Clinical Nutrition

• Clinical Nutrition
• Program Information
• Client Information
• Virtual Nutrition Video Conference (1.7 mb pdf file)
• Frequently Asked Questions
• Parenteral Nutrition
• Contact & Directions Information
• Our People
• Nutrition Related Sites

Nutrition Frequently Asked Questions

Nutrition Frequently Asked Questions

Working with UCVMC SD Clinical Nutrition Program
Sources for Home-cooked Diet Recipes
Data Used For Formulating
Energy Requirement/Determining How Much To Feed
Recipe Components
Recipe/Food Preparation
Treats
Commercial Food Options
Feeding the Prepared Recipe
Storing Food
Follow-Up and Monitoring

Working with UCVMC SD Clinical Nutrition Program

How do I get the UCVMC SD Clinical Nutrition Program to help me?

For Veterinarians: Please call us if you have a question regarding nutritional case management. If your case involves the need for a parenteral solution or diet formulation, please visit: http://www.ucvmc-sd.vetmed.ucdavis.edu/nutrition.cfm

Request forms for formulation can be downloaded and submitted either electronically or via fax. Pricing information for these services can also be found at this site. Please note all consults are billed directly to the requesting clinic and not the client. In addition all communication is conducted via the referring veterinarian, in order to adhere to regulations defining the establishment of a client-patient-veterinarian relationship. Members of the Clinical Nutrition Program do not speak with clients directly unless they are seen for an appointment at the University of California Veterinary Medical Center (UCVMC) in San Diego.

For Clients/Pet Lovers: Our service technician can answer general questions regarding pet food labeling and well-pet feeding. More in-depth questions are best handled with an in-person appointment which can be set up by calling 858-875-7505 or through a remote consult submitted directly by your veterinarian to the University of California Veterinary Medical Center (UCVMC) in San Diego.

Why can I not speak with the veterinary nutritionist directly?

The Clinical Nutrition Program is a support service which means that it supports the referring veterinarian or clinician with the nutritional aspects of the case but do not have a direct client-patient-veterinarian relationship. Therefore, communications are best handled with the veterinarian that has the most familiarity with the case and can best evaluate how to use guidance from a variety of resources such as a radiologist, pathologist, and nutritionist.

If one would like to establish a direct client-patient-veterinarian relationship, this can be accomplished with an appointment at the UCVMC Clinical Nutrition Program in San Diego.

-TOP-

Sources for Home-cooked Diet Recipes

Why are published recipes sometimes a problem?

Static recipes that are not constantly reviewed or updated have the potential to use ingredients or concepts that have changed. For example, an ingredient like tuna was once commonly used but given the concern of methyl mercury toxicity from bioaccumulation, it is now avoided. To avoid published recipes from becoming dated by suggesting supplements that are no longer available, some recipes recommend generic supplements like “human multivitamin”. Unfortunately, there is no standard formulation for human multivitamins so the actual content may vary greatly; leading to potential deficiencies and excesses of essential nutrients if the “wrong” one is selected at random. In addition, ingredients that were once thought to be safe can later be found to be potentially toxic. The most recent example is grapes and raisins which can cause renal failure in amounts easily consumed by dogs. Finally, nutritional knowledge is constantly evolving and published recipes may not incorporate that new knowledge. An example would be the benefits of long chain omega-3 fatty acids like EPA in a variety of conditions.

Who formulates the recipes that the UCVMC SD Clinical Nutrition Program provides?

Recipes are formulated by veterinary nutrition residents under the guidance of faculty members or by faculty members of the UCVMC Clinical Nutrition Program. These individuals are veterinarians with additional training in the field of veterinary nutrition. They use their expertise and clinical experience to review the specific history of each patient to make custom recommendations for the patient. Even when very similar nutritional concepts may be used for different patients, plans are refined to meet the patient’s specific caloric needs and ingredient preferences.
-TOP-

Data Used For Formulating

Where does the nutritional information come from?

Most of the nutritional data comes from the USDA National Nutrient Database but is supplemented with other resources and databases.

What nutritional requirements are used when formulating?

Most recipes are created checking the 40 or so essential nutrients against the nutrient profiles established by the Association of Animal Feed Control Officials (AAFCO) and/or the 2006 National Research Council (NRC) Nutrient Requirements of Dogs and Cats.
-TOP-

Energy Requirement/Determining How Much To Feed

How is the amount of calories to feed determined?

The UCVMC Clinical Nutrition Program uses standardized equations for calculating a pet’s energy requirement or more preferably uses a patient’s detailed diet history to determine their actual caloric needs. Using a detailed diet history is preferred because it is the most accurate method to determine a pet’s individual caloric needs. Using an equation that calculates a patient’s energy requirement based solely on body weight, although acceptable, carries a greater potential to either over- or underestimate a pet’s energy requirement by as much as 50%. Therefore, if a recommendation is based on body weight it is more likely that the amount fed will need to be adjusted to maintain/achieve an ideal body weight or condition.

What is an ideal weight for a pet?

The UCVMC Clinical Nutrition Program uses a 9-point body condition system that has been validated using more precise methods of determining how under- or overweight a patient is. This system assigns a score based on the degree of fat that has accumulated over the ribs and in the abdomen. Patients that are at an ideal weight have ribs that can be felt but that are not easily seen and have a tapered waistline and are assigned a “5” on the 9-point scale. Extremely underweight pets are a “1” while grossly obese pets are given a “9”.
-TOP-

Recipe Components

Why are specific foods selected for the recipes?

Attempts are always made to select ingredients that the patient will find palatable and tolerable in cases where there are concerns of food allergy. In addition, every attempt is made to use foods that can be the most easily purchased. Specific forms of the foods are used as even subtle differences in preparation or different cuts or processing of foods can drastically change the nutritional profile of a food. Therefore, foods must match the recipe description exactly. It is not appropriate to boil a meat that is to be baked per the recipe. In addition, using a different cut like thigh meat instead of chicken breast must be avoided. Adding oils or flavorings when cooking grains, pasta or potatoes also should be avoided unless the recipe specifically directs the addition of these seasonings

Can foods be substituted?

Although variation is an appealing concept, it must be carefully done. Seemingly simple substitutions can throw a diet off balance and potentially create deficiencies or excesses. For example, using ground beef instead of turkey breast would drastically change the protein and fat content of a recipe. Even changes that seem more subtle can be problematic. For example, using a pork chop instead of pork loin can drastically increase the fat content of a recipe while decreasing the protein content. Therefore, a veterinarian or veterinary nutritionist should be contacted about changes in a recipe or additional recipes should be requested at the start if a variety of different recipes is desired.

Can any vegetable oil be used?

Corn oil is often used (especially in lower fat formulations) as it is rich in the essential fatty acid, linoleic acid. Other fat sources (canola oil, butter, etc.) are lower in linoleic acid, and larger amounts are needed to meet this requirement. These fat sources are sometimes used in diet formulations with higher fat levels, but ingredients are not directly interchangeable due to the variation in fatty acid contents. All recipes are formulated to meet or exceed essential fatty acid requirements regardless of the specific fat source, so the recipe must be followed exactly to avoid deficiency. Also, we have not recognized any problems associated with using corn oil even in patients with adverse reactions to corn as oils do not appear to retain the antigenicity of their vegetable origin (most likely since they do not contain protein).

-TOP-

Why have the specific supplements been used?

The supplements have been selected for a variety of reasons. In the case of human supplements they have been selected for their availability nationally and their specific formulation. For example, One-A-Day Maximum multivitamin/multimineral is frequently used since it uses a bioavailable form of copper (copper sulfate) rather than copper oxide which pets cannot use as a source of copper, but is commonly found in other major, national human brands. It also happens to have a relatively good balance of nutrients even though it is not designed for pets. Other supplements like Posture are used because they are the only somewhat readily available source (e.g. Posture is the only calcium and phosphorus supplement that can be purchased with any ease). In the case of many animal multivitamins/multivitamins, they are not complete or concentrated enough in essential nutrients to be used when making home-cooked pet food. Most animal supplements are designed to be added onto commercial complete and balanced pet food and, therefore, keep essential nutrients at a lower level to prevent the creation of nutrient excesses others have unnecessarily high levels of some nutrients like vitamin A. Specific animal multivitamin and multimineral products can be used in formulations if they are not energy containing (beyond any energy from added amino acids) and if they are already in our database (otherwise an additional fee may apply to research and add the supplement into the database if appropriate). In addition, any supplement that adds non-essential nutrients (except the sulfur amino acid, cystine, taurine, and vitamin K for dogs) are typically avoided due to a concern that the effects of these other ingredients are often not fully understood.

Can supplements be substituted?

Supplements vary greatly and substituting supplements is never recommended as it can lead to nutritional deficiencies and excesses.

Where can I find the supplements for purchase?

Most of the human supplements can be purchased at a drugstore or supermarket. The Posture supplement (not Posture – D), may need to be special ordered by speaking with the pharmacist at the local drugstore or through a website such as www.americarx.com or www.familymeds.com. The supplement line, Balance IT®, can be ordered online at balanceit.com or by calling 888-346-6362 and placing the order over the phone. If a special veterinary code is needed for ordering the Balance IT® (some are only sold under the supervision of a veterinarian) that code will be provided on the recipe formulation. Specific fish oil retailers may be suggested since the amounts of long chain omega-3 fatty acids and vitamins A & D is known as well as whether the product is tested for pollutants/contaminants such as PCBs, dioxins, and mercury.

If specific supplements are desired an additional charge may apply for their use and a delay may occur to allow for the time it takes to research and then enter the supplement into the database.

-TOP-

Are some of the recipe’s ingredients redundant?

Although some ingredients may seem redundant they all have a purpose and cannot be eliminated from the recipe. For example, as many as three different supplements may be providing some calcium to the recipe but they are all needed to meet the total calcium needs of the pets. Moreover, there may be more than one source of salt in the recipe but they may be added to provide the right proportions of sodium, chloride, potassium, and iodine. Using a variety of supplements prevents excesses in other nutrients that would otherwise be added if only one supplement was used. For example, if a calcium and phosphorus containing supplement was used as the sole source of calcium it might lead to adding unnecessary and even harmful levels of phosphorus. Likewise, adding only one type of salt might lead to an excess of potassium to meet the sodium requirement.

-TOP-

What nutrients do the ingredients provide?

-TOP-

Recipe/Food Preparation

I am not good at measuring in fractions, is there an easier way to measure?

Almost all recipes provide both the gram amount and the common measures such as cups, ounces and teaspoons. The easiest and most reliable method to measure ingredients is to weigh them using a kitchen gram scale. Kitchen gram scales can be purchased at drug- and grocery stores and even office supply stores usually for less than $50.

Why is 1/16th of a cup used this seems like a very hard to measure amount?

Actually, 1/16th of an eight fluid ounce cup equals 1 tablespoon if that is easier to use. Other common measure conversions include:

1 tablespoon = 3 teaspoons
1 pound = 16 ounces
1 ounce = 28.35 grams

Also note that “fluid ounce” is measure of volume and “ounce” is a measure of weight. Therefore, one ounce always represents the same amount regardless the type of food while one fluid ounce is dependent on the specific food’s density. For example, one fluid ounce of water weighs more than one fluid ounce of oil (this is the reason why oil floats on water – its lighter), but one ounce of water and one ounce of oil weighs the same (the oil just takes up more space).

How do I prepare a batch of the home-cooked food?

Most recipes provide the amount of food that is to be fed daily (confirm this before batch cooking by checking the recipe). Thus, one can simply multiply the amount of each ingredient by the number of days that one wished a batch to last. It is often easier to use the gram amount of each ingredient for this calculation to prevent the need to multiply fractions. For example, if a recipe calls for 312 grams of chicken breast and a batch for one week or seven days is being made, multiply 312 by 7 to get the new amount of 2184 grams of chicken breast. One must be careful to multiply every ingredient to keep the exact proportions as called for in the recipe. See the storage FAQ for further information pertinent to batch cooking.

-TOP-

Treats

Can I give my pet treats?

Typically, treats can be given to patients on home-cooked diets if they have been reviewed (and possibly adjusted) by the referring veterinarian and/or veterinary nutritionist. Sometimes recommendations will be given to stop treats at least temporarily in cases where there is a concern about the specific treat or where a history of food allergy is reported. Sometimes alternative treat recommendations and amounts will be specifically given.

-TOP-

Commercial Food Options

Are their commercial diet options that might also work in my patient?

If a commercial diet option (or options) is readily available every attempt will be made to provide this option even before a formulation is made. It is felt that this is a better option for many patients since commercial food is more consistent, less expensive, and more proven than any home-cooked diet.

-TOP-

Feeding the Prepared Recipe

How quickly can I transition to the new food?

In general, a slow transition over 5-7 days is always recommended when switching to a new food. This can be accomplished by feeding a small amount of the new food on the first day and reducing the amount of the “old” food accordingly. Then slowly increase the amount of the new food at each meal and decrease the amount of the old food until on the final day only the new food is being fed.

Can the recipe be fed to other pets in the household?

No. Recipes are made for the specific patient and may incorporate nutritional strategies that when fed to another pet could be harmful. For example, a recipe appropriate for a patient with kidney disease could lead to a phosphorus deficiency and anemia if fed to a healthy pet.

-TOP-

Storing Food

How long can I store a prepared home-cooked food?

Prepared home-cooked food can be stored in an airtight container in the refrigerator (32-40?F) for two to three days or frozen (<0?F) for up to three weeks (less if high in long-chain omega-3 fatty acids/fish oil). The amount of food for a single meal should be warmed prior to feeding if refrigerated or frozen to increase the palatability of the food (check that the food is not too hot before serving). Recipes are formulated without any preservatives and care should be taken to assess for spoilage (changes in color and odor) prior to serving. Any uneaten portion of food should be promptly removed within 30 minutes and either stored in the refrigerator for use later the same day or discarded. If the food is prepared in batches and stored in the refrigerator or freezer for future use, supplements should not be added to the batch but rather added to the food after warming but before serving. Heating the supplements can degrade or destroy essential nutrients and this should be avoided.

-TOP-

Follow-Up and Monitoring

How often do I need to have my patient visit their veterinarian now that they are fed a home-cooked diet?

It is recommended that any pet on a home-cooked diet be checked by a veterinarian at least every six months (animals with a concurrent medical condition may need to be seen more frequently as directed by your veterinarian). This visit should include an assessment of body condition, body weight, and physical examination and often diagnostic tests such as blood work and urinalysis. It may also include specific diagnostic tests to determine how well the patient is responding to its medical and/or nutritional management.

-TOP-