbohydrate– Resistant to
mammalian digestive enzymes
– Found in plants
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Fiber-enhanced
Carbohydrates
Simple sugars(Monosaccharides,dissacharides)
Starch( bonds)
Fiber( bonds)
Complex carbohydrates(Polysaccharides,oligosaccharides)
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Fiber Enhanced
Fiber Levels in Pet Foods
% Fiber(DM)
Typicalfoods. 1%
15%
27%
HighFiber
ModerateFiber
LowFiber
4%
1%
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Fiber-enhanced
Soluble vs. insoluble– Refers to the ability of a
fiber to disperse in water– Most rapidly fermentable
fibers are soluble (e.g., gums, pectins)
– Most slowly fermentable fibers are insoluble (e.g., cellulose, soy mill run)
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Fiber-enhanced
Fermentable vs. poorly fermentable– Digestion of fiber by
intestinal microbes
– Produces SCFA (VFA) and gases
– SCFA provide nutrition for enterocytes and may modulate GI motility and fecal water content
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Fiber Fermentability in the Colon
cellulose
beet pulp
pectin
peanut hulls
soybean hulls
bran
soy fiber
guar gum
slowly fermentable rapidly fermentable
Fiber-enhanced
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cellulose
beet pulp
pectin
peanut hulls
soybean hulls
bran
soy fiber
guar gumRapidly
Fermentable
Slowly Fermentable
Moderately Fermentable
Fiber-enhancedFiber-enhanced
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Fiber-enhanced
Prebiotic fibers– FOS– MOS– GOS– Lactosucrose– Lactulose– Inulin
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Fiber– VFA → nutritive to
mucosa– Normalizes motility
(insoluble)– Acidifies contents →
change flora
Fiber Enhanced
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Diet Types
Highly digestible Fiber enhanced “Hypoallergenic”
Novel protein/limited antigen Hydrolyzed protein
Fat restricted Gluten-free Lactose-free
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Nutrient profile – limited or controlled antigen diet– Avoid protein excess– Limited number, novel
proteins– Highly digestible protein– Additive free– Free of vasoactive
amines
Novel protein
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Hydrolyzed protein (protein hydrolysates)
Native protein Denatured protein
Protein hydrolysate
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Mast cell/Basophil
Hydrolyzed protein (protein hydrolysates)
Inhalation Transdermal Ingestion Injection
Allergen
Chymase
Tryptase
Leukotriene
Histamine
Cytokines
TNF-α
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Hydrolyzed protein (protein hydrolysates)
No cross linkageNo cross linkageNo degranulationNo degranulation
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Protein Hydrolysates
Advantages– Truly “hypoallergenic”– Will not elicit IgE-mediated response– Protein source is less important
Disadvantages– Expensive– Difficult to
manufacture– Bitter taste
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Diet Types
Highly digestible Fiber enhanced Hypoallergenic Fat restricted
- Amount
- Fatty acid content (amount/ratio) Gluten-free Lactose-free
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Fat Restricted Diets
Fat Levels in Dog Foods%
Fat
(DM
)
Typical
SeverelyRestricted
ModeratelyRestricted
50
10
8
5
0
8-15
3-8
Growth
Adult
15-50
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Gluten– Cereal grain protein which
contains the antigen gliadin
– Present in wheat, barley, rye and oats
– Many dietsdon’t containgluten
Gluten-Free Diets
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Lactose-free diets– Brush-border lactases
often deficient in intestinal disease
– Lactose osmotic diarrhea
Lactose-Free Diets
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PancreaticAmylase
SalivaryAmylase
GastricHCI
EnterocyteLactaseSucraseMaltaseIsomaltase
G
G
CaG
F
M I+
Lactose-Free DietsLactose-Free Diets
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Nutrient content milk– Lactose mg/kcal ME
Bitch 28
Queen 71
Cow 77
Goat 62
Lactose-Free Diets
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Acute gastroenteritis Gastric dilatation-
volvulus
Acute GI Disease
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Most common GI disease Causes:
– Parasites– Diet
indiscretion– Infectious
diseases– Toxins
Acute Gastroenteritis
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Dietary management– Reduce stimulus for
vomiting
NPO 12-24 hrs– Reduce/resolve
diarrhea
no food 12-24 hrs
Acute Gastroenteritis
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Acute Gastroenteritis
Gastric Emptying
NeuralMyogenicAutonomic
Nutrients - Fats, Proteins
HormonalSecretinCCKGastrin
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Acute Gastroenteritis
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Dietary management– Small frequent meals
(3-6 x’s/day)– Gradually increase
amount(3 days)
– Highly digestible diet
Acute Gastroenteritis
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Appropriate emergency medical/surgical management
Dietary management = acute gastroenteritis
Acute Gastric Dilation-Volvulus
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Acute Gastric Dilation-Volvulus
Dietary risk factors?– Large meals– Temporal relationship:
exercise & eating– Rapid/competitive
eating– Diet
form/size/ingredients– Elevated food bowls
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Acute Gastric Dilation-Volvulus
Dietary management - prevention– Reduce aerophagia– Multiple daily
feedings– Highly
digestiblediets
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Maldigestion
– EPI– Bile acid
deficiency– Loss of
brushborder enzymes
Malassimilation
Malabsorption– Lymphangiectasi
a– Bacterial
overgrowth– Inflammatory
bowel disease– Gluten-sensitive
enteropathy
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Maldigestion
Exocrine Pancreatic Insufficiency (EPI)
100
50
0
DMDigestibility(%)
Normal EPI + Enzymes Normal EPI + Enzymes
Commercial diet Veterinary diet
Pidgeon, JAVMA 181 (1982)
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Dietary management of EPI– Small frequent meals– Highly digestible diet– Avoid high fiber diet
Maldigestion
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Parasites Inflammatory/
infiltrative Psychogenic
Colon Disorders
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Definitive diagnosis Appropriate
pharmacologic management
Dietary management
Colon Disorders
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Colon Disorders
Diet type Highly
digestible
“Hypoallergenic”
Fiber enhanced
EffectDecreased ingesta to colon
Decreased exposure to antigens
VFA normalizes motility change flora
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Constipation
Environmental Pain Colonic
obstruction Neuromuscular
disease
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Constipation
Appropriate pharmacologic and surgical management
Highly digestible diet High fiber diet
(multiple small meals)– Decreases stool density– Normalizes transit time
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Flatulence
Swallowed air Intestinal gases
99% no odor = H2, CH4, CO2
1% odor = NH3, H2S, VFA’s, indoles/skatoles
Maldigestion/malabsorption
Constipation
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Flatulence
Control aerophagia– Multiple small meals
Highly digestible diet
Avoid
High fiber diets
High protein diets
Vegetables
Vitamin supplements
Garbage
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Summary
Multiple diet types are suitable for dietary management of GI disease
Appropriate dietary management requires diagnosis
Acute GI disease = highly digestible diet