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Learning Objectives After participating in this web conference, you - - PDF document

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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

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 1

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.

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

Learning Objectives

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 2

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.

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 3

Introduction

The process:

One (weekend) meeting in CO in 11/09, followed by circulation and comment on nine (!) iterations

  • f the initial draft, all coordinated by an unbiased

facilitator.

Definitions & Acronyms

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 4

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

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 5

Effect of Lifestage

  • n Energy Needs

0.5 1 1.5 2 2.5 3 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180

Kcal/day (X M) Time - Months

Neutering

Body Condition Score

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 6

Muscle Condition Score

Diet Factors

  • 1. What is fed

(exactly)

  • 2. How much

(cups, cans)

  • 3. How often
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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 7

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?

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 8

Environment Health

Barren Chaotic

Good Poor

Where Are We?

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

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 9

Basic Assessment

Nutritional Screening Risk Factor

Check () 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 () 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

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 10

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

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 11

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, athlete, old Orphan, 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

  • vercoat

Coat Quality

Good Poor Very poor

Lab Evaluation

No AN Few AN Many AN

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 12

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 Altered GI Function Effect on FI? Food intolerance Spoiled food Overeating, gorging Barren or chaotic environment medical conditions/disease Correct diet for disease? Effect on FI? Effect on access or

  • compet. for food?

Meds ± diet suppl. Affecting diet adequacy? Effect on FI? Total calorie intake? Who is doing this? Are

  • thers affected?

Unconventional diet How is the pet affected? Is the diet satisfactory? Effect on FI? Other “unconventional”? features Snacks, treats, table food > 10% Effect on diet adequacy? Other features affected? Inadequate or inappropriate housing Barren or chaotic; competition Physical Examination BCS Many diseases Quality, suitability for the situation identified Amount, frequency Effect on access or

  • compet. for food?

MCS BW > 10% Others with similar problems? dental dz or disorder Effect on appetite or food intake? Poor skin or hair coat New disease

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 13

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

  • Healthy

– Food intake & appetite – BCS, MCS, BW – GIT, CQ – Overall wellness

  • Hospitalized

– Weight – Food intake & appetite – Clinical progress

Monitoring

™

Used with permission of the American College of Veterinary Nutrition, www.acvn.org

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 14

Client Education Importance & Effects of the Guidelines for Practice

  • Evidence-based
  • Practical (we hope)
  • Actionable
  • Updatable
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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 15

Summary and Perspective QUESTIONS?

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 16

1. To complete the evaluation, please go to the following website: 2. After completing the evaluation, you will automatically be linked to the Continuing Education Certificate. The CE certificate can

  • nly be accessed after the evaluation is completed.

3. Download the CE Certificate (in pdf format) to your computer and print enough copies for those persons viewing the web conference with you. Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible. If you have any questions about completing the evaluation or accessing your CE certificate, please email us at webconference@aahanet.org or call 800/252-2242. http://www.keysurvey.com/survey/326688/e8be/

Questions to the Speaker Please email your questions to webconference@aahanet.org by Friday, September 24, 2010.

  • Dr. Buffington will provide written responses to all of the questions and

they will be posted on AAHA’s website by Wednesday, October 6, 2010.

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.

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AAHA National Staff Meeting Web Conference - The AAHA Nutritional Assessment Guidelines - What They Mean to You September 2010 17

Taking Action with the AAHA Nutritional Assessment Guidelines web conference, Thursday, September 23, 2010. Nutrifluent: Speak the Clients’ Language workshops, beginning October 2010. Please visit www.aahanet.org/nutrition

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.