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JFMS CLINICAL PRACTICE 739

REV IEW / Weight loss in the elderly cat

assessment will mean that not all patients areweighed on every visit to the clinic. There are a number of small work-top scales suitablefor consulting room use (eg, Marsden scales, model MS-2300-V; www.marsden-weighing.co.uk). Scales such as these shouldhelp ensure that all patients are weighed onevery visit.

Body condition scoring is another valuablemethod of patient evaluation and provides a‘double check’ to counteract any errors inweight recording. Although subjective, andlikely to vary at least a little between clini-cians, body condition scoring offers a furthermethod of assessing whether or not bodyweight is acceptable. Body condition score (ona scale of either 1–5 or 1–9) should be record-ed in the patient’s notes at every visit. If unfamiliar with the scoring process, it isadvisable to start by using a five-point scale(Table 1). If desired, this can be expanded to anine-point scale (which is effectively a five-point scale with half points).

Gradual but considerable weight loss

often passes unnoticed by owners, so it is essential

to have good patient records of body weight

so that any change can be detected swiftly.

FIG 1 All patients – whether healthy or sick – should havetheir weight and body condition score recorded on every visitto the clinic

Individual animals and body systems age at dif -ferent rates but, as described in the AmericanAssociation of Feline Practitioners’ updated ‘SeniorCare Guidelines’, which appear on pages 763–778of this issue of JFMS (doi:10.1016/j.jfms.2009.07.011), a convenient way to view older cats is toclassify them as ‘mature’ (7–10 years), ‘senior’(11–14 years) and ‘geriatric’ (15+ years). These arethe life stages that have recently been defined bythe Feline Advisory Bureau (FAB) in its WellCat forLife programme (www.fabcats.org/wellcat/for_life)to help focus on and predict the changes that mightbe occurring in terms of a cat’s physical and mentalhealth.

What is e lder ly?

The WellCat life stage chart, developed as part ofFAB’s WellCat for Life programme, defines five lifestages in the light of how cats mature physically andbehaviourally. It also expresses the cat’s age in termsof the human equivalent, to encourage owners tothink about what their cat’s age might mean as far asthe risks of certain diseases are concerned

✜ Thyroid disease Hyperthyroidism is still considered by many to be themost common feline endocrinopathy. Increased awareness of the con-dition, and hence earlier testing, has meant that many patients are nowdiagnosed before they may be exhibiting more classic signs such ashyperactivity and tachycardia. Weight loss – in spite of a normal (oreven increased) appetite – can be an early indication of the disease.

✜ Diabetes mellitus The second most common feline endocrino -pathy for many clinicians, this is a condition that is increasing inprevalence.10,11

✜ Chronic kidney disease Although often associated with a poorappetite, in the early stages of kidney disease a cat’s appetite may be variable. Also a slight reduction in appetite may not beappreciated by the cat’s owner.

✜ Inflammatory bowel disease This condition is commonly asso -ciated with weight loss. In addition patients may show appetitechanges (an increase is more common but some cats have areduced appetite), as well as gastrointestinal signs such as vomiting and/or diarrhoea.

Common causes of weight loss (in spite of a normal appetite)

740 JFMS CLINICAL PRACTICE


Initial assessmentHistory takingWhere weight loss is documented or wherethis is an owner concern, a thorough history isa vital component to the work-up. A nutrition-al history, paying attention to the diet offeredand amount consumed, is important. Manyowners may not initially be able toquantify the amount of food theircat is eating but follow-up appoint-ments with this information arevery valuable. For example, in single-cat households it is possibleto weigh the amount of foodoffered and what is left after a mealto calculate nutritional intake.

Careful attention should be paid tolooking for clues of any underlyingdisease. For example, polydipsia(Fig 2) may be present in cats withhyperthyroidism, renal disease anddiabetes mellitus – all common causes of weightloss. It is important to remember that elderlycats often have more than one clinical problem.

Score Classification Descriptors

1 Very thin Ribs and bony prominences are easily palpated, with no overlying fat cover There is an exaggerated abdominal tuck when viewedfrom the side When viewed from above, the cat has an exaggeratedhourglass shape

2 Underweight Ribs and bony prominences are easily palpated, with minimal overlying fat coverThe waist is obvious when viewed from the sideWhen viewed from above, a marked hourglass shape is seen

3 Ideal Ribs and bony prominences are palpable, with a smallamount of overlying fat An abdominal tuck is visible when viewed from the sideA well proportioned waist is visible when viewed fromabove

4 Overweight Ribs and bony prominences are difficult to feel, with amoderate amount of fat covering them There is little or no abdominal tuck when viewed from the sideThe back is slightly broadened when viewed from above

5 Obese Ribs and bony prominences are very difficult to palpateunder a thick layer of fat There is a pendulous ventral bulge and no waist whenviewed from the sideThe back is markedly broadened when viewed from aboveThere is a marked abdominal fat pad and there may be fatdeposits on the limbs and face

Adapted from Thatcher et al (2000)12. Images courtesy of Hill’s Pet Nutrition

Feline body condition scoreTABLE 1

Elderly cats often have more than one clinical problem.

Successful case outcome depends on identifying and treating all of the cat’s problems.

FIG 2 Polydipsia is commonin elderly cats with a varietyof conditions associatedwith weight loss

FIG 4 Doppler blood pressure measurement is an essentialcomponent of the geriatric cat assessment

Successful case outcome depends on identify-ing and treating all of the cat’s problems.

A checklist for owner questioning is pre-sented on page 741.

Clinical examinationAs with the clinical history, a thorough clinicalexamination is vital in assessing the elderlyweight loss patient. Observation of the cat walk-ing around the consult-ing room may revealevidence of mobilityproblems which, as acause of chronic pain,can be associated withweight loss (Fig 3).Specific questioning ofthe owner regardingthe cat’s behaviour (seepage 741) is also essential in identifyingcats that may have chronic mobilityissues. Physical exami-nation needs to bethorough with the aimof identifying as manypossible clues to thecause of the weightloss. If behavioural abnormalities have beendetected in the history then neurological exami-nation, ocular examination and blood pressuremeasurement (Fig 4) are indicated. The latter twoassessments should be performed as a routinewhen evaluating any elderly cat.

Table 2 outlines some key areas to considerwhen examining a patient with weight loss in spite of a normal appetite. These shouldalways be assessed in the context of a thorough general examination.

FIG 3 An elderly cat withsevere elbow osteoarthritisshowing abduction of theelbow joints when she walks



Some useful lines of questioning

H i s t o r y t a k i n g

Is thirst normal?✜ Polydipsia can be seen with a variety of conditions causing weight loss including:

– Hyperthyroidism– Diabetes mellitus– Chronic renal disease– Chronic diarrhoea or vomiting (compensatory thirst)

✜ The magnitude of the polydipsia can be helpful in indicating some of the above; for example, polydipsiaassociated with diabetes mellitus is usually quite dramatic

Is appetite normal?✜ Reduced appetite (though not the specific subject of this article) is a common cause of weight loss

and can occur for many reasons✜ Increased appetite may indicate certain disorders such as hyperthyroidism, diabetes mellitus,

inflammatory bowel disease, diffuse alimentary lymphoma, exocrine pancreatic insufficiency and somehepatopathies

✜ While weight loss in cats in the face of a normal appetite is the focus of this article, some owners may find characterisation of their cat’s appetite difficult. Where possible, documenting exactly what the cat is eating is very helpful

Any pain or difficulty eating?✜ Dental and oral disease are common causes of reduced appetite in older cats

Has behaviour changed?Consider the possibilities of:✜ Hyperactivity, restlessness and less time spent sleeping in some hyperthyroid cats✜ Apparent senility in some cats with cognitive dysfunction✜ Altered behaviour due to hypertensive encephalopathy✜ Reduced activity and mobility due to chronic pain (eg, osteoarthritis). This often manifests as a cat being

less active and less interested in interacting, playing, jumping, going up or down stairs, using a cat flap, etc.Careful questioning is needed to identify mobility disorders

Any vomiting or regurgitation known of?✜ If present, further questions are justified to gather more information (frequency, nature of food brought up,

vomiting or regurgitation, etc). Metabolic and endocrine causes such as hyperthyroidism should beconsidered as well as primary gastrointestinal diseases

Any changes in urination?✜ Polydipsia and polyuria are common with many causes of weight loss in older cats. In cases where water

consumption cannot be monitored, owners may notice that more cat litter is being used

Any coat changes noticed?✜ Although a non-specific finding, coat changes often accompany conditions such as hyperthyroidism

and diabetes mellitus

Any diarrhoea known of?✜ If present, further questions are justified to gather more information (frequency, appearance, evidence of

urgency/pain, etc). Metabolic and endocrine causes such as hyperthyroidism should be considered as wellas primary gastrointestinal diseases



Laboratory tests

Initial testsInitial laboratory tests should be performedwith the intention of following up specificareas of concern and ruling out common caus-es of weight loss. A good minimum databasein these cases includes:✜ Routine haematology A complete bloodcount may, for example, reveal erythrocytosisin a hyperthyroid cat or anaemia in a cat with chronic haemorrhage from an intestinaltumour.✜ Serum biochemistry Ensure that liverenzymes (alanine aminotransferase [ALT],alkaline phosphatase [ALP]), proteins,phosphate, renal parameters (urea,creatinine), glucose and ideally electrolytes(sodium, potassium, calcium) are evaluated.Elevated levels of ALT and ALP are oftenfound in cats with hyperthyroidism andshould prompt thyroid assessment if seen. Stress hyperglycaemia can makeinterpretation of blood glucose difficult. In cases where this is a possibility, assessmentfor the presence of glucose in home-collectedurine samples and blood fructosamineanalysis can be useful. ✜ T4 measurement Resting (basal) serumtotal thyroxine measurement is the moststraightforward initial screening test forhyperthyroidism. Diagnosis of complicatedcases is discussed later.✜ Retroviral testing Blood tests forretroviral infections may be indicated in somepatients. Feline immunodeficiency virus (FIV)status, for example, is relevant in cats with a history of fighting or other potentialindicators of infection such as poorly healingwounds.✜ Urinalysis Assessment of urine specificgravity with a dipstick test for glucose,protein, blood and bilirubin is a good startingpoint. More detailed urinalysis (sedimentexamination, bacterial culture, urine

protein/creatinine ratio ormicroalbuminuria estimation)

is justified in some cases – for example, in cats diagnosed

with renal insufficiency.Recent studies have shownthat older cats are morevulnerable to urinary tractinfections (UTIs).13,14

Occult UTIs are notuncommon in older catsand, in view of this,

cystocentesis and culture is justified. Cats with

hyperthyroidism, renal diseaseand diabetes mellitus are

especially vulnerable to UTIs,

Compiling a problem list

Compiling a list of problems identi-fied from the history and physi-cal examination ensures thatnothing is forgotten in sub-sequent problem-solving.Elderly cats often haveseveral concurrentproblems. While somefindings such as weightloss are non-specific,identifying other issuescan help point to thelikely cause(s). It is alsohelpful to prioritise theproblems identified accord-ing to how significant they areto the patient.

Component Relevance

Oral cavityexamination

Dental and oral disease is common in elderly cats and may beassociated with a poor or variable appetite

Eye examination

It is important to look for evidence of systemic hypertension suchas retinal oedema, detachment and haemorrhage. Systemichypertension is common in older cats – often in association withrenal and/or thyroid disease

Ocular examination can be helpful in identifying evidence ofinflammatory and infectious diseases such as FIP, FIV and FeLVinfection, and toxoplasmosis

Neck examination

Palpation for a thyroid nodule. Remember that non-functionalnodules and non-thyroidal masses may be palpated so a diagnosis of hyperthyroidism depends on definitive laboratory test results

Cardiac auscultation

Tachycardia, gallop rhythm and systolic heart murmurs are common in hyperthyroid cats. Systolic heart murmurs are alsocommon in cats with systemic hypertension, as a consequence of secondary cardiac remodelling

Blood pressuremeasurement

Systemic hypertension is common in elderly cats. In addition, several important causes of weight loss (eg, hyperthyroidism, chronic kidney disease) are associated with this complication

Bowel palpation Focal or diffuse bowel wall thickening and mesenteric lymphadenopathy can be found in association with inflammatorybowel disease and diffuse bowel neoplasia

Renal palpation Changes in renal size and shape can be helpful in identifying possible renal pathology such as polycystic kidney disease andrenal neoplasia

Abdominal palpation

It is important to palpate for possible adrenal and pancreaticmasses, hepatomegaly and other changes

Neurologicalexamination

Perform where indicated by the history and clinical examination

Orthopaedicexamination

Perform where indicated by the history and clinical examination

FIP = feline infectious peritonitis, FIV = feline immunodeficiency virus, FeLV = feline leukaemia virus

Clinical examination checklistTABLE 2

Initial diagnostics or initial monitoring?

If the initial history and physicalexamination are normal other than

documenting weight loss, then preliminarydiagnostics should be aimed at ruling out

common causes of weight loss. In cases whereweight change has not been documented becauseof lack of data in the patient’s records, a decision willneed to be made as to whether initial monitoring ismore appropriate than further diagnostics.



with recent studies havingdocumented UTIs in up to 22% of hyperthyroid, 22% of renal insufficiency and13% of diabetic patients.13,15

Further testsDepending on the results of initialtests, there may or may not be areason to perform further labora-tory tests. However, if the causeof the weight loss has still notbeen determined, further testscan be helpful.✜ Faecal analysis Faecalcollection and analysis isindicated in cats with diarrhoea.Collection of a faecal sample isalso valuable in any patient withweight loss for which a cause remainselusive, since owners will often not be aware that their cat has diarrhoea. Analysis of several faecal samples collected over 3–5 days is ideal. In practical terms, to reducelaboratory costs, a pooled faecal samplecomprising three faecal samples over a periodof 3–5 days is acceptable. Samples should besubmitted to a laboratory for parasitologyand bacteriology.✜ Bile acid tests Liver testing in the form of pre- and post-prandial bile acid analysis is valuable in identifying cats with liverdysfunction and should be considered in catsthat return abnormal liver enzyme results. In addition, a small number of cats with liverdisease have normal liver enzyme levels but elevated bile acids. A blood sample iscollected before and then around 2 h after ameal. Feeding stimulates contraction of thegall bladder, releasing bile acids into theintestinal tract and portal circulation. It isnormal, therefore, for the post-prandial bileacid levels to be slightly higher than fastinglevels in healthy cats. In cats with impairedliver function the increase is more dramaticand prolonged since there is slower clearanceof bile acids. Focal liver disease, includingneoplasia, does not always result in anincrease in bile acids. Cats with biliaryobstruction, whatever the cause, will haveelevated bile acids.✜ Investigation of hypoproteinaemiaHypoproteinaemia identified on routinetesting should prompt further investigationto establish whether it is the result of proteinloss from the bowel or kidneys or reducedprotein synthesis by the liver. Urine proteinquantification using microalbuminuria testsor urine protein/creatinine ratios areindicated to rule out protein-losingnephropathy. Liver enzyme and bile acidanalysis may indicate a hepatopathy.

Further tests may includeimaging, endoscopy and biopsy of the relevant organs.✜ Further tests for suspectedhyperthyroidism In some cats, anormal resting (basal) total serumthyroxine result is obtaineddespite hyperthyroidism beingsuspected on clinical grounds.Repeating this same test after 2–4 weeks may yield a diagnosticresult. This is usually aconsequence of fluctuating T4 levels – in early disease,especially, T4 can fluctuate in andout of the reference range. If asecond total T4 reading is normalthen a free T4 assessment usingthe equilibrium dialysis technique

is indicated. This test is more sensitive inidentifying hyperthyroid cats than thestandard basal T4 test but a small number offalse positive results can be seen.16 Furtherthyroid tests that can be considered includethe T3 suppression test and thyroidscintigraphy (Fig 5).✜ Tests for pancreatic or gastrointestinaldisease Where pancreatic or gastrointestinaldisease is known or suspected, assessment of cobalamin (B12) and folate is indicated.Low cobalamin is not uncommon in cats with a variety of inflammatory and neoplasticgastrointestinal conditions.17,18 Correction of hypocobalaminaemia, for example with 250 μg cobalamin subcutaneously once aweek for 4 weeks, can lead to significantimprovements including weight gain.19

Assessment of feline pancreatic lipaseimmunoreactivity (fPLI) and feline trypsin-like immunoreactivity (for diagnosingchronic pancreatitis and exocrine pancreaticinsufficiency, respectively) should beconsidered.20

✜ Retroviral testing If not alreadyperformed, retroviral testing is indicated torule out weight loss associated with eitherfeline leukaemia virus (FeLV) or FIV infection.

Imaging studies

Radiography and ultrasonography can be ofuse as a screening examination as well as infollowing up specific leads.

FIG 5 Radionuclide thyroidimaging can be helpful indiagnosing hyperthyroidism,especially if a thyroid massis not palpable. In this case,a lateral scan of the head,neck and thorax shows twohyperfunctional thyroidnodules in the neck and onein the cranial thorax

There is a small increase in the diameter

of the pancreatic duct as cats age,

so ultrasonography findings alone should not be

interpreted as indicating pancreatitis.



some cats can pass normal stools in spite ofhaving severe pathology. Appetite in thesepatients is usually normal or increased. A few patients will present with anorexia orinappetence.

Dietary trials and assessment of bowel functionTrial treatment with an elimination diet can be

considered if the patient is not so thinthat a delay in other investigations

could compromise health. Dietarytrials should be implemented for a

minimum of 3 weeks. Sincepalatability can be more of aproblem in older cats, any newdiet should be introducedgradually. Further assessmentof bowel function can includebreath hydrogen studies ofcarbohydrate assimilation (seeleft), which involves a non-

invasive test that is relativelysimple to perform. Bear in mind that normal

ultrasound and radiography resultsdo not rule out gastro intestinal

disease.

EndoscopyEndoscopy is indicated in patients with un -diagnosed weight loss and constitutes a rela-tively non-invasive test (Fig 6). A veterinary

Survey radiography should include the lat-eral thorax and abdomen. If not too overzeal-ous in collimating, these views can also yieldsome information on joint disease andosteoarthritis.

Survey ultrasonography should includeevaluation of the liver and biliary tract,abdominal lymph nodes, pancreas, spleen,bowel wall layering and thickness, and kid-neys. Ultrasound in combination with fPLIis the most sensitive method for diag-nosing feline pancreatitis.20 There is asmall increase in the diameter of thepancreatic duct as cats age so ultrasonography findings aloneshould not be interpreted as indi-cating pancreatitis.21 Abdominallymph adenopathy, increasedbowel thickness and loss of nor-mal layering in the appearanceof the bowel can be features ofinflammatory bowel disease anddiffuse alimentary neoplasia.

Ultrasound may provide a routefor biopsy (needle core or fine needle aspirate) of abnormalitiesidentified such as enlarged lymphnodes. Where bowel pathology is suspect-ed, ultrasound may indicate whetherendoscopy is likely to be diagnostic or if alaparotomy is a better choice for biopsy proce-dures – for example, if abnormalities involvethe distal small intestine. Assessment ofbleeding and clotting using blood coagulationprofiles is advisable prior to core biopsies,especially when sampling the kidneys or liver.

Further diagnostics

Where no useful indicators as to the cause ofweight loss have been identified by the histo-ry, physical examination or laboratory tests,the bowel is a logical place to examine in moredetail. In cats, intestinal lymphoma andinflammatory bowel disease are the mostcommon causes of malabsorptive disease.Less common causes would include parasiticproblems (eg, Giardia infection), food allergiesand exocrine pancreatic insufficiency.Malabsorptive small intestinal disease com-monly causes diarrhoea and weight loss but

FIG 6 Investigations aimed at identifying inflammatory bowel disease and diffuse alimentary lymphoma should be considered in cats with weight loss due to an undiagnosed cause

Where no useful indicators as to the cause of weight loss have been

identified by the history, physical examination or laboratory tests,

the bowel is a logical place to examine in more detail.

Normal ultrasound and radiography results do not rule out gastrointestinal disease.

Breath hydrogen testBreath hydrogen testing can be helpful where facilities exist to

do this. A simple carbohydrate such as xylose (0.75 g/kg) isadministered in aqueous solution by nasogastric tube. Xyloseshould normally be completely absorbed, leaving no sugar avail-able for bacterial fermentation in the colon. However, in cats with acarbohydrate malassimilation – for example, due to inflammatorybowel disease or diffuse infiltrative intestinal lymphoma – xylose isnot completely absorbed. Consequently, bacterial fermentationresults in the production of hydrogen, which is absorbed intothe bloodstream and then exhaled via the lungs. Therefore,

in these cats an increase in exhaled breath hydrogen isseen. Exhaled breath can be collected using a face

mask attached via a one-way valve to a reservoirbag. Hand-held devices are available to

quantitate exhaled hydrogen.



or human paediatric endoscope with an outerdiameter of 7.9–8.5 mm is recommended forthis procedure. The endoscope should includea biopsy channel and have four-way deflec-tion. The patient should be starved for 12–18 hbefore endoscopy and anaesthetised using aregime that avoids atropine and opioids suchas morphine since these increase pyloric tonewhich can make exiting the stomach more difficult.

The patient should be positioned in left lat-eral recumbency for upper gastrointestinalendoscopy. Biopsies should be collected fromthe stomach, and small and large intestine –even if there are no large bowel signs reported.Between five and eight good biopsies shouldbe collected from each area examined.

Colonoscopy is relatively quick and helpfulin diagnosing conditions such as inflammato-ry bowel disease.

Laparoscopy is being used in an increasingnumber of practices and offers a route toobtaining larger biopsies than withendoscopy, while performing less invasivesurgery than a laparotomy. Full-thicknessbiopsies are more likely to be diagnostic thanendoscopic biopsies and there is a reducedrisk of misdiagnosis.22

FIG 7 If a laparotomy is performed, biopsies should becollected even if everything appears grossly normal

✜ Where not contraindicated, high calorie diets, such as convalescent diets, can be fed. Although palatable and high in fat and calories, renal diets are less ideal. Feeding a protein-restricteddiet to an older cat that is not suffering from chronic kidney disease risks inducing proteinmalnutrition.

✜ Appetite stimulants such as cyproheptadine (1–2 mg per cat twice a day) and mirtazapine (1/8 to 1/4 of a 15 mg tablet per cat twice a week) can be used in patients with a suboptimal appetite.

✜ An analgesia trial, for example using sublingual buprenorphine (0.02–0.03 mg/kg every 6–8 h), can behelpful in identifying pain as a cause of poor appetite.

✜ Close monitoring and frequent check-ups are vital to the clinician and reassuring to the client.

Non-specific management of the weight loss patient

It is a sad fact that, for some illnesses,

it is only with the passing of time and progression

of disease that the cause makes itself known.

Exploratory laparotomyAn exploratory laparotomy should be consid-ered in patients with weight loss for whichthe cause remains undiagnosed.Biopsies should be collected evenwhen tissue appears grosslynormal (Fig 7). Samplesshould be taken from any abnormal areas visualised, in addi tion toliver, pancreas, lymphnodes, stomach and sev-eral areas of small intes-tine. Note that without apancreatic biopsy, manycases of pancreatic dis-ease, including pancreati-tis, often cannot be accurately diagnosed – andthat, as long as this organ ishandled gently, the procedureshould not be compromising tothe patient.

It is common to diagnose a combination of cholangiohepatitis, pancreati-tis and inflammatory bowel disease – so-called ‘triaditis’.23

If a diagnosis remains elusive . . .

In those patients where a cause still cannot befound, the most helpful approach is to repeatthe history and clinical examinations to ensurethat no new clues are passing un noticed. It is asad fact that, for some illnesses, it is only withthe passing of time and progression of diseasethat the cause makes itself known.

While awaiting test results, and in thosecases where a diagnosis is not forthcoming,support is needed to ensure that the weightloss does not progress. Management optionsare outlined above.

Pancreatic biopsiesBiopsy of the pancreas is performed in a similar manner to

biopsy of the liver. A generally recommended approach is that,in patients with diffuse pancreatic disease, a segment of the rightor left limb of the pancreas is identified. An encircling ligature ofmonofilament synthetic absorbable suture (3-0 Maxon; Syneture)is placed around the pedicle. As the ligature is tightened, it cutsthrough the pancreatic parenchyma, ligating vessels and pancre-atic ducts. The distal pedicle of pancreas is carefully removedwith a number 15 BP scalpel blade or Metzenbaum scissors.

Care is taken to avoid cutting the suture. If a relatively largeportion of pancreas is to be removed (eg, for removal of

an insulinoma), a similar technique is employed. In this situation, 2-0 or 3-0 monofilament

non-absorbable suture materialshould be used.



Available online at www.sciencedirect.com

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5 Clarke SP, Mellor D, Clements DN, et al. Prevalence of radio -graphic signs of degenerative joint disease in a hospital popula-tion of cats. Vet Rec 2005; 157: 793–99.

6 Harper EJ. Changing perspectives on ageing and energy require-ments: ageing and digestive function in humans, dogs and cats. Nutr 1998; 128 (suppl): 2632S–2635S.

7 Peachey SE, Dawson JM, Harper EJ. The effect of ageing on nutri-ent digestibility by cats fed beef tallow-, sunflower oil- or oliveoil-enriched diets. Growth Dev Aging 1999; 63: 61–70.

8 Laflamme D. Nutrition for aging cats and dogs and the impor-tance of body condition. Vet Clin North Am Small Anim Pract 2005;35: 713–42.

9 Campbell DJ, Rawlings JM, Koelsch S, Wallace J, Strain JJ,Hannigan BM. Age-related differences in parameters of felineimmune status. Vet Immunol Immunopathol 2004; 100: 73–80.

10 McCann TM, Simpson KE, Shaw DJ, Butt JA, Gunn-Moore DA.Feline diabetes mellitus in the UK: the prevalence within aninsured cat population and a questionnaire-based putative riskfactor analysis. J Feline Med Surg 2007; 9: 289–99.

11 Prahl A, Guptill L, Glickman NW, Tetrick M, Glickman LT. Timetrends and risk factors for diabetes mellitus in cats presented toveterinary teaching hospitals. J Feline Med Surg 2007; 9: 351–58.

12 Thatcher CD, Hand MS, Remillard RL. Small animal clinicalnutrition: an interactive process. In: Hand MS, Thatcher CD,Remillard RL, Roudebush P, eds. Small animal clinical nutrition.4th edn. Mark Morris Institute, 2000: 1–19.

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PH. Evaluation of urine specific gravity and urine sediment asrisk factors for urinary tract infections in cats. Vet Clin Pathol 2008;37: 317–22.

14 Eggertsdottir AV, Lund HS, Krontveit R, Henning SA. Bacteriuriain cats with feline lower urinary tract disease: a clinical study of134 cases in Norway. J Feline Med Surg 2007; 9: 458–65.

15 Mayer-Roenne B, Goldstein RE, Erb HN. Urinary tract infectionsin cats with hyperthyroidism, diabetes mellitus and chronic kidney disease. J Feline Med Surg 2007; 9: 124–32.

16 Peterson ME, Melian C, Nichols R. Measurement of serum con-centrations of free thyroxine, total thyroxine, and total triiodothy-ronine in cats with hyperthyroidism and cats with non thyroidaldisease. J Am Vet Med Assoc 2001; 218: 529–36.

17 Kiselow MA, Rassnick KM, McDonough SP, et al. Outcome of catswith low grade lymphocytic lymphoma: 41 cases (1995–2005).J Am Vet Med Assoc 2008; 232: 405–10.

18 Reed N, Gunn-Moore DA, Simpson K. Cobalamin, folate andinorganic phosphate abnormalities in ill cats. J Feline Med Surg2007; 9: 278–88.

19 Ruaux CG, Steiner JM, Williams DA. Early biochemical and clini-cal responses to cobalamin supplementation in cats with signs ofgastrointestinal disease and severe hypocobalaminaemia. J VetIntern Med 2005; 19: 155–60.

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21 Larson MM, Panciera DL, Ward DL, Steiner JM, Williams DA.Age-related changes in the ultrasound appearance of the normalfeline pancreas. Vet Radiol Ultrasound 2005; 46: 238–42.

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23 Weiss DJ, Gagne JM, Armstrong PJ. Relationship between inflammatory hepatic disease and inflammatory bowel disease,pancreatitis, and nephritis in cats. J Am Vet Med Assoc 1996; 209:1114–16.

✜ Weight loss is very common in older cats and may have two or more underlying causes.

✜ A thorough history and clinical examination are essential in adequately characterising the cat’s problems and identifying differential diagnoses.

✜ Common causes of weight loss should be eliminated quickly via blood work and urinalysis.

✜ Occult intestinal disease should be considered if other causes of weight loss have beenruled out.

✜ Body weight and body condition scoring are essential for monitoring patient progress.

✜ High calorie diets can provide useful support while investigating problem cases.

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