4 Dec 2015
Figure 1. The selection of pet food is extensive and can be confusing.
Have you ever struggled with deciding on the best diet for a difficult case? Perhaps you are treating a dog that has both pancreatitis and kidney disease, a cat with adverse reaction to food that will not eat any commercial diets or an obese pet that just won’t lose weight.
Do your clients ask difficult questions about the “best diet” or feeding raw diets? A veterinary nutritionist can help.
The importance of nutrition to health has been recognised for more than 2,000 years, since the time of Hippocrates. Nutrition is critically important to maintain optimal growth and health, ensure good performance and manage the signs and progression of many disorders.
Knowledge of nutrition is therefore vital for veterinary surgeons so they are able to inform owners about care of healthy animals, as well as prevent and treat diseases.
A survey of pet owners showed 90% wished to obtain a dietary recommendation from the veterinary health care team, but only 15% perceived they had received one1. A majority of pet owners visiting 18 veterinary clinics in Germany perceived a nutritional recommendation to be important, but 77% did not feel they had received one2.
Studies have shown veterinary surgeons do not feel they receive adequate training in small animal nutrition during veterinary school. In a 1996 survey among veterinarians in the United States, 70% said their nutrition education was inadequate3. In a 2013 survey in the UK, 50% of 134 veterinarians felt their nutrition education in veterinary school was insufficient and a further 34% said it was adequate, but they would have liked more. Only 16% said they received enough training in nutrition4.
In a survey of European veterinary schools, nutrition was considered important by the school management; however, performance of the graduates and resources for teaching in nutrition were often deemed inadequate5.
A key resource for veterinary practitioners for advice about nutrition is board-certified veterinary nutritionists. Many small animal general practitioners may not be familiar with working with a clinical nutritionist as they may have had no exposure to one, either in veterinary school or in practice. This can also be complicated because the term “nutritionist” is not a protected term. Many individuals call themselves a “nutritionist”, but have little, if any, training in nutrition and advertise themselves on websites and other media as experts. Many are not veterinary surgeons.
The American College of Veterinary Nutrition (ACVN) was founded in 1988 by members of the American Academy of Veterinary Nutrition (AAVN)6,7. The AAVN is open to any veterinary surgeon with an interest in nutrition, and to nutrition scientists. Many members are from the UK.
The mission statement of the ACVN states its primary objectives are to advance the speciality of veterinary nutrition and increase the competence of those who practise in this field by establishing requirements for certification in veterinary nutrition, encouraging continuing professional education, promoting research and enhancing the dissemination of new knowledge of veterinary nutrition through didactic teaching and postgraduate programmes.
In 1998, a similar college, the European College of Veterinary and Comparative Nutrition (ECVCN), was founded by members of the European Society of Veterinary and Comparative Nutrition.
The ACVN and ECVCN are comprised of board-certified veterinary nutritionists – that is, veterinary surgeons who are diplomates of the ACVN and/or ECVCN. Training involves intensive clinical, teaching and research activities spanning at least two, and sometimes three or more years. Trainees are required to publish, present detailed case reports and pass a rigorous written (and oral for ECVCN) examination to obtain board certification.
Veterinary nutritionists are uniquely trained in the nutritional management of both healthy animals and those with one or more diseases. They are qualified to recommend commercial foods and supplements, formulate home-prepared diets, manage the complex medical and nutritional needs of individual animals and understand the underlying causes and implications of specific nutritional strategies that are used to prevent and treat diseases.
Veterinary nutritionists may be involved in a variety of activities, including conducting research, taking care of patients, consulting with veterinarians and owners, working in industry and teaching. They work in different environments, including veterinary schools, pet food or drug companies, government agencies or private veterinary hospitals and some run their own businesses7.
One of the most common ways for nutritionists to provide help to practitioners is to provide advice on difficult cases. Often, this can be done over the telephone or by email. In some cases, it may be possible for the client to be referred for a face-to-face consultation with the veterinary nutritionist. Telephone consultations directly with clients are not normally possible because the nutritionist does not have a direct relationship with the owner and pet, unless a face-to-face consultation has taken place8.
Clients often wish to have information about what is the optimal diet to feed their pets. The choice of pet food is huge and this decision can be difficult for owners (Figure 1). A nutritionist may be able to help the client choose a diet and feeding plan that more closely fits the needs of the pet and the client. For example, some dogs with high energy needs may need a change in the type of diet or in their feeding management.
Some owners may also wish to feed supplements that may not be appropriate and a nutritionist can help with the evaluation of these. For example, a client may give an inappropriate supplement high in vitamin D to a hypercalcaemic cancer patient. A myriad of treats and snacks exist – some of which may be inappropriate for some pets (Figure 2).
Veterinary surgeons, as well as clients, may have questions about the optimal therapeutic diet to feed a pet – for example, with kidney, gastrointestinal or liver disease. An extremely large number of disorders have a nutritional component to their therapy. A nutritionist can provide specific, unbiased recommendations on the types and amount of food to be fed, address questions about appropriate treats, aid in the transition to the new diet and provide tips for dealing with multi-pet households.
Pets with complicated disease, more than one disease process or very high or very low energy requirements can be particularly challenging in the selection of an appropriate diet. A nutritionist is able to evaluate the nutrient content of the available commercial diets to help select the optimal one.
Practitioners often contact a veterinary nutritionist for assistance with a client who desires to feed a home-made diet or when none of the commercial diets are acceptable, either due to complicated disorders or the pet not being willing to eat an appropriate diet. Some owners wish to feed home-made diets with pets with a medical disorder rather than feed a commercial therapeutic diet.
It is often possible for the nutritionist to formulate a diet appropriate for the pet, working through the practitioner and the clinic by email. The owner will usually be asked to fill out a dietary history form, which provides information about the pet, any disorders and its dietary likes and requirements. Formulation of a diet may take several hours and the cost will reflect the time involved.
Obesity is the number one nutritional disorder of pets in the UK and it can be a very challenging problem to manage. A nutritionist can help design a weight loss programme and encourage the owner’s compliance with it.
For refractory obese patients, a consultation with the veterinary nutritionist can be very helpful as part of the referral service (Figure 3). The nutritionist can create a specific, detailed plan with exact recommendations for food and treat types and amounts, and outline the goals of the weight loss programme.
Critical care patients often require supplemental feeding using enteral tubes or parenteral nutrition. A nutritionist can provide advice about the placement of tube feeding, including protocols for feeding. Advice on the types of venous access and formulas used for parenteral nutrition can make it more feasible and practical for use in general practice.
Most of the top pet food companies in Europe employ ACVN and/or ECVCN diplomates to help formulate and test their diets.
Diplomates may also be engaged in providing nutritional information to industry representatives, vets, vet nurses, students and pet owners. Before recommending a food, it is worth finding out if the company employs a nutrition diplomate or a qualified nutrition scientist to formulate its food11.
Nutritionists are invariably enthusiastic about nutrition and keen to educate vets, nurses, students and owners. Independent nutritionists can provide unbiased information about all the aspects of nutritional information.
ACVN and ECVCN diplomates are highly trained specialists who have undergone a programme in nutrition similar to those of boarded internal medicine specialists and surgeons. Diplomates can provide many nutrition-related services for clients and can help extend and enhance the services provided by veterinary practices. Go online for lists of ACVN and ECVN nutrition diplomates.
