Nestlé Purina PetCare Company

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1 Feline Fantasies: Feeding the carnivore Nestlé Purina PetCare Company D. P. Laflamme DVM, PhD DACVN

2 Cats are Carnivores Carnivores are flesh eaters Carnivores are NOT meat eaters

3 What is a Natural Diet? Prey: mice, insects, birds, etc High protein, low carbohydrate diet Hunting : Provides exercise Provides mental stimulation Expends energy

4 Optimal diet? Natural or Evolutionary Diet Nutritional Requirements Ingredient based Opportunistic Supported survival Nutrient based Defined by lifestage, lifestyle, genomics The average lifespan of feral cats is about 2 years

5 How are MOST cats fed today? Study involving 367 U.S. cat owners >95% cats fed 100% commercial foods Dry cat food: ~ 57% receive 100% dry food ~ 87% received > 50% dry food Human foods < 5% receive home-prepared diets, table scraps or other non-commercial foods Prey?

6 How do NUTRIENTS compare: Commercial dry food v Natural? Dry food higher in carbohydrate, lower in fat and protein vs prey Commercial food balanced for all known nutrients vs?? Commercial foods delivered without the hunt (exercise)

7 Concerns about Feeding Cats Carbohydrates Unnecessary? Cause of disease? Protein Animal v vegetable? Quality? Quantity?

8 Perceptions about Carbohydrates for Cats Feeding your cat food that is high in carbohydrates is very detrimental to your kitty s health. carbohydrates wreak havoc on a cat s blood sugar balance Intake of carbohydrates is the number one cause of obesity in cats. Cats have a decrease in the ability to utilize carbohydrates due to the lack of specific enzymatic pathways and they lack a salivary enzyme called amylase.

9 Do cats REQUIRE dietary CHO?

10 Carbohydrates (CHO) FACT: Cats do NOT require a DIETARY source of CHO Does this mean cats do not require CHO? Does this mean cats cannot use CHO?

11 Carbohydrate (glucose) is... so important that multiple systems are in place to assure a consistent level at all times It is a not an essential dietary nutrient, but it is PHYSIOLOGICALLY ESSENTIAL

12 Cellular Energy: Sources of Glucose Nitrogen group Proteins Glycogen Amino acids Dietary carbohydrates Gluconeogenesis GLUCOSE Glycerol Fats Cells Fatty acids

13 Protein oxidation vs intake (Green, A. S. et al. J. Nutr. 2008;138: )

14 Myth or Fact? : Cats cannot digest carbohydrates in their diet

15 Can cats digest carbohydrates? Cats lack salivary amylase (as do dogs) Some studies suggests lower levels of digestive enzymes (pancreatic amylase, intestinal disaccharidases) in cats vs dogs (Meyer & Kienzle 1991; Batchelor, 2011) Other data shows higher levels of intestinal disaccharidases vs dogs (Hore & Messer 1968)

16 Digestibility of CHO: Impact of amount Apparent digestibility % Dietary NFE, % dry basis Kendall CAT Kendall DOG Fekete CAT Thiess CAT

17 Digestibility of Diets*: Dogs v Cats Percent apparent digestibility Corn Sorghum Rice Pea Cat CHO Dog CHO Cat Prot Dog Prot * C&B extruded diets made with Grains (32% to 40% starch in diet dm); Protein from PBM & soy protein isolate (28 37% protein in diet dm) (Carciofi et al 2008; de-oliveira et al 2008)

18 MTYH or REALITY? Cats are not able to metabolize sugars from grains and dietary carbohydrates so high CHO diets cause hyperglycemia and diabetes in cats

19 Carbohydrate Metabolism GLUCOSE + Glucokinase Glucose-6-Phosphate + Hexokinase GLUCOSE Glucose-6-Phosphate

20 Dietary SUGAR Dietary sugars at 28 40% of diet dry matter resulted in glucosuria Dietary sucrose (40% of diet) and lactose (28% of diet) also caused diarrhea Dietary 11% of diet did not cause diarrhea Dietary galactose (39% of diet) appeared to induce cataracts in one cat NONE of these problems occurred when cooked starch was used (Kienzle J Nutr 1994)

21 Effect of CHO on Blood Glucose (de-oliveira et al 2008) 34 37% CHO Plasma Glucose mg/dl Rice Corn Sorghum Pea Hours post prandial

22 Effect of HIGH CHO Diets Hewson-Hughes et al 2011: 41% NFE/30% Protein (Hewson Hughes 2011) 41% NFE 31% NFE 12% NFE

23 Effect of HIGH CHO, Low Protein Diets Coradini et al 2011: 51% NFE/22% Protein 51% NFE resulted in mean PEAK glucose 7.6mmol Worsened after cats gained weight Lean Cats 51% NFE 23% NFE*

24 Effect of HIGH CHO, Low Protein Diets Coradini et al 2011: 51% NFE/22% Protein 51% NFE resulted in mean PEAK glucose 7.6mmol Worsened after cats gained weight Obese Cats *22% Protein 51% NFE 23% NFE* *46% Protein

25 Effect of HIGH CHO, Low Protein Diets In some cats, diets with very HIGH CHO and LOW PROTEIN may cause increase in blood glucose Effects is worse in obese cats Role of low protein Vs high carb not known» Protein and/or amino acids shown to stimulate insulin secretion Implications of this not currently known. Profile not typical of commercial foods

26 Is there Evidence that High Carb OR Commercial Cat foods Cause Diabetes? No published studies reporting on controlled, long-term studies comparing high v low intake Epidemiology: 3 studies Control Cats N = 778 Diabetic Cats N = 139 P Value Mixed Foods 71.2% 71.2% -- Dry Only 22.0% 23.0% 0.92 Wet Only 6.8% 5.8% 0.81 (McCann et al UK; Slingerland ea al Netherlands)

27 Is there Evidence that High Carb OR Commercial Cat foods Cause Diabetes? Sallander et al 2012: Study in Sweden 85% of cats consumed dry food and 70 75% consumed canned food, so mix was typical Control Cats N = 20 Diabetic Cats N = 20 % of total intake, D.M. P Value Dry Foods 79% 44% <0.05 Wet Foods N.S. Table Foods 6 10 N.S. Study suggests that dry food intake may be protective against diabetes

28 Do high CHO diets cause diabetes mellitus? > 75 millions cats in U.S % of cat owners feed commercial food ~50% fed dry ( high CHO ) foods exclusively 79% fed dry most often Incidence of DM is less than 0.25% of VMDB patients

29 Increasing Prevalence of DM? Why? Primary epidemiological risk factors: AGE (8.3x if 7-10 yrs; 14.4x if >10 yrs)» % of cats in VTH > 10 years increased from 10% in 1983 to 40% in 1995 OBESITY ( x)» Prevalence of overweight and obesity in cats = ~25-40% of adult cats seen by first-opinion vets Lifestyle: Inactivity and genetics are independent risk factors for NIDDM in humans. Possible also for cats.

30 High Protein/Low Carbohydrate Diets in Feline Diabetics Addresses compromised ability to clear blood glucose by slowing glucose entry into the blood Research supportive of enhanced insulin sensitivity Ongoing reports highly supportive of clinical use Diet-induced vs Diet-responsive Disease

31 MTYH or REALITY? High CHO diets cause obesity in cats

32 CHO v Fat on Lipogenesis Dietary CHO stimulates insulin release & lipogenesis Excess CHO stored as TG Lipogenesis 3x greater with High CHO Dietary FAT stimulates TG storage Net TG deposition 2.5X with High Fat vs High CHO (Brunengraber 2003) Diet as risk factor for obesity (Scarlett & Donoghue 1994, 1998; Coradini 2011) High fat diet = higher risk High CHO diet = lower risk

33 Hi v Low Dietary Fat in Cats % chg wt % chg body fat IF-HF IF-LF SF-HF SF-LF IM-HF IM-LF NM-HF NM-LF Body fat, Percent Fat, Percent of Dietary Energy (Nguyen et al AJVR 2004) (Backus et al Brit J Nutr 2007)

34 Do High CHO diets Cause Obesity? Intake of calories in excess of need causes obesity Fats are more energy dense vs CHO or Protein Low Carb diets usually higher in fat & calories, and may increase risk for obesity No evidence that Low CHO promotes weight loss or prevents weight gain unless calories restricted

35 Low Carb OR High Protein?

36 How much protein do cats need? Basis of estimating needs: Nitrogen balance Protein turnover Lean Body Mass

37 Protein Turnover DIETARY PROTEIN Catabolism LEAN BODY MASS ENERGY AMINO ACIDS Synthesis PROTEINS Enzymes Insulin Immunoglobulins Etc, etc.

38 Changes in Lean Tissue (g) of Cats with Age (n=256) grams to 3 3 to 5 5 to 7 7 to 9 9 to to to to to 20 Years (Perez-Camargo 2004)

39 Implications from loss of LBM LBM serves as reservoir for protein turnover Decreased protein turnover associated with decreased immune function and greater susceptibility to infection, toxins and stress LBM loss associated with atrophy of muscle mass (strength) and viscera LBM loss is associated with increased morbidity and mortality

40 Does Diet have an Effect on LBM?

41 Effect of Method on Protein Needs in Cats Adult Cats *Grams protein/kg body weight Min. Requirement* 1.5 Nitrogen Balance Optimal Protein* 5.2 Lean Body Mass ~34% of calories (Laflamme JFMS 2013) from protein

42 Protein Needs in Senior Cats 38 cats completing 6 month study Starting age 7-17 years Protein needs to maintain LBM g/kg body weight/day 30 cats completing 12 month study AGE drove loss of LBM Apparent protein needs to preserve LBM increased with age

43 Myth or Reality? Cats need to have a meat based diet rather than a plant based diet in order to survive and be healthy. A cat s body cannot properly utilize plant protein.

44 Protein Quality Based on: Content of essential amino acids Bioavailability (digestibility) of protein Amino acid requirement (by species)

45 Biological Value of Single Protein Ingredients Whole egg 93.7 Milk 84.5 Fish 76.0 Beef 74.3 Soybeans 72.8 Rice, polished 64.0 Wheat, whole 64.0 Corn 60.0 (FAO 1970) There is no perfect protein a single protein source that provides 100% of the essential amino acids in the right proportions for dogs or cats Complementary proteins provide each other s limiting amino acids

46 Complementary Proteins Protein quality defined by lowest amino acid relative availability Low quality protein + = High biological value High quality protein

47 Cats need NUTRIENTS not INGREDIENTS

48 Kitties are NOT small dogs... But, they are not so different. Cats have the ability to adapt metabolism to intakes of different amounts of protein, and different energy sources So long as protein is sufficient, the non-protein energy can come from fat and/or carbohydrate A low carbohydrate diet may be better for diabetic cats, but a low fat (higher carbohydrate) diet may be better for reducing obesity

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