Cutaneous adverse food reaction

• Limited antigen diet
  • Novel/hydrolyzed protein
  • Limited ingredients

• Ingredients impact success of treatment
• Noningredients may also impact success (e.g., additives, Food intolerance Maillard production reaction)

Food intolerance

Food-responsive chronic enteropathy

Non-food-related skin condition

• High n-3 fatty acids
  • Consider n-6:n-3 ratio
• High vitamin A
• High vitamin E
• High zinc
• Added antioxidants

• Individual diseases may require different supplements and doses

• High EPA/DHA
• Added glucosamine
• Added chondroitin
• Added antioxidants
• Low energy density if overweight/obese

• Additional supplementation may be required to achieve optimal dose
• High n-3 fatty acid supplementation may result in gastrointestinal disturbance

Cognitive dysfunction

• Added lipoic acid
• Added carnitine
• High EPA/DHA
• Added antioxidants

• Synergistic effects of nutrients when combined

Idiopathic epilepsy

• High medium-chain triglycerides

Anxiety

• Added L-tryptophan
• Added hydrolyzed casein
• Added antioxidants
• Modified fiber

Degenerative valve disease

• Controlled sodium
• High EPA/DHA
• Avoid low protein

• Supplement potassium as required
• Maintain optimal body and muscle condition

Hypertrophic cardiomyopathy

Dilated cardiomyopathy

• Controlled sodium
• High EPA/DHA
• Avoid low protein
• Added taurine
• Added carnitine

Calcium oxalate

• Low oxalate ingredients
• Controlled calcium with appropriate calcium to phosphorus ratio
• Avoid vitamin C supplementation
• Low relative supersaturation
• Added water

• Many of these nutrients of concern can be incorporated into other diets but may be difficult to identify unless specifically labeled for this use
• Aim for USG ≤1.020 (dogs) or ≤1.035 (cats)
• Struve urolithiasis in dogs is typically infection related and special diet may not be required long term

Struvite

• Controlled magnesium
• Controlled phosphorus
• Controlled protein
• Target acidic urine pH
• Added water

Urate

• Low purines
  • Does not necessarily mean low protein
• Target alkaline urine pH
• Added water

Cystine

• Controlled cystine
• Controlled methionine
• Target alkaline urine pH
• Added water

Matrix-crystalline plugs

• Based on mineral content of the plug
• Added water

• Many of these nutrients of concern can be incorporated into other diets but may be difficult to identify unless specifically labeled for this use
• Aim for USG ≤1.020 (dogs) or ≤1.035 (cats)
• Struve urolithiasis in dogs is typically infection related and special diet may not be required long term

Feline idiopathic cystitis

• Added antioxidants
• High EPA/DHA
• Added water
• Low energy density if overweight/obese

Endocrine

Diabetes mellitus

• High soluble and insoluble fiber
• Low carbohydrate (cats)
• High protein (unless contraindicated, e.g., proteinuria)
• Low energy density if overweight/obese

• Consistency of meal timing and insulin regimen are most important

Exocrine

Pancreatitis

• Added antioxidants
• High EPA/DHA
• Added water
• Low energy density if overweight/obese

• Dietary fat recommendations may depend on baseline intake and degree of hyperlipidemia

Exocrine pancreatic insufficiency

• Achieve optimal body condition

• In most cases no specific diet is needed with appropriate enzyme supplementation
• Assess serum cobalamin and supplement if indicated
• In cases with persistent soft stool, additional fiber supplementation may be warranted

Acute vomiting, diarrhea

• Highly digestible
• Low to moderate fat

• Difficult to identify digestibility unless specifically labeled for this use

Chronic enteropathy

• Limited antigen diet
  • Novel/hydrolyzed protein
• ± modified fiber
• ± low fat

• Assess serum cobalamin and folate and supplement if indicated

Intestinal dysbiosis

• Modified fiber

• Assess serum cobalamin and supplement if indicated

Fiber-responsive colitis

• Moderate to high fiber
• Mixed fiber types

• Fiber can be separately supplemented

Large bowel diarrhea

Constipation

• Moderate to high fiber
• Mixed fiber types
• Low energy density if overweight/obese
• Increased water

• Investigate underlying causes (e.g., hypercalcemia, hypokalemia, obesity)

Obstipation

• Highly digestible
• Low energy density if overweight/obese

• Difficult to identify digestibility unless specifically labeled for this use
• Caution with high-fiber weight loss diets

Hyperlipidemia

• Low fat

• Consider EPA/DHA supplementation

Feline idiopathic hypercalcemia

• Controlled calcium
• Avoid excess vitamin D
• Avoid excess vitamin A
• ± increased fiber

Hyperthyroid

• Low iodine

• Impossible to achieve necessary level of iodine restriction without specific formulation and production procedures
• Specific nutritional modification not required if hyperthyroidism is managed by other means

Encephalopathic

• Low fat

• Low protein
• ± B12 supplementation

Copper-associated hepatopathy

Portosystemic shunt

• Low copper
• Added zinc

• Only specifically designed low-copper diets are below AAFCO minimums

Microvascular dysplasia

Chronic hepatitis

Nonencephalopathic

• Moderate protein

Protein-losing nephropathy

• 25–50% protein reduction from current intake
  • Meet essential amino acid requirements
• High EPA/DHA
• Low phosphorus if azotemic

• Protein recommendations will depend upon the degree of proteinuria
• Many medications used to address proteinuria and hypertension may exacerbate hyperkalemia, and reducing dietary potassium intake may help

Acute kidney injury

• Moderate protein

• Consider as a critical care disease category when hypercatabolic

Chronic kidney disease

• Low phosphorus
• ± potassium supplementation
• High EPA/DHA
• Increased energy density to maintain body and muscle condition (unless obese)
• Excess protein

• Many medications used to address proteinuria and hypertension may exacerbate hyperkalemia, and reducing dietary potassium intake may help
• Consider vitamin D supplementation • Protein intake can vary based on staging, presence of uremia, and proteinuria

• High protein
• Moderate to high fiber
• Low energy density
• Increased nutrient to calorie ratio
• Moderate to low fat

• Restriction below RER is not recommended with over-the-counter products

• Mechanical action or masking flavor for
  • Plaque or tartar reduction and/or prevention
  • Control of bad breath odor

• Mechanical brushing and dental prophylaxis are most effective

• Highly digestible
• Increased energy density
• High fat
• Added antioxidants
• Texture more amenable to tube feeding slurry use

• Difficult to identify digestibility unless specifically labeled for this use