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

0

5

10

15

20

25

30

'6-7 '8-9 '10-11 '12-13 '>13

CRF

0

5

10

15

20

25

'6-7 '8-9 '10-11 '12-13 '>13

GI disease

Dogs Cats

0

2

4

6

8

10

'6-7 '8-9 '10-11 '12-13 '>130

10

20

30

40

50

'6-7 '8-9 '10-11 '12-13 '>13

CancerDiabetes

(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

Nutritional Evaluation

Animal Factors

– 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

Age Group (Years)

Appro

xim

ate

% O

verw

eig

ht

0

10

20

30

40

50

10-12 12-15 15+0-5 5-7 7-10

Cats Dogs

(from: Armstrong & Lund 1996)

Geriatric Nutrition:

Percent of Overweight Patients

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

Age Group (Years)

Appro

xim

ate

% U

nderw

eig

ht

0

10

20

30

40

50

10-12 12-15 15+0-5 5-7 7-10

Cats

Dogs

(from: Armstrong & Lund 1996)

Geriatric Nutrition:

Percent of Underweight Patients

Body Weight in last 4 yrs. prior to death

3000

3200

3400

3600

3800

4000

4200

4400

4600

4800

5000

012345678910111213141516

Quarter prior to death

BW

(g

)

Cancer Predicted Cancer Other Predicted OtherRenal Predicted Renal Thyroid Predicted Thyroid

(n=258)

(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

Age (years)

2 4 6 8 10 12 14 16 18

ME

R (

Kcal/kg

bo

dy

weig

ht)

20

40

60

80

100 MatureAdult Geriatric

(Laflamme 2005)

Daily Energy Intake in Cats (Kcal/kg bwt)

Aged 10 to 15 yr

TKC/KG v. AGE

AGE

TK

C/K

G

48

52

56

60

64

68

72

76

10 11 12 13 14 15

(Cupp 2003)

n = 85

0

2

4

6

8

10

12

14

16

18

20

1 to 7 8 to 10 10 to 12 12 to 14 >14

Years of age

Incidence of Reduced Protein Digestibility

in Cats by Age%

In

cid

en

ce

(Perez-Camargo 2004)

Incidence of Reduced Fat Digestibility*

0

5

10

15

20

25

30

35

1 to 7 8 to 10 10 to 12 12 to 14 >14

years

* Low Fat Digestibility: < 80%

0

5

10

15

20

25

30

35

40

12 to 14 >14 years

Wet

Food

Dry

Food

(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)

1000

1500

2000

2500

3000

3500

grams

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 DietsAAFCO

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 DogsYoung 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)

88

90

92

94

96

98

100

LB

M,

% o

f in

itia

l

Initial 1 yr. 2 yr.

17% protein

46% protein

Kealy, 1998

Effect of Dietary Protein on Lean

Body Mass in Aging Pointers

Balanced Nutrition for Seniors

An increased nutrient to calorie ratio is needed

to maintain essential nutrient intake when

calorie intake is lower

Carbohydrate

Non-essential fat

Essential Fat

Minerals

Vitamins

Protein

Normal Inactive Obese

Tot

al int

ake

SOME senior foods

are reduced in 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

% 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

Protein, as % of dry diet

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

PGE2

5-LOX

LTB4

IL-1 TNF-MMPs

Pain

Receptors

N.O.

LTB4

AA

PGH2

5-LOX

COX

TXA2PGE2

Promotes and/or stimulates:

Neutrophil chemotaxis

Inflammation

Promotes and/or stimulates:

TNF IL-1 MMPs

Inflammation & Pain

NSAIDs

Role of Arachidonic Acid

•COX produces PGE2 and TXA2

•Stimulate TNF-, IL-1, and

MMPs

•LOX produces LTB4

•Neutrophil chemotaxis

LTB5

EPA

PGH3

5-LOX

COX

Weak neutrophil

chemotaxis

TXA3PGE3

Decreased stimulation of

TNF IL-1 MMPs

n-3n-6

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)

(Bauer 2007 )

Omega-6:Omega-3

ratios are not

meaningful!

What is the link

between

Obesity and

Arthritis?

Adipokines

17HSD

AdipsinAngiotensinogen

VEGF

PAI-1

Leptin

100+

Resistin

Adiponetin

RBP4Lipocalin 2

WNT5aIL-18

IL-6

IL-1

RAS /ACE

proteins

MCP-1

Amyloid A

Complement 3 TNF-CRP

ANGPTL2

Incidence of CHD (OFA) in Ad libitum and

Limit Fed Dogs at Two years of Age

(Kealy et al 1993)

20

15

10

5

Severe

Moderate

Mild

Borderline

Control Lean-fed

Lifetime OA Scoring

-0.5

0.0

0.5

1.0

1.5

2.0

0 5 10 15

Age (yrs)

Hip

Sco

re

Restricted

Control

Lean body condition delayed need for

medication for osteoarthritis

Control Restricted

Age @

treatment

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:

Can diet help?Behaviours affected Orientation

Social interaction

Housetraining

Sleep wake cycle

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

(Milgram 2003)

Learning ability declines with age

1-6y 6-8y 8-11y >11y

Errors,

mean

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

MCTs increase β-hydroxybutyrate

in Senior Dogs

0

20

40

60

80

100

120

140

160

Day 0 Day 120 Day 240

Ser

um

BH

B (

um

ol/

L)

Control

MCT

* p<0.05

*

*

(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:

Can diet help?Behaviours affected

Orientation

Social interaction

Housetraining

Sleep wake cycle

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

Thank you !!

Obrigada !!

Nestlé Purina PetCare Company