What s New in the Old?: Feeding Older Pets D. P. Laflamme, DVM, PhD, DACVN Nestlé Purina PetCare Company
Pets are Living Longer Improved nutrition Balanced diets Improved health care Preventative health care, vaccination & dental care Better diagnosis & treatment of dz Changes in management systems Confinement trauma + infectious dz
Effect of Age on Disease Prevalence Dogs Cats 30 25 CRF 25 20 GI disease 20 15 15 10 5 10 5 0 '6-7 '8-9 '10-11 '12-13 '>13 0 '6-7 '8-9 '10-11 '12-13 '>13 10 8 Diabetes 50 40 Cancer 6 30 4 20 2 10 0 '6-7 '8-9 '10-11 '12-13 '>13 0 '6-7 '8-9 '10-11 '12-13 '>13 (Kraft 1998)
Effect of Pet Age on Owner-Perceived Health Status Age % Cats Dogs H G U H G U < 7 60% 92% 7% <0.5% 95% 5% <0.5% 7-11 29% 69% 28% 2% 71% 28% 1% 12-15 9% 58% 42% 0 52% 46% 2% >15 3% 52% 35% 13% 33% 33% 33% Total number = 1101 (Laflamme et al, 2008)
Especially for senior pets, it is important to complete a thorough nutritional evaluation.
ACVN
Animal Factors Nutritional Evaluation Signalment and medical history Physiologic status & environment Body weight & Body condition score Physical examination & laboratory evaluation Recent changes
Body Condition Scoring
Each unit increase (above ideal) =~ 10-15% excess body weight
Geriatric Nutrition: Percent of Overweight Patients Approximate % Overweight 50 40 30 20 10 Cats Dogs 0 0-5 5-7 7-10 10-12 12-15 15+ Age Group (Years) (from: Armstrong & Lund 1996)
Senior Pet Evaluation Change in body weight/ condition»percent change in weight 0.5kg change in 4kg cat is comparable to ~ 9kg change in 70 kg person
Geriatric Nutrition: Percent of Underweight Patients Approximate % Underweight 50 40 30 20 10 Cats Dogs 0 0-5 5-7 7-10 10-12 12-15 15+ Age Group (Years) (from: Armstrong & Lund 1996)
Body Weight in last 4 yrs. prior to death 16 15 14 13 12 11 10 9 8 Quarter prior to death 7 6 5 4 3 (n=258) 2 1 0 5000 4800 4600 4400 4200 4000 3800 3600 3400 3200 3000 Cancer Predicted Cancer Other Predicted Other Renal Predicted Renal Thyroid Predicted Thyroid BW (g) (Perez-Camargo 2004)
Preventing weight loss may aid survival Anecdotal reports, esp. CKD cats Research: 90 cat longevity study: All cats lost weight over time Longest surviving group lost least Maintaining weight, BCS, LBM, fat mass increased odds for survival (p < 0.001) (Cupp et al 2006; 2008)
Why are Cats Losing Weight? Effect of Age on Energy Metabolism & Digestive Function
Effect of Age on MER of Adult Cats MER (Kcal/kg body weight) 100 Adult Mature 80 60 40 Geriatric 20 2 4 6 8 10 12 14 16 18 Age (years) (Laflamme 2005)
Daily Energy Intake in Cats (Kcal/kg bwt) Aged 10 to 15 yr 76 72 n = 85 TKC/KG v. AGE 68 TKC/KG 64 60 56 52 48 10 11 12 13 14 15 AGE (Cupp 2003)
% Incidence Incidence of Reduced Protein Digestibility in Cats by Age 20 18 16 14 12 10 8 6 4 2 0 1 to 7 8 to 10 10 to 12 12 to 14 >14 Years of age (Perez-Camargo 2004)
Incidence of Reduced Fat Digestibility* 35 Wet Food Dry Food 30 25 20 15 10 5 0 40 35 30 25 20 15 10 5 0 1 to 7 8 to 10 10 to 12 12 to 14 >14 years 12 to 14 >14 years * Low Fat Digestibility: < 80% (Perez-Camargo 2004)
Implications of Compromised Digestive Capacity Negative energy balanced and weight loss Deficiency/depletion of fat soluble (EFA, Vitamins A, D, E) & water soluble nutrients (B- Vitamins, trace minerals) Negative nitrogen balance, loss of LBM, reduced protein turnover, decreased immune function
Changes in Lean Tissue (g) of Cats with Age (n=256) grams 3500 3000 2500 2000 1500 1000 1 to 3 3 to 5 5 to 7 7 to 9 9 to 11 11 to 13 13 to 15 15 to 17 17 to 20 Years (Perez-Camargo 2004)
Age alters Gene Expression in Canine Skeletal Muscle Geriatric dogs had decreased expression of genes related to: Energy metabolism, including electron transport & TCA cycle Protein biosynthesis & ribosomal function Cell cycle/turnover, cell proliferation & cell differentiation Immune functions and oxidative stress response Metabolic changes in aged muscle contribute to reduced strength & function (from Middelbos et al 2009)
Muscle Mass Score Systems Score Muscle Mass 0 On palpation over the spine, scapulae, skull, or wings of the ilia, muscle mass is severely wasted 1 On palpation over the spine, scapulae, skull, or wings of the ilia, muscle mass is moderately wasted 2 On palpation over the spine, scapulae, skull, or wings of the ilia, muscle mass is mildly wasted 3 On palpation over the spine, scapulae, skull, or wings of the ilia, muscle mass is normal (Michel et al 2011; Buffington et al 2004)
ACVN
Nutritional Evaluation Dietary Factors Normal diet» Commercial pet foods, by brands» Treats, snacks and other foods» Nutritional supplements Nutritional content Nutritional adequacy for patient
Survey about OTC Senior K9 Diets AAFCO MIN Adult diet Senior Diets (n = 37) Kcal/cup 433 336 (246 408) cup 365 (312 411) can g or mg/ 100 Kcal Protein 5.1 5.9 6.9 (4.8 13.1) Fat 1.4 3.4 3.4 (2.4 6.3) Crude fiber 0.4 0.9 (0.2 2.9) Sodium 20 105 89 (33 412) Phosphorus 140 243 264 (134 412) (from Hutchinson et al 2011)
Geriatric Nutrition: Calorie Requirements Generally decreased across species due to lower activity and lean body mass Daily energy needs decrease in DOGS by 20 25% from young adults to seniors Daily energy needs decrease in CATS by ~20% from young adults to middle age, but then increase.
Geriatric Nutrition: Protein Requirements Decreased efficiency in digestion and/or metabolism leads to increased requirement with age Actual estimate of minimum requirement differs based on methods used
Effect of Method and Age on Minimum Protein Needs in Dogs Young dogs Old dogs *Grams protein/kg body weight Min. Requirement* 0.9 1.25 Nitrogen Balance Optimal Protein Turnover* 2.5 3.75 Protein:DNA Ratio (Wannemacher J Nutr 1966)
Effect of Dietary Protein on Lean Body Mass in Aging Pointers 100 98 17% protein 46% protein LBM, % of initial 96 94 92 90 88 Initial 1 yr. 2 yr. Kealy, 1998
Total intake Balanced Nutrition for Seniors An increased nutrient to calorie ratio is needed to maintain essential nutrient intake when calorie intake is lower SOME senior foods are reduced in protein Normal Inactive Obese Carbohydrate Non-essential fat Essential Fat Minerals Vitamins Protein
Geriatric Nutrition: Protein Needs Older cats should receive at least 34% of calories as protein Older dogs should receive at least 20-25% calories as protein Protein, as % of dry diet % FAT 6-10% 11-15% 16-20% 20-22% Percent Protein Cat >30-33 >34-36 >36-38 >40-44 Dog >20-25 >22-28 >24-30 >26-33
ACVN
Nutritional Evaluation Feeding Management Amount and frequency fed Shared food bowls Diet acceptance Recent changes
Reasons for decreased intake in healthy aging dogs & cats Change in diet Lower calorie Lower palatability Different Reduced access to food Competition Location Loss of senses: smell, taste, appetite
ACVN
Some Common Diet Related Problems in Aging Pets FEEDING INDUCED Obesity DIET SENSITIVE Osteoarthritis* Renal disease Cognitive Dysfunction* Diabetes Mellitus
Update on Canine OA: Inflammatory Mediators COX-2 PGE 2 Pain Receptors IL-1 MMPs TNF- N.O. LTB 4 5-LOX
n-6 Promotes and/or stimulates: Neutrophil chemotaxis Inflammation Weak neutrophil chemotaxis n-3 5-LOX COX LTB 4 AA PGH 2 Role of Arachidonic Acid COX produces PGE 2 and TXA EPA 2 Stimulate TNF-, COXIL-1, and MMPs NSAIDs 5-LOX LTB 5 PGH 3 LOX produces LTB 4 PGE 2 TXA 2 Neutrophil chemotaxis PGE 3 TXA 3 Promotes and/or stimulates: TNF IL-1 MMPs Inflammation & Pain Decreased stimulation of TNF IL-1 MMPs
Update on Diets for Canine OA Clinical studies published in 2010 2012 show improvement in: Client assessment of lameness, ability to rise, walk, play, etc. Force plate analysis of weight bearing ~1.0 % 1.5% EPA + DHA effective for OA (Hansen 2008; Moreau 2012 ) Other supplements MAY be beneficial but evidence is poor (Vandeweerd et al. 2012)
Is all Omega-3 fatty acid the same? ALA (C18:n-3) has only ~ 7% the efficiency to raise EPA levels vs preformed EPA (Aterburn 2006) Omega-6:Omega-3 ratios are not meaningful! (Bauer 2007 )
What is the link between Obesity and Arthritis?
RBP4 VEGF Complement 3 IL-6 IL-18 Adipokines Angiotensinogen PAI-1 CRP Lipocalin 2 Adipsin TNF- MCP-1 WNT5a Adiponetin Leptin IL-1 100+ Amyloid A RAS /ACE proteins ANGPTL2 Resistin 17 HSD
Incidence of CHD (OFA) in Ad libitum and Limit Fed Dogs at Two years of Age 20 15 Severe Moderate Mild Borderline 10 5 (Kealy et al 1993) Control Lean-fed
Lifetime OA Scoring Hip Score 2.0 1.5 1.0 0.5 0.0-0.5 Restricted Control 0 5 10 15 Age (yrs)
Lean body condition delayed need for medication for osteoarthritis Age @ treatment Control Restricted 10.3* 13.3 + 3 years! * P < 0.01
Effects of Weight Loss in Dogs with OA: Enhanced ability to: Jump into car/truck or onto furniture Sit down and rise from a sitting or lying down position Walk up or down stairs Less stiffness in the morning or evening Less pain when walking/turning Posturing to urinate/defecate appeared easier Increased voluntary activity = enhanced quality of life
Canine Cognitive Dysfunction: Behaviours affected Orientation Social interaction Housetraining Sleep wake cycle Can diet help? Owners of Senior dogs report the their dogs... forget things and are less interested in their environment and family activities can be resistant to changes in their life and dislike novel new things can lose focus when playing or become distracted
Learning ability declines with age Errors, mean 1-6y 6-8y 8-11y >11y (Milgram 2003)
Antioxidants & Brain function Aged canine & human brain shows mitochondrial energy dysfunction and increased free radicals with oxidative stress Brain benefits from dietary antioxidants: Reduced oxidative stress Reduced amyloid proteins (precursor & betaa) Enhanced mitochondrial respiration Reduced neuron loss & Improved cognitive function All effects greatest with combination of antioxidants and mental enrichment (Pop 2010; Snigdha 2011)
Energy Metabolism in the Brain Glucose Predominant energy source Use by brain decreases dramatically with age, particularly in the memory and learning region Lactate: Produced by astrocytes via glycolysis Produced during exercise Increased use by brain during exercise Ketone bodies: produced by astrocytes or liver - Beta-hydroxybutyrate (BHB); Acetoacetate
Alternate Energy Sources to Preserve Brain Function Ketones feed the TCA cycle to overcome brain hypometabolism MCTs provide alternate energy source and source of ketones Studies in humans & dogs show improved cognitive function with MCT supplementation
Serum BHB (umol/l) MCTs increase β-hydroxybutyrate in Senior Dogs 160 140 120 * * p<0.05 * 100 80 Control MCT 60 40 20 0 Day 0 Day 120 Day 240 (Pan et al 2010)
Study Results Dogs fed MCT diet had significant improvements Attention span & Spatial memory Trainability Executive function (decision making; switch strategies) Concept learning capacity Overall cognitive function Other studies showed MCT supplementation: Improved mitochondrial energy metabolism Decreased β-amyloid precursor proteins Decreased oxidative damage Increased n-3 PUFA in parietal cortex (Studzinski 2008; Taha 2009; Pan et al 2010)
Canine Cognitive Dysfunction: Behaviours affected Orientation Social interaction Housetraining Sleep wake cycle Can diet help? Beneficial targets: Antioxidants Alternative energy sources (e.g. MCTs) Weight management Exercise Mental Stimulation
SUMMARY Especially for senior pets, it is important to complete a thorough nutritional evaluation. Diet and amount tailored to need of individual pet Energy needs can change with age Protein requirements increase with age Senior pets more susceptible to chronic diseases which may benefit from diet
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