Dietary Management of Gastrointesti nal Disease
Mar 30, 2015
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