NUTRITIONAL ASSESSMENT GUIDELINES

The WSAVA has developed a global initiative to standardize five vital signs as part of the standard physical examination for all small animals. These are:

1. Temperature
2. Pulse
3. Respiration
4. Pain Assessment
5. NUTRITIONAL ASSESSMENT.

The specific goals of this document are to provide:

• Awareness of the importance of nutritional assessment in dogs and cats
• Guidelines for nutritional evaluation of dogs and cats
• Evidence and tools to support recommendations.

Appropriate feeding is fundamental throughout all stages, can help prevent diet-associated diseases as well as to assist in the management of other diseases. Incorporating Nutritional Assessment during examination requires little to no additional time or cost.

The factor to be evaluated are:

• Animal-specific factors (age, physiological status, activity)
• Diet-specific factors (safety and appropriateness of the diet fed to that animal)
• Feeding management and environmental factors (frequency, timing, location and method of feeding).

The nutritional assessment is a two-part process: Screening Evaluation and Extended Evaluation.
Nutritional screening is performed on every animal. During physical examination all information collected should include assessment of factors specific to the animal, the diet and feending management/ environment. Use a consistent method and scale to measure body weight (BW), Body Condition Score (BCS) and Muscle Condition Score (MCS).
If no concerns are raised by the screening evaluation the nutritional assessment is complete.
If risk factors are raised and influence nutritional status like altered gastrointestinal function, previous or ongoing medical conditions/disease, currently receiving medication/dietary supplements, unconventional diet, inappropriate housing, BCS score less than 4 or greater than 5, muscle wasting, unexplained weight change, dental abnormalities or disease, poor condition of the integument or new medical conditions/ disease, extended evaluation is performed. Extended nutritional evaluation is important when one or more risk factors are found. During extended evaluation first review and summarize the history, medical record and information obtained during the screening evaluation. Second obtain additional data, evaluating:

Animal factors

• Changes in food intake or behavior
• Condition of the integument
• Diagnostic workup (laboratory testing, specific testing)
• Current medical conditions and medications

Diet factors

• Check the caloric density of food
• Evaluate other sources of nutrients (snack or table food)
• Submit testing if disease conditions are a result of tainted food

1. 1. Evaluate commercial foods: requirements for label information vary by country. In many countries the AAFCO adequacy statement provides several important facts:
      Complete and balanced diet or intermittent or supplement use only
   2. Adequacy statement for chemical analysis of food or feeding trial analysis of food

• Evaluate homemade foods
• Evaluate any unconventional imbalances

Feeding and environment factors

• Primary feeder of pets
• Feeding management
• Issues with multiple pets
• Other food sources
• Activity of peta t home
• Environment stressors
• Surrounding environment

Following the nutritional assessment, interpret and analyze the information that has been gathered in order to devise an action plan.
So evaluate the animal’s condition with respect to the current food intake and estimate its current energy needs. Create a monitoring plan teaching the client to monitor BW, BCS and MCS as appropriate. Sometimes a diet change is necessary recommending methods based on their individual assessment of patient.
Determine if current ammount and type of food is appropriate, based on lifestage, lifestyle, activity, disease, body conditions and concurrent medications and for medical procedures.
If diet factors are determined to be inadequate, prepare a plane for food that provides appropriate calories and nutrient content for the patient, that can include commercial pet food as treats, table food. If necessary determine environment and feeding management changes. For hospitalized animals create a feedng plan and if possible a monitoring plan offering usual and “comfort” foods. The achievement towards nutrient requirements should be reassessed daily and may include voluntary oral feeding, coax feeding, syringe feeding or parenteral nutrition. Closely evaluate and watch for compilcations associated with route of nutrition used, particulary with recumbent or neurologically impaired patients. If the animal presents obesity provide a comprehensive plan and alsommodify the surrounding environment and lifestyle habits.

MONITORING

Adults in good body conditions should be reassessed regularly.
Decisions regarding specific frequency of visits are made on an individual basis, based on the age, species, breed, health and environment of the pet. Healthy pregnant, lactating, growing animals or senior require more frequent monitoring. Pet owners should monitor food intake and appetite, BCS, BW, gastrointestinal signs and activity.
Animals with disease conditions or have been recommended a extended nutritional evaluation may require more frequent monitoring. Monitoring of BCS and MCS is important as many diseases are associated with suboptimal scores. Moreover animals with current medical conditions are more likely to receive dietary supplements and to have medications administered with food, so nutritional evaluation is important at each visit, if necessary to update and optimize the dietary plan.
Monitoring in hospitalized patients must be daily evaluate risk factors, fluid balance, clinical signs, diagnostic tests, addressing optimal route of intake, quantifying nutrient intake.
Many hospitalized patients are dischareed prior to complete resolution, so communicate the feeding method to the client and discuss any issues that may limit adherence to dietary recommendations.
Engage the client in decision making and nutritional recommendations may be modified by the clients time. Lifestyle and financial limitations in order to have a relationship of trust with them and so achieving desidered outcomes.