Dietary Management of Gastrointestinal Disease. Animal Diet Feeding Method Clinical Nutrition...

Dietary Management of Gastrointestinal Disease

Animal

Diet Feeding

Method

Clinical Nutrition Assessment

Dietary Management - GI Disease

GI Functions Diet types Acute GI disease Chronic GI disease

Dietary Management - GI Disease

Digestion and absorption

Water regulation Immune monitoring Hormone production Enteric nervous

system Waste elimination

Diet Types

Highly digestible Fiber enhanced Hypoallergenic Fat restricted Gluten-free Lactose-free

Highly Digestible

Diet digestibility is a function of:– Ingredients– Processing– Meal size– Animal’s GI

function

Highly Digestible

Starch Digestibility in Dogs

Corn Rice Barley Oats

Walker, et.al., 1993. J. Animal Sci.

100

75

50

0

25

99.4 99.5 98.8 98.5

Nutrient profile (dog)– Increased digestibility >

90%– Moderate protein < 30%– Moderate fat < 15%– Low fiber < 1%

Highly Digestible

Nutrient profile (cat)– Increased digestibility >

90%– Moderate protein < 35%– Moderate fat < 25%– Low fiber < 1%

Highly Digestible

Diet Types

Highly digestible Fiber enhanced

- High → Low

- Soluble vs insoluble

- Fermentable vs poorly fermentable

Hypoallergenic Fat restricted Gluten-free Lactose-free

Fiber-enhanced

Fiber– Complex carbohydrate– Resistant to

mammalian digestive enzymes

– Found in plants

Fiber-enhanced

Carbohydrates

Simple sugars(Monosaccharides,dissacharides)

Starch( bonds)

Fiber( bonds)

Complex carbohydrates(Polysaccharides,oligosaccharides)

Fiber Enhanced

Fiber Levels in Pet Foods

% Fiber(DM)

Typicalfoods. 1%

15%

27%

HighFiber

ModerateFiber

LowFiber

4%

1%

Fiber-enhanced

Soluble vs. insoluble– Refers to the ability of a

fiber to disperse in water– Most rapidly fermentable

fibers are soluble (e.g., gums, pectins)

– Most slowly fermentable fibers are insoluble (e.g., cellulose, soy mill run)

Fiber-enhanced

Fermentable vs. poorly fermentable– Digestion of fiber by

intestinal microbes

– Produces SCFA (VFA) and gases

– SCFA provide nutrition for enterocytes and may modulate GI motility and fecal water content

Fiber Fermentability in the Colon

cellulose

beet pulp

pectin

peanut hulls

soybean hulls

bran

soy fiber

guar gum

slowly fermentable rapidly fermentable

Fiber-enhanced

cellulose

beet pulp

pectin

peanut hulls

soybean hulls

bran

soy fiber

guar gumRapidly

Fermentable

Slowly Fermentable

Moderately Fermentable

Fiber-enhancedFiber-enhanced

Fiber-enhanced

Prebiotic fibers– FOS– MOS– GOS– Lactosucrose– Lactulose– Inulin

Fiber– VFA → nutritive to

mucosa– Normalizes motility

(insoluble)– Acidifies contents →

change flora

Fiber Enhanced

Diet Types

Highly digestible Fiber enhanced “Hypoallergenic”

Novel protein/limited antigen Hydrolyzed protein

Fat restricted Gluten-free Lactose-free

Nutrient profile – limited or controlled antigen diet– Avoid protein excess– Limited number, novel

proteins– Highly digestible protein– Additive free– Free of vasoactive

amines

Novel protein

Hydrolyzed protein (protein hydrolysates)

Native protein Denatured protein

Protein hydrolysate

Mast cell/Basophil

Hydrolyzed protein (protein hydrolysates)

Inhalation Transdermal Ingestion Injection

Allergen

Chymase

Tryptase

Leukotriene

Histamine

Cytokines

TNF-α

Hydrolyzed protein (protein hydrolysates)

No cross linkageNo cross linkageNo degranulationNo degranulation

Protein Hydrolysates

Advantages– Truly “hypoallergenic”– Will not elicit IgE-mediated response– Protein source is less important

Disadvantages– Expensive– Difficult to

manufacture– Bitter taste

Diet Types

Highly digestible Fiber enhanced Hypoallergenic Fat restricted

- Amount

- Fatty acid content (amount/ratio) Gluten-free Lactose-free

Fat Restricted Diets

Fat Levels in Dog Foods%

Fat

(DM

)

Typical

SeverelyRestricted

ModeratelyRestricted

50

10

8

5

0

8-15

3-8

Growth

Adult

15-50

Gluten– Cereal grain protein which

contains the antigen gliadin

– Present in wheat, barley, rye and oats

– Many dietsdon’t containgluten

Gluten-Free Diets

Lactose-free diets– Brush-border lactases

often deficient in intestinal disease

– Lactose osmotic diarrhea

Lactose-Free Diets

PancreaticAmylase

SalivaryAmylase

GastricHCI

EnterocyteLactaseSucraseMaltaseIsomaltase

G

G

CaG

F

M I+

Lactose-Free DietsLactose-Free Diets

Nutrient content milk– Lactose mg/kcal ME

Bitch 28

Queen 71

Cow 77

Goat 62

Lactose-Free Diets

Acute gastroenteritis Gastric dilatation-

volvulus

Acute GI Disease

Most common GI disease Causes:

– Parasites– Diet

indiscretion– Infectious

diseases– Toxins

Acute Gastroenteritis

Dietary management– Reduce stimulus for

vomiting

NPO 12-24 hrs– Reduce/resolve

diarrhea

no food 12-24 hrs

Acute Gastroenteritis

Acute Gastroenteritis

Gastric Emptying

NeuralMyogenicAutonomic

Nutrients - Fats, Proteins

HormonalSecretinCCKGastrin

Acute Gastroenteritis

Dietary management– Small frequent meals

(3-6 x’s/day)– Gradually increase

amount(3 days)

– Highly digestible diet

Acute Gastroenteritis

Appropriate emergency medical/surgical management

Dietary management = acute gastroenteritis

Acute Gastric Dilation-Volvulus

Acute Gastric Dilation-Volvulus

Dietary risk factors?– Large meals– Temporal relationship:

exercise & eating– Rapid/competitive

eating– Diet

form/size/ingredients– Elevated food bowls

Acute Gastric Dilation-Volvulus

Dietary management - prevention– Reduce aerophagia– Multiple daily

feedings– Highly

digestiblediets

Maldigestion

– EPI– Bile acid

deficiency– Loss of

brushborder enzymes

Malassimilation

Malabsorption– Lymphangiectasi

a– Bacterial

overgrowth– Inflammatory

bowel disease– Gluten-sensitive

enteropathy

Maldigestion

Exocrine Pancreatic Insufficiency (EPI)

100

50

0

DMDigestibility(%)

Normal EPI + Enzymes Normal EPI + Enzymes

Commercial diet Veterinary diet

Pidgeon, JAVMA 181 (1982)

Dietary management of EPI– Small frequent meals– Highly digestible diet– Avoid high fiber diet

Maldigestion

Parasites Inflammatory/

infiltrative Psychogenic

Colon Disorders

Definitive diagnosis Appropriate

pharmacologic management

Dietary management

Colon Disorders

Colon Disorders

Diet type Highly

digestible

“Hypoallergenic”

Fiber enhanced

EffectDecreased ingesta to colon

Decreased exposure to antigens

VFA normalizes motility change flora

Constipation

Environmental Pain Colonic

obstruction Neuromuscular

disease

Constipation

Appropriate pharmacologic and surgical management

Highly digestible diet High fiber diet

(multiple small meals)– Decreases stool density– Normalizes transit time

Flatulence

Swallowed air Intestinal gases

99% no odor = H2, CH4, CO2

1% odor = NH3, H2S, VFA’s, indoles/skatoles

Maldigestion/malabsorption

Constipation

Flatulence

Control aerophagia– Multiple small meals

Highly digestible diet

Avoid

High fiber diets

High protein diets

Vegetables

Vitamin supplements

Garbage

Summary

Multiple diet types are suitable for dietary management of GI disease

Appropriate dietary management requires diagnosis

Acute GI disease = highly digestible diet