AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You The AAHA Nutritional Assessment Guidelines – What They Mean to You September 9 & 17, 2010 By C. A. Tony Buffington, DVM, PhD, DACVN Professor of Veterinary Clinical Sciences The Ohio State University Veterinary Medical Center The AAHA Nutritional Assessment Guidelines for Dogs and Cats were sponsored by a generous educational grant from Hill’s Pet Nutrition. Educational events are presented in collaboration with Hill’s Pet Nutrition. Learning Objectives After participating in this web conference, you will be able to: 1. Explain the use of the Circle of Nutrition for patient assessment 2. Perform BCS and MCS scoring 3. Conduct a basic assessment and extended evaluation 4. Determine a nutrition action and monitoring plan for each patient 1
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Introduction The committee: • Kimberly Baldwin, CVT, VTS, ECC • Joe Bartges, D.V.M., Ph.D., DACVIM, DACVN • Tony Buffington, D.V.M., Ph.D., DACVN, Chair • Lisa M. Freeman, D.V.M., Ph.D., DACVN • Mary Grabow, D.V.M. • Julie Legred, CVT • Donald Ostwald, Jr., D.V.M., DABVP (Canine & Feline) Introduction The charge - produce a document to: • Increase awareness of the importance of nutritional assessment in dogs and cats. • Provide guidelines for nutritional evaluation of animals to promote optimal health and response to disease. • Present available evidence and tools to support recommendations. 2
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Introduction The process: One (weekend) meeting in CO in 11/09, followed by circulation and comment on nine (!) iterations of the initial draft, all coordinated by an unbiased facilitator. Definitions & Acronyms 3
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You The ACVN Circle of Nutrition Reminds us to consider • Animal factors • Diet factors • Feeding factors • Environmental factors • Interactions ™ Used with permission of the American College of Veterinary Nutrition, www.acvn.org Animal Factors – Species – Breed – Lifestage (age) – Neuter status – Physical evaluation 4
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Effect of Lifestage on Energy Needs 3 2.5 Kcal/day (X M) 2 1.5 Neutering 1 0.5 0 0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180 Time - Months Body Condition Score 5
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Muscle Condition Score Diet Factors 1. What is fed (exactly) 2. How much (cups, cans) 3. How often 6
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Feeding Factors 1. What is fed (exactly) 2. How much 3. How often 4. When 5. Where 6. How Environmental Factors What’s going on here? 7
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Where Are We? Good Health Environment Barren Chaotic Poor 15 The ACVN Circle of Nutrition Reminds us to consider • Animal factors • Diet factors • Feeding factors • Environmental factors • Interactions ™ Used with permission of the American College of Veterinary Nutrition, www.acvn.org 8
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Basic Assessment Check ( ) Nutritional Screening Risk Factor if present History Altered gastrointestinal function (e.g., vomiting, diarrhea, nausea, flatulence, constipation) Previous or ongoing medical conditions / disease Currently receiving medications and/or dietary supplements Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar) Snacks, treats, table food > 10% of total calories Inadequate information about or inappropriate feeding management Inadequate or inappropriate housing Physical Examination Body condition score 5-pt scale: any score other than a 3 9-pt scale: any score less than 4 or greater than 5 Muscle condition score: Mild, moderate, or marked muscle wasting Unintended weight loss of > 10% Dental abnormalities or disease Poor skin or hair coat New medical conditions / disease Basic Assessment Nutritional Screening Risk Factor Check ( ) History if present Altered gastrointestinal function (e.g., vomiting, diarrhea, nausea, flatulence, constipation) Previous or ongoing medical conditions / disease Currently receiving medications and/or dietary supplements Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar) Snacks, treats, table food > 10% of total calories Inadequate information about or inappropriate feeding management Inadequate or inappropriate housing Physical Examination Body condition score 5-pt scale: any score other than a 3 9-pt scale: any score less than 4 or greater than 5 Muscle condition score: Mild, moderate, or marked muscle wasting Unintended weight loss of > 10% Dental abnormalities or disease Poor skin or hair coat New medical conditions / disease 9
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Index of Suspicion Low Signalment Adult History Environment Enriched Diet Satisfactory commercial Food Intake Appropriate to conditions Owner Commitment Physical Weight Appropriate BCS Moderate (3/5) MCS Normal Coat Quality Good Lab Evaluation Normal Index of Suspicion Moderate Signalment Gest, lact, growth, athlete, old History Environment ? Diet Commercial, good home-made Food Intake Unknown Owner → Commitment Physical Weight 20% < or > Normal BCS 2/5, 4/5 MCS Mild wasting Coat Quality Poor Lab Evaluation Few abnormalities 10
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Index of Suspicion High Signalment Orphan, hospitalized History Environment Unknown Diet Unknown Food Intake Unknown Owner Commitment Physical Weight 40% < or > Normal BCS 1/5, 5/5 MCS More than mild wasting Coat Quality Very poor Lab Evaluation Many abnormalities Index of Suspicion Low Moderate High Signalment Adult Gest, lact, growth, Orphan, athlete, old Hospitalized History Environment Enriched ? ? Diet Satisfactory ? Commercial ? good home-made Food Intake Appropriate Unknown ? Owner Committed OK ? Physical Weight Appropriate 20% < or > N 40% < or > N BCS 3/5 2/5, 4/5 1/5, 5/5 MCS N ↓ ↓↓ or overcoat Good Poor Very poor Coat Quality Lab Evaluation No AN Few AN Many AN 11
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Extended Evaluation The Circle of Nutrition • Animal factors • Diet factors • Feeding factors • Environmental factors • Interactions ™ Used with permission of the American College of Veterinary Nutrition, www.acvn.org Extended Evaluation Screening Animal Diet Feeding Environment History Food intolerance Barren or chaotic Altered GI Function Overeating, gorging Spoiled food environment medical Correct diet for Effect on access or Effect on FI? Effect on FI? conditions/disease disease? compet. for food? Affecting diet Effect on FI? Total Who is doing this? Are Meds ± diet suppl. adequacy? calorie intake? others affected? Other Is the diet Unconventional diet “unconventional”? satisfactory? features How is the pet Snacks, treats, table Other features Effect on FI? affected? food > 10% affected? Effect on diet adequacy? Inadequate or Barren or chaotic; inappropriate housing competition Physical Examination BCS Effect on access or MCS Many diseases compet. for food? BW > 10% Quality, suitability for dental dz or disorder the situation Amount, frequency Effect on appetite or identified Others with similar Poor skin or hair coat problems? food intake? New disease 12
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Interpretation, Analysis & Action Another iteration • Animal factors • Diet factors • Feeding factors • Environmental factors ™ Used with permission of the American College of Veterinary Nutrition, www.acvn.org Monitoring • Healthy – Food intake & appetite – BCS, MCS, BW – GIT, CQ – Overall wellness • Hospitalized – Weight ™ – Food intake & appetite Used with permission of the American College of Veterinary Nutrition, www.acvn.org – Clinical progress 13
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Client Education Importance & Effects of the Guidelines for Practice • Evidence-based • Practical (we hope) • Actionable • Updatable 14
AAHA National Staff Meeting Web September 2010 Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You Summary and Perspective QUESTIONS? 15
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