Ackerman N Critical care nutrition and supportive feeding methods. The Veterinary Nurse. 2019; 10:(2)84-89

Barr J, Hecht M, Flavin KE, Khorana A, Gould MK Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest. 2004; 125:(4)1446-1457

Braun V, Clarke V Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3:(2)77-101

Chan DL, Freeman LM Nutrition in critical illness. Vet Clin North Am Small Anim Pract. 2006; 36:(6)1225-vi

Chan DLUK: John Wiley & Sons; 2015

Chan DL Nutritional support of the critically ill small animal patient. Vet Clin North Am Small Anim Pract. 2020; 50:(6)1411-1422

Chandler ML, Gunn-Moore DA Nutritional status of canine and feline patients admitted to a referral veterinary internal medicine service. J Nutr. 2004; 134:(8)

Cline MG, Burns KM, Coe JB 2021 AAHA nutrition and weight management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2021; 57:(4)153-178

Corbee RJ, Kerkhoven WJSV Nutritional Support of Dogs and Cats after Surgery or Illness. Open J Vet Med. 2014; 04:(04)44-57

Delaney SJ Management of anorexia in dogs and cats. Vet Clin North Am Small Anim Pract. 2006; 36:(6)1243-vi

Doria-Rose VP, Scarlett JM Mortality rates and causes of death among emaciated cats. J Am Vet Med Assoc. 2000; 216:(3)347-351

Edgley K Early enteral nutrition: indications, benefits and complications. The Veterinary Nurse. 2019; 10:(7)346-351

Eirmann L Nutritional assessment. Vet Clin North Am Small Anim Pract. 2016; 46:(5)855-867

Fabretti A, Fonseca I, Coelho A, Silva C, Pereira P Evaluation of clinical, laboratory, and electrophoretic profiles for diagnosis of malnutrition in hospitalized dogs. Semina: Ciências Agrárias. 2015; 36:(1)217-230

Fabretti AK, Gomes LA, Pereira PM Clinical determination of the nutritional status of companion animals. Semina: Ciências Agrárias. 2020; 41:(5)1813-1830

Fascetti AJ, Delaney SJChichester, West Sussex: John Wiley & Sons; 2012

Freeman LM Cachexia and sarcopenia: emerging syndromes of importance in dogs and cats. J Vet Intern Med. 2012; 26:(1)3-17

Freeman L, Becvarova I, taskforce WSAVA WSAVA Nutritional Assessment Guidelines. J Small Anim Pract. 2011; 52:(7)385-396

Gray K Management of tubes, lines and drains. The Veterinary Nurse. 2018; 9:(10)525-531

Harpe SE How to analyze Likert and other rating scale data. Currents in Pharmacy Teaching and Learning. 2015; 7:(6)836-850

Holt SL, Farrell M, Corrigan RH Developing the SVN CLEI: A novel psychometric instrument for evaluating the clinical learning environment of student veterinary nurses in the UK. J Vet Med Educ. 2023; 50:(1)94-103

Kerl ME, Johnson PA Nutritional plan: matching diet to disease. Clin Tech Small Anim Pract. 2004; 19:(1)9-21

Laflamme DP Development and validation of a body condition score system for dogs. Canine Practice. 1997a; 22:(4)10-15

Laflamme DP Development and of a body condition score system for cats: a clinical tool. Feline Practice. 1997b; 25:(5)13-18

Latimer-Jones K The role of nutrition in critical care. The Veterinary Nurse. 2020; 11:(4)166-171

Leung YB, Cave N, Wester TJ Loss of body weight and lean mass in longstay, hospitalized canine patients. J Anim Physiol Anim Nutr (Berl). 2023; 107:(6)1444-1455

Li P, Wu G Amino acid nutrition and metabolism in domestic cats and dogs. J Anim Sci Biotechnol. 2023; 14:(1)

Liu DT, Brown DC, Silverstein DC Early nutritional support is associated with decreased length of hospitalization in dogs with septic peritonitis: A retrospective study of 45 cases (2000-2009). J Vet Emerg Crit Care (San Antonio). 2012; 22:(4)453-459

Lumbis RH, de Scally M Knowledge, attitudes and application of nutrition assessments by the veterinary health care team in small animal practice. J Small Anim Pract. 2020; 61:(8)494-503

Lumbis RH, Rinkinen M Veterinary nutritional assessment: the importance of an interprofessional approach. The Veterinary Nurse. 2022; 13:(5)214-219

Michel KE, Sorenmo K, Shofer FS Evaluation of body condition and weight loss in dogs presented to a veterinary oncology service. J Vet Intern Med. 2004; 18:(5)692-695<692eobcaw>;2

Molina J, Hervera M, Manzanilla EG, Torrente C, Villaverde C Evaluation of the prevalence and risk factors for undernutrition in hospitalized dogs. Front Vet Sci. 2018; 5

Nakajima M, Ohno K, Goto-Koshino Y, Fujino Y, Tsujimoto H Plasma transferrin concentration as a nutritional marker in malnourished dogs with nutritional treatment. J Vet Med Sci. 2014; 76:(4)539-543

Perea SC Parenteral nutrition.UK: Wiley-Blackwell; 2012

Remillard RL, Darden DE, Michel KE, Marks SL, Buffington CA, Bunnell PR An investigation of the relationship between caloric intake and outcome in hospitalized dogs. Vet Ther. 2001; 2:(4)301-310

Rogers QR, Morris JG, Freedland RA Lack of hepatic enzymatic adaptation to low and high levels of dietary protein in the adult cat. Enzyme. 1977; 22:(5)348-356

Schoonenboom J, Johnson RB How to construct a mixed methods research design. Kolner Z Soz Sozpsychol. 2017; 69:(Suppl 2)107-131

Shoveller AK, DiGennaro J, Lanman C, Spangler D Trained vs untrained evaluator assessment of body condition score as a predictor of percent body fat in adult cats. J Feline Med Surg. 2014; 16:(12)957-965

Stella J, Croney C, Buffington T Effects of stressors on the behavior and physiology of domestic cats. Appl Anim Behav Sci. 2013; 143:(2-4)157-163

Taherdoost H Determining sample size; how to calculate survey sample size. International Journal of Economics and Management Systems. 2017; 2:237-239

Taylor S, Chan DL, Villaverde C 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat. J Feline Med Surg. 2022; 24:(7)614-640

Tonozzi C Nutritional status.Ames, Iowa: Wiley Blackwell; 2016

Vandendriessche VL, Picavet P, Hesta M First detailed nutritional survey in a referral companion animal population. J Anim Physiol Anim Nutr (Berl). 2017; 101:(Suppl 1)4-14

Wang X, Cheng Z Cross-sectional studies: strengths, weaknesses, and recommendations. Chest. 2020; 158:(1S)S65-S71

Zoran DL, Buffington CA Effects of nutrition choices and lifestyle changes on the well-being of cats, a carnivore that has moved indoors. J Am Vet Med Assoc. 2011; 239:(5)596-606

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

02 April 2024
18 mins read
Volume 15 · Issue 3



There is minimal research surrounding malnutrition in hospitalised cats and dogs. This study investigated current attitudes, knowledge, practices and barriers for veterinary nurses when managing patients at risk of malnutrition.


A 28-question online survey was distributed to UK veterinary nurses. The quantitative data underwent both descriptive and inferential analysis, while the qualitative data was analysed using latent thematic analysis. The sample totaled 56 registered veterinary nurses and 23 student veterinary nurses.


Respondents were less confident identifying cats at risk of malnutrition (median 7.0/10.0) compared to dogs (median 8.0/10.0). Respondents were less satisfied that malnutrition is addressed effectively in cats (median 6.0/10.0) compared to dogs (median 7.0/10.0). Satisfaction that malnutrition is addressed in a timely manner was 6.0/10.0 (median), mostly due to delayed feeding tube placement (n=23, 29%). Few respondents use a muscle condition score (n=18, 23%) and even fewer (2.5%, n=2) listed muscle loss as a risk factor. Barriers included a lack of protocols (n=53, 67%).


Malnutrition is addressed less effectively, and assessed less confidently, in cats. Moreover, malnutrition is not addressed in a timely manner due to slow and inconsistent interventions. Therefore, education, increased awareness and protocols may aid in addressing malnutrition.

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).

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