Feeds intended for special nutritional needs, also called veterinary diets, are often given to animals to prevent, reduce symptoms and/or cure disease. The recovery of a patient is partly dependent on whether the animal will eat or not, and also whether the animal is fed an optimal and balanced diet intended for the actual disease. Today, with increasing education and awareness of the importance of nutrition, veterinary nurses play an important role in the care of patients with specific nutritional needs.
In 1991, Donoghue commented on a university clinic in Pennsylvania (USA) that worked extensively with clinical nutrition; the clinic employed a specialist in nutrition, whose knowledge was available to other staff members and animal owners. In addition, the nutritional status of patients was assessed by a clinical examination, feeding history, and a body condition assessment (BCS). In 1994, Donogue emphasized that the primary goal of nutritional support of hospitalized dogs and cats is to minimize loss of tissue protein. Even simple surgical procedures or head injuries were shown to increase the energy needs of patients by 5–10% and 200%, respectively, compared with healthy animals.
Worldwide, there are few scientific studies reporting the use of veterinary diets in animal clinics. The purpose of the present study was to examine how many of the dogs and cats were given diets suitable for their medical conditions both when hospitalized and when leaving the veterinary hospital. Another goal was to see how the owners complied with possible dietary prescriptions, which may be of importance to improve the procedure of prescribing diets in the future.
Material and methods
The present study included a 5 day recording of dietary intake in hospitalized patients at the Small Animal Clinic at the Swedish University of Agricultural Sciences (SLU) in Sweden (May, 2005). This was followed up 6 months later by a combined mail and telephone questionnaire to the owners (November, 2005).
Hospitalized patients
At the time of hospitalization, the second author registered the dietary intake of the dogs and cats, and communicated her findings to the veterinary nurses. During the time the animal was hospitalized, the following were recorded: type of diet given (veterinary/ regular commercial diet or home-made); amount served/consumed; number of feedings per day; and appetite. The individuals included in the study were both from the surgery and medicine sections of the clinic. All individuals hospitalized in these sections during the 5 days of the study were included. The mean number of feedings per day was calculated by using the number of feedings (of any type of feed) divided by the number of days the individuals consumed something during the stay in the hospital.
Medical records
The medical records of all the animals incuded in the study were reviewed in order to obtain information about medical conditions, BCS, if the patient was prescribed veterinary diets or not, how the dietary intake worked at the clinic and at home, which feed the animal was prescribed, and if the animal had been back to the clinic again after going home. The medical records were continued until 6 months post hospitalization.
Combined mail and telephone questionnaire
Six months after being presented to the animal clinic, a previously validated combined mail and telephone questionnaire was mailed to the owners (Sallander et al, 2001). Within a week the second author interviewed the owners by telephone. In order to avoid interviewer bias, the interviewer had undergone training in interviewing techniques. The questionnaire included questions about: prescribed veterinary diet (type, product name, time consumed, and compliance); previous consumption of veterinary diets; normal feeding patterns; disease at the time of the interview; appetite; BCS; and if the owner had wanted more information about veterinary diets when they visited the clinic. Most questions were multiple choices or were formulated to record continuous data.
Data processing and statistics
Summary statistics for all variables were calculated. As the present study had few individuals, only numbers and proportions were calculated. The data were analyzed with Microsoft Excel (2003).
Results
Dogs and cats hospitalized at the veterinary university clinic
Data were collected from 38 individuals (25 dogs and 13 cats) hospitalized at the veterinary university clinic at the SLU. The mean bodyweight was 23.0 kg (range 6.0–86.0 kg) for dogs, and 4.4 kg for cats (range 0.8–8.0 kg). The most common type of disease seen for both hospitalized dogs and cats at the university clinic was gastrointestinal problems. Cats had more urology diseases, while dogs had more individuals that had been poisoned (Table 1).
| Types of diseases** | Dogs (n=25)*** | Cats (n=13)*** | ||||
|---|---|---|---|---|---|---|
| With disease(n) | Bodyweight | With disease(n) | Bodyweight | |||
| Mean | Range | Mean | Range | |||
| Gastroenterology | 11 | 20.9 | 6.0–86.0 | 6 | 4.2 | 0.8–8.0 |
| Urology | 0 | — | — | 4 | 5.4 | 4.8–6.0 |
| Oncology | 3 | 25.5 | 8.8–34.6 | 0 | — | — |
| Orthopaedics | 2 | 11.7 | 8.5–15.0 | 2 | 3.7 | 2.5–5.0 |
| Reproduction | 2 | 19.4 | 10.0–28.8 | 0 | — | — |
| Respiratory | 2 | 22.9 | 8.9–37.0 | 0 | — | — |
| Neurology | 1 | 55.5 | — | 1 | 2.0 | — |
| Dermatology | 1 | 33.0 | — | 0 | — | — |
| Autoimmunology | 0 | — | — | 0 | — | — |
| Cardiology | 0 | — | — | 0 | — | — |
| Ophthalmology | 0 | — | — | 0 | — | — |
| Odontology | 0 | — | — | 0 | — | — |
| Other | 3 | 20.5 | 9.9–34.0 | 0 | — | — |
The cats were of the breeds Birman Cat (n=1), Cornish Rex (n=1), European Shorthair (n=10), and Maine Coon (n=1).
Dietary intake during hospitalization
At the clinic, a total of 56% (14/25) of the dogs and 85% (11/13) of the cats were put on commercial veterinary diets. Among both cats and dogs, all individuals were given moist veterinary diets, and in dogs two individuals were also served dry veterinary feeds. Most dogs (91%) and cats (100%) with gastrointestinal diseases were prescribed a veterinary diet. Also, all cats (100%) with urological diseases were put on veterinary diets. For other diseases, few of the individuals were given veterinary diets (Table 2.).
| Types of diseases | Dogs (n=25) | Cats (n=13) | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| With disease(n) | Given commercial veterinary diets(n) | Given commercial regular diets (n) | Given table foods (n) | Partly or only starved (n) | With disease(n) | Given commercial veterinary diets(n) | Given commercial regular diets (n) | Given table foods (n) | Partly or only starved (n) | ||||||
| Dry | Wet | Dry | Wet | Dry | Wet | Dry | Wet | ||||||||
| Gastroenterology | 11 | 2 | 8 | — | — | 3* | 6 | 6 | 0 | 6 | 0 | 0 | 1** | 2 | |
| Urology | 0 | — | — | — | — | — | — | 4 | 0 | 4 | 0 | 0 | 0 | 1 | |
| Oncology | 3 | 0 | 2 | 3 | 0 | 0 | 1 | 0 | — | — | — | — | — | — | |
| Orthopaedics | 2 | 0 | 1 | 0 | 0 | 0 | 2 | 2 | 0 | 1 | 0 | 1 | 1** | 2 | |
| Reproduction | 2 | 0 | 1 | 0 | 0 | 0 | 2 | 0 | — | — | — | — | — | — | |
| Respiratory | 2 | 0 | 1 | 1 | 1 | 0 | 1 | 0 | — | — | — | — | — | — | |
| Neurology | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 0 | |
| Dermatology | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | — | — | — | — | — | — | |
| Other | 3 | 0 | 1 | 2 | 0 | 0 | 1 | 0 | — | — | — | — | — | — |
Commercial regular diets intended for adult healthy individuals were given to 28% (7/25) of the dogs and 15% (2/13) of the cats. Among dogs, all individuals were given dry regular feeds, and two of these individuals were also served wet regular diets. In cats, the individuals were only served moist regular diets (Table 2.).
Twelve percent (3/25) of the dogs were served broth at least once at the clinic, as one way to enhance the appetite and to help them start eating. Fifteen percent of the cats (2/13) were given cod and shrimps at least once at the clinic, also as a last attempt to make them eat after having tried to give them veterinary diets (Table 2.).
Approximately 56% (14/25) of the dogs and 38% (5/13) of the cats were starved 1 or more days during their stay at the veterinary clinic (Table 2.). The animals either chose to starve themselves, or were intentionally starved before surgery, if being hospitalized for only a few hours before going home, or if suffering from gastroenteritis.
During hospitalization, it was most common to be fed either once or twice a day (Figure 1.; Table 3.).
| Types of diseases | Dogs (n=25) | Cats (n=13) | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| With disease(n) | No feed (n)* | Once (n) | Twice (n) | Three times or more (n) | With disease(n) | No feed (n)* | Once (n) | Twice (n) | Three times or more (n) | |
| Gastroenterology | 11 | 1 | 5 | 4 | 1 | 6 | 0 | 1 | 3 | 2 |
| Urology | 0 | — | — | — | — | 4 | 0 | 3 | 1 | 0 |
| Oncology | 3 | 0 | 2 | 1 | 0 | 0 | — | — | — | — |
| Orthopaedics | 2 | 1 | 0 | 1 | 0 | 2 | 1 | 1 | 0 | 0 |
| Reproduction | 2 | 1 | 1 | 0 | 0 | 0 | — | — | — | — |
| Respiratory | 2 | 1 | 0 | 0 | 1 | 0 | — | — | — | — |
| Neurology | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 |
| Dermatology | 1 | 0 | 1 | 0 | 0 | 0 | — | — | — | — |
| Other | 3 | 0 | 0 | 3 | 0 | 0 | — | — | — | — |
Medical records
In 60% of the medical records, the veterinarian had mentioned ‘diet’, ‘feed’ or similar. For example, it could be written ‘the cat should have a kidney diet’. In 86% of these records, a specific brand and feed name was mentioned. With the prescribed diet, the veterinarian also suggested how many meals the individual should consume per day. However, the amount of feed that should be given per day to the individuals was never prescribed by any veterinarian; this was something the veterinary nurses had to estimate. Furthermore, none of the records had noted how much feed the owner needed or had bought at the time the animal went home. In the medical records, the veterinarian had commented on the body condition of the animals in 37% of the cases. The proportion of patients that visited the clinic within 6 months following hospitaliza-tion was 41 and 54% for dogs and cats, respectively.
Combined mail and telephone questionnaire
Most (92%, n=35) owners of the 38 patients answered a questionnaire 6 months after their pet had been hospitalized. Among the respondents, 22 were dog owners and 13 were cat owners. The dogs whose owners did not participate in the questionnaire had been hospitalized because of gastrointestinal (n=2) and orthopaedic diseases (n=1).
All owners participating in the questionnaire had a dog or a cat that was alive when leaving the animal clinic. Six months later when the questionnaire was performed, 13 dogs were regarded as healthy, three of the dogs were considered as having a disease (all individuals had other diseases than those that they had been hospitalized for), and six had been euthanized. All cat owners stated that their cat was healthy, and none of them had been euthanized since the hospitalization.
Veterinary diets prescribed after hospitalization
The total proportion of individuals prescribed a veterinary diet when going home was 43% (15/35), and among dogs and cats the proportion was 32% (7/22) and 62% (8/13), respectively. The feeds prescribed to be consumed at home were only in the categories gas-troenterology and urology. Most dogs (7/9) and cats (5/6) with gastrointestinal diseases and most cats (3/4) with urological disease were prescribed a veterinary diet when discharged from the clinic (Table 4.).
| Types of diseases | Dogs (n=22) | Cats (n=13) | ||||
|---|---|---|---|---|---|---|
| With disease (n) | Given commercial veterinary diets (n) | With disease (n) | Given commercial veterinary diets (n) | |||
| Dry | Wet | Dry | Wet | |||
| Gastroenterology | 9 | 0 | 7 | 6 | 0 | 5 |
| Urology | 0 | — | — | 4 | 0 | 3 |
| Oncology | 3 | 0 | 0 | 0 | — | — |
| Orthopaedics | 1 | 0 | 0 | 2 | 0 | 0 |
| Reproduction | 2 | 0 | 0 | 0 | — | — |
| Respiratory | 2 | 0 | 0 | 0 | — | — |
| Neurology | 1 | 0 | 0 | 1 | 0 | 0 |
| Dermatology | 1 | 0 | 0 | 0 | — | — |
| Other | 3 | 0 | 0 | 0 | — | — |
Among the dogs prescribed veterinary diets, the number of feedings varied from 2–4 times per day, while cats were served between 2–8 meals per day or had free access to feed. Often the individuals were prescribed to start the feeding with many small meals a day, and then the number of meals was successively reduced and at the same time the size of each meal increased to normal. Among dogs and cats prescribed veterinary diets, the time the diet should be consumed varied from 2 weeks to the rest of their life, depending on type of disease.
The majority (80%) of the dogs and cats consumed the veterinary diets with good or very good appetite (determined on a scale on one to four, very bad to very good appetite). Those who had bad or very bad appetite (20%) were individuals with anorexia, bloody diarrhoea and kidney disease. Although some individuals had bad or very bad appetite, all dogs and cats in the study finished the whole portions served.
Most owners (92%) stated that they believed the veterinary diet had positively influenced the health of the animal. The statements were based on the subjective experiences that the owners had that their pet became healthier when consuming the diets.
Three out of 15 (20%) dogs and cats stopped eating the diet earlier than prescribed. The reasons for this was, according to the owners, that the feed bag was empty and that it was too much work to get a new supply from the veterinary clinic, that the feed was not needed any more as the dog had stopped vomiting, and that the animal became too slim when consuming the veterinary diet.
Sixty percent of the owners stated that they knew what their dog or cat had consumed during the hos-pitalization. Eleven out of 35 (31%) owners stated that they would have liked to have more information about the feeding of the animals during the disease. Several (71%) of the owners said that they had not got any information about how much to feed per day or how many meals should be given per day. Some (14%) of them stated that they had become very insecure about the amount to feed, and that ‘feed the size of a meatball’ was something they regarded as difficult to estimate.
Regular dietary intake
Fourteen out of 35 (40%) owners stated that the veterinarian had asked them when their pet was hospitalized what their animal usually consumed at home. The proportion of veterinarians who asked for the normal diet of the dogs and cats was 69% for gastrointestinal diseases, 60% for urological diseases, 50% for orthopaedic diseases, and 25% for the group ‘other diseases’. For the diseases in reproduction, oncology, neurology and dermatology, none of the veterinarians asked for the normal diets of the dogs.
Most (95%, n=25) dogs normally consumed dry feeds, while fewer (77%, n=13) cats normally consumed dry feeds to some extent. Nine percent of the dogs and 54% of the cats normally consumed canned feeds to some extent. The dogs and cats were normally served canned feeds as a ‘topping’ on the dry feeds. Forty percent of the dogs and cats were sometimes served table foods, on average 15% of the total diet (volume basis), and 21% of the cats were served table foods to some extent.
The body condition
Over half (51%) of the owners considered that their animal had a normal body condition, 20% thought their pets were overweight and 29% thought the animal was underweight during the hospitalization. In the medical records, the veterinarian had commented on the body condition of the animals in 37% of the cases. In all cases except one, the veterinarian and the owner had the same opinion about the body condition of the animal.
Discussion
This study is a pilot study carried out on a relatively small number of animals that gives an overview of the dietary intake both in hospitalized patients and when leaving the clinic.
Future practice
This study has shown that the routines at the clinics could be improved. To put more emphasis of the importance of the diet, education of the staff is crucial. Preferably, a couple of veterinary nurses specialized in clinical nutrition could be responsible for taking a dietary history, prescribing a veterinary diet, recommending amount and frequency, and planning and implementing a nutritional plan. The clinic should use standard sheets for dietary questions so that every animal has the same questions registered. The nurses should also be responsible for regular follow-ups and available for possible questions. Through calculation at the clinic, the amount of feed that would be enough for the prescription period could either be sold at the time of discharge, or at the time of a planned return visit. In addition, it would be important for the staff to critically evaluate different brands and products intended for the same disease; one product may be better suited to an individual animal than another.
Omitting questions about the normal diet of an individual could contribute to staff failing to help the animal eat the best possible diet while at the clinic. This is especially important in cats that often have difficulties in changing from different types of feeds or even different products and tastes. Also, for individuals who are sensitive to special ingredients, it is extremely important to note that dry and canned veterinary diets with the same name might often have different ingredients (Eliasson, 2005).
Further research
Results of this study indicate where research could be continued in this area. The study could be repeated on a larger number of individuals, which would make the proportions relevant for more detailed analysis. The time between the hospitalization and the questionnaire was 6 months, a time span that might have affected the reliability of the data collected. Possibly it would have been better if visits could have been scheduled for example every month, with the possibility of validating the data against the owner questionnaire.
As this study has shown, the veterinarians prescribed veterinary diets for only a few types of diseases, possibly because they did not have experience or knowledge in prescribing veterinary diets for other diseases. The authors believe that future researchers should determine whether this is also the case in other clinics.
Conclusions
This study shows that it is important to put more focus on the fact that diet plays an important role in the recovery of the animal. Results in the study indicate where research could be continued in this area. More education for the staff in combination with time to formulate a dietary plan is needed.