Awareness, perceptions and practices of UK veterinary nurses on managing the risk of malnutrition in hospitalised cats and dogs

Nutrition is important for animals recovering from illness (Corbee and Kerkhoven, 2014). According to the International Society of Feline Medicine (ISFM) consensus guidelines, inappetence is the third most common reason a cat is presented in practice (Taylor et al, 2022). Similarly, one study found 84% of hospitalised dogs consumed less than 25% of their resting energy requirement (RER) (Molina et al, 2018).

Malnutrition is defined as poor nutritional status due to insufficient, unbalanced or excess nutrients and can increase morbidity and mortality in critically ill patients (Chan, 2015). One study found vomiting, older age and longer hospitalisation are risk factors for malnutrition with a link between insufficient calorific intake and death (Molina et al, 2018). A patient is at a low risk of malnutrition when calorific intake is less than 80% RER for 3 days. Moderate risk factors include: a calorific intake of less than 80% RER for 3–5 days, weight loss, illness of 2–3 days, hypoalbuminaemia and mild muscle loss. High risk factors include: a calorific intake of less than 80% RER for more than 5 days, severe vomiting or diarrhoea, a body condition score (BCS) of less than four out of nine, moderate or severe muscle loss, and illness exceeding a duration of 3 days (Perea, 2012; Taylor et al, 2022). Significant weight loss is defined as a loss of 5% within 5 days or 10% gradual loss, without fluid deficits (Fabretti et al, 2020). Other risk factors include anorexia of more than 5 days, sepsis, and wounds and burns which cause protein loss (Chan and Freeman, 2006). A stable patient with two or more high-risk factors should receive prompt nutritional intervention (Perea, 2012; Taylor et al, 2022). Moreover, during illness, stress starvation may occur, which is the catabolism of lean body mass as a result of an inadequate calorific intake. This negatively influences immune function, wound healing and muscle strength (Chan, 2020). Overall, the effects of malnutrition during hospitalisation include longer hospitalisation and elevated risk of sepsis (Chan, 2015).