{"id":986,"date":"2014-07-01T23:28:27","date_gmt":"2014-07-01T23:28:27","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=986"},"modified":"2022-02-16T15:49:10","modified_gmt":"2022-02-16T15:49:10","slug":"acvn-nutrition-notes-practical-approaches-to-feeding-the-cancer-patient","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/nutrition\/acvn-nutrition-notes-practical-approaches-to-feeding-the-cancer-patient\/","title":{"rendered":"Practical Approaches to Feeding the Cancer Patient"},"content":{"rendered":"<p><em>Korinn E. Saker, MS, DVM, PhD, DACVN<\/em><\/p>\n<hr \/>\n<div class=\"orange-box\">\n<p>The <span class=\"brown\">American College of Veterinary Nutrition<\/span> (<a href=\"http:\/\/acvn.org\">acvn.org<\/a>) and <em><span class=\"brown\">Today&#8217;s Veterinary Practice<\/span><\/em> (<a href=\"http:\/\/todaysveterinarypractice.com\">todaysveterinarypractice.com<\/a>) are delighted to bring you the Nutrition Notes column, which provides the highest quality, cutting-edge information on companion animal nutrition, provided by the ACVN&#8217;s foremost nutrition specialists.The primary objectives of the ACVN are to:<\/p>\n<ul>\n<li>Advance the specialty area of veterinary nutrition<\/li>\n<li>Increase the competence of those practicing in this field<\/li>\n<li>Establish requirements for certification in veterinary nutrition<\/li>\n<li>Encourage continuing education for both specialists and general practitioners<\/li>\n<li>Promote evidence-based research<\/li>\n<li>Enhance dissemination of the latest veterinary nutrition knowledge.<\/li>\n<\/ul>\n<p>The ACVN achieves these objectives in many ways, including designating specialists in animal nutrition, providing continuing education through several media, supporting veterinary nutrition residency programs, and offering a wide array of resources related to veterinary nutrition, such as this column.<\/p>\n<hr \/>\n<\/div>\n<p><span class=\"garamond-9-5\"><strong>Editor\u2019s Note:<\/strong> This article was originally published in July 2014. Please use this content for reference or educational purposes, but note that it is not being actively vetted after publication. For the most recent peer-reviewed content, see our <a href=\"https:\/\/todaysveterinarypractice.com\/issue-archives\/\">issue archive<\/a>.<\/span><\/p>\n<hr \/>\n<p><span class=\"garamond-9-5\">One of the most significant nutritional issues that can arise during cancer treatment in companion animals is malnutrition.<sup>1<\/sup><\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Malnutrition is characterized by various clinical signs, including:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Poor wound healing with altered immune response<\/span><\/li>\n<li><span class=\"garamond-9-5\">Fluid and electrolyte imbalances<\/span><\/li>\n<li><span class=\"garamond-9-5\">Body weight changes characteristically associated with a cachectic state.<\/span><\/li>\n<\/ul>\n<p><span class=\"indent-125\">In general, malnutrition of the cancer patient\u2014both human and animal:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Significantly decreases response to treatment protocols and time of remission<\/span><\/li>\n<li><span class=\"garamond-9-5\">Increases mortality and morbidity<\/span><\/li>\n<li><span class=\"garamond-9-5\">Has an overall detrimental effect on quality of life.<\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Pets with cancer\u2014similar to human cancer patients\u2014experience side effects when undergoing common oncologic therapies. The continuum of cancer survival, treatment, recovery, and living with advanced cancer requires an integrated approach to patient care. Appropriate and timely nutritional support is a key component in caring for these pets.<\/span><\/p>\n<div class=\"orange-box\">\n<h2 class=\"indent-125\">Nutritional Goals for Veterinary Cancer Patients<\/h2>\n<p class=\"indent-125\">Nutritional support goals for veterinary cancer patients can range from simple to complex, but most important, they need to be defined and agreed upon by the pet caregiver and veterinarian at time of diagnosis. There is no published benefit to delaying nutrition assessment and support for the cancer patient.Each nutrition support plan should be developed with defined goals in mind, and these goals should be individually defined for each pet. However, universal concerns for any pet with cancer include:<\/p>\n<ul>\n<li>Preserving lean muscle<\/li>\n<li>Minimizing metabolic and gastrointestinal (GI) intolerance to food<\/li>\n<li>Optimizing the pets&#8217; quality of life.<\/li>\n<\/ul>\n<\/div>\n<h2 class=\"indent-125\"><span class=\"brown\">FACTORS THAT AFFECT NUTRITIONAL STATUS<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Numerous factors impact\u2014both directly and indirectly\u2014the nutritional status of cancer patients, including:<sup>2,3<\/sup><\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Ongoing tumor\u2013host competition for dietary energy substrates, which results in chronic malnourishment for the host (pet)<\/span><\/li>\n<li><span class=\"garamond-9-5\">The disease process itself (eg, neoplasms that cause vomiting)<\/span><\/li>\n<li><span class=\"garamond-9-5\">Use of antineoplastic therapies<\/span><\/li>\n<li><span class=\"garamond-9-5\">Pets\u2019 health status prior to initiation of treatment.<\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Cachexia is a complex syndrome characterized by severe, chronic, undesired, and progressive weight loss and muscle wasting, with or without loss of fat mass.<sup>4<\/sup> This syndrome is:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Associated with an underlying disease, anorexia, inflammation, insulin resistance, and increased lean muscle breakdown<sup>5<\/sup><\/span><\/li>\n<li><span class=\"garamond-9-5\">Linked to tumor-disease driven changes in carbohydrate, lipid, and protein metabolism as a consequence of altered cytokine activity.<sup>4<\/sup><\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Cancer cachexia is observed in approximately 50% of human cancer patients4 and, although the incidence rate in pets is not reported, it is considered to be similar based on clinical observations.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"brown\">TREATMENT IMPACT ON NUTRITION<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Multimodal therapy for veterinary cancer patients is considered the current standard of care. Surgery, chemotherapy, and radiation therapy are commonly utilized, but can have deleterious direct and indirect effects on the nutritional status of the patient.<sup>6-8<\/sup> <\/span><strong><span class=\"garamond-bold\">Table 1<\/span><\/strong><span class=\"garamond-9-5\"> summarizes the major nutritional concerns associated with these therapies.<\/span><\/p>\n<table id=\"table-1\" border=\"0\" width=\"100%\" cellspacing=\"1\" cellpadding=\"3\">\n<tbody>\n<tr>\n<td colspan=\"2\" align=\"center\">\n<p class=\"left-justified\"><span class=\"brown\">Table 1. Anticancer Therapy Impact on Nutritional Status<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#f9e3b3\">\n<p class=\"left-justified\"><span class=\"brown\">TREATMENT MODALITY<\/span><\/p>\n<\/td>\n<td bgcolor=\"#daecc8\">\n<p class=\"left-justified\"><span class=\"greenheader\">IMPACT ON NUTRITIONAL STATUS<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"greenheader\">SURGERY<\/span><\/p>\n<\/td>\n<td valign=\"top\" bgcolor=\"#ecf5e2\">\n<ul>\n<li><span class=\"helvetica-9-pt\">Acute stress response (acute phase proteins, inflammatory mediators, hypermetabolism)<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Anorexia-hyporexia, malabsorption<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Electrolyte imbalances, development of hyperglycemia<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">GI alterations (diarrhea, nausea, bloat, regurgitation, vomiting)<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr bgcolor=\"#faedcf\">\n<td colspan=\"2\" bgcolor=\"#ffffff\">\n<p class=\"left-justified\"><span class=\"greenheader\">CHEMOTHERAPY<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><strong><span class=\"helvbold-9-5\">Cytotoxic and Immunotherapy<\/span><\/strong><\/p>\n<\/td>\n<td valign=\"top\" bgcolor=\"#ecf5e2\">\n<ul>\n<li><span class=\"helvetica-9-pt\">Anorexia, food aversion<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Diarrhea, nausea, and vomiting<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Dysbiosis<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Fatigue, immunosuppression<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><strong><span class=\"helvbold-9-5\">Hormonal<\/span><\/strong><\/p>\n<\/td>\n<td valign=\"top\" bgcolor=\"#ecf5e2\">\n<ul>\n<li><span class=\"helvetica-9-pt\">Edema<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Hypercalcemia, hyperglycemia<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Nausea, vomiting<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr bgcolor=\"#faedcf\">\n<td colspan=\"2\" bgcolor=\"#ffffff\">\n<p class=\"left-justified\"><span class=\"greenheader\">RADIATION<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><strong><span class=\"helvbold-9-5\">Head\u2013Thorax<\/span><\/strong><\/p>\n<\/td>\n<td valign=\"top\" bgcolor=\"#ecf5e2\">\n<ul>\n<li><span class=\"helvetica-9-pt\">Anorexia, food aversion<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Dysphagia, esophagitis<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Fatigue, immunosuppression<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><strong><span class=\"helvbold-9-5\">Abdominal\u2013Pelvic<\/span><\/strong><\/p>\n<\/td>\n<td valign=\"top\" bgcolor=\"#ecf5e2\">\n<ul>\n<li><span class=\"helvetica-9-pt\">Abdominal pain, bloat, and flatulence<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Diarrhea, nausea, and vomiting<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Gastric ulceration, GI inflammation<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Maldigestion, malabsorption<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><strong><span class=\"helvbold-9-5\">Extremities<\/span><\/strong><\/p>\n<\/td>\n<td valign=\"top\" bgcolor=\"#ecf5e2\">\n<ul>\n<li><span class=\"helvetica-9-pt\">Protein loss, inflammation due to radiation-associated burns<\/span><\/li>\n<li><span class=\"helvetica-9-pt\">Anorexia\u2013hyporexia associated with limb pain\/discomfort<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 class=\"left-justified\"><\/h3>\n<h2 class=\"left-justified\"><span class=\"brown\">TUMOR IMPACT ON NUTRITION<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Presence of a tumor results in alterations of a patient\u2019s nutrient metabolism. Research suggests that rapidly growing tumors:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Preferentially utilize glucose from dietary carbohydrates (CHO) as their major fuel source<\/span><\/li>\n<li><span class=\"garamond-9-5\">Require protein to support metabolic pathways<\/span><\/li>\n<li><span class=\"garamond-9-5\">Are subsequently less efficient at utilizing dietary fats to support growth.<\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Alternatively, slow growing tumors:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Preferentially utilize fat (lipids) as their major fuel source<\/span><\/li>\n<li><span class=\"garamond-9-5\">Upregulate lipoprotein lipase production, promoting entry of fatty acids into tumor cells for metabolism<\/span><\/li>\n<li><span class=\"garamond-9-5\">Have reported de novo synthesis (lipogenesis) of fatty acids.<\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><span class=\"garamond-bold\">The omega-3 fatty acids<\/span><span class=\"garamond-9-5\">\u2014eicosapentaenoic (EPA) and docosahexaenoic (DHA)\u2014have reported antitumorigenic (models in humans, rodents, cats, and dogs) and anticachectic (models in humans and rodents) functions.<sup>9-11<\/sup><\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Select amino acids<\/span><span class=\"garamond-9-5\"> are essential to support tumor cell functions, as is the case in non-neoplastic cells. <\/span><strong><span class=\"garamond-bold\">Table 2 <\/span><\/strong><span class=\"garamond-9-5\">summarizes the most important amino acids in tumor cell metabolism.<sup>12 <\/sup>Further scientific investigation is needed to determine the precise balance of amino acid\u2013protein intake for specific patients.<\/span><\/p>\n<table id=\"table-2\" border=\"0\" cellspacing=\"1\" cellpadding=\"3\">\n<tbody>\n<tr>\n<td colspan=\"2\" align=\"center\">\n<p class=\"left-justified\" style=\"text-align: center\"><span class=\"brown\">Table 2. Tumor Utilization of Amino Acids<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#f9dea8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">METABOLIC FUNCTION<\/span><\/p>\n<\/td>\n<td bgcolor=\"#cfe7b8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">AMINO ACID<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Protein synthesis<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">All amino acids<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">ATP production<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Glutamine<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Glucose production<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Alanine, threonine, serine, glycine<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Nucleotide synthesis<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Glutamine<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Polyamine synthesis<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Arginine, ornithine<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Nitric oxide synthesis<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Arginine<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Methyl group transfer<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Methionine<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Serotonin synthesis<\/span><\/p>\n<\/td>\n<td bgcolor=\"#ecf5e2\">\n<p class=\"tabs-and-bullets\"><span class=\"helvetica-9-pt\">Tryptophan<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Dietary CHO restriction<\/span><span class=\"garamond-9-5\"> results in glucose deprivation of tumor cells, which limits hydroperoxide detoxification in these cells, rendering them more susceptible to oxidant-induced cytotoxicity.<sup>13<\/sup><\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Avoid dietary antioxidant (AOX) supplementation<\/span><span class=\"garamond-9-5\"> because it can \u201cdetoxify\u201d damaging oxidant species in both normal and neoplastic cells, preventing tumor cell devitalization and destruction.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"brown\">APPROACH TO NUTRITIONAL SUPPORT<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">The ACVN recommends <\/span><span class=\"garamon-italics\">assessment of the patient, the food (diet), and the feeding method<\/span><span class=\"garamond-9-5\"> as a stepwise, integrated, and individual approach to nutritional support.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Taken together, the patient\u2019s cancer diagnosis, treatment protocol, prognosis, and nutrition status category will aid in developing an optimal nutritional support plan. This approach is summarized in the table, <\/span><span class=\"garamond-bold\">Feeding Guidelines Based on Nutritional Status for Dogs &amp; Cats with Cancer<\/span><span class=\"garamond-9-5\">, available at <\/span><span class=\"garamond-bold\">tvpjournal.com\/resources.asp#resources<\/span><span class=\"garamond-9-5\">.<\/span><\/p>\n<p class=\"left-justified\"><span class=\"greenheader\">Patient Assessment<\/span><\/p>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Assessment of the patient is based on physical examination, clinical history, dietary history, and diagnostics; these findings can be translated into one of 3 nutritional status categories:<sup>3<\/sup><\/span><\/p>\n<ol>\n<li><span class=\"garamond-9-5\">Well nourished<\/span><\/li>\n<li><span class=\"garamond-9-5\">Borderline or at risk for becoming malnourished<\/span><\/li>\n<li><span class=\"garamond-9-5\">Significantly malnourished.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"greenheader\">Diet Ingredients<\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">When choosing or recommending a commercial food for a pet with cancer, reviewing the product ingredient list may be helpful. Examples of ingredients are listed in <\/span><strong><span class=\"garamond-bold\">Table 3<\/span><\/strong><span class=\"garamond-9-5\">.<\/span><\/p>\n<table id=\"table-3\" border=\"0\" cellspacing=\"1\" cellpadding=\"3\">\n<tbody>\n<tr>\n<td colspan=\"2\" align=\"center\">\n<p class=\"left-justified\"><span class=\"brown\">Table 3. Examples of Pet Food Ingredients<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#f9dea8\">INGREDIENT<\/td>\n<td bgcolor=\"#cfe7b8\">EXAMPLES<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Animal protein<\/td>\n<td bgcolor=\"#ecf5e2\">Beef, chicken, turkey, duck, fish, lamb, venison<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Vegetable protein<\/td>\n<td bgcolor=\"#ecf5e2\">Corn gluten meal, soybean meal, soy isolate<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Soluble CHOs<\/td>\n<td bgcolor=\"#ecf5e2\">Ground grains, meals, flour, and starch<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Complex CHOs<\/td>\n<td bgcolor=\"#ecf5e2\">Whole grains and soluble fibers (guar gum, beet pulp, fructopolysaccharides, sweet potato, brown rice)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<hr \/>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Protein sources of animal origin provide more essential amino acids for dogs and cats compared with plant-derived protein sources.<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Soluble CHO sources are more readily available sources of glucose compared with complex CHO counterparts. Since glucose is thought to be a primary nutrient source for solid tumor types, reducing the overall soluble CHO content of the diet may be beneficial.<\/span><\/li>\n<li><span class=\"garamond-9-5\">Soluble fibers are another complex CHO source in pet foods; in excess, fiber may decrease overall diet digestibility, but soluble fibers promote GI health. Therefore, inclusion of soluble fiber sources is considered overall beneficial.<\/span><\/li>\n<li><span class=\"garamond-9-5\">Fat-enriched diets, such as recovery or growth life-stage diets, should be avoided in pets with concurrent medical issues (ie, pancreatitis, hyperlipidemia, cholangitis) that require dietary fat restriction.<\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">The pet\u2019s current clinical picture helps determine which CHO\/fiber sources are most beneficial. For example:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">With concurrent diseases such as renal or hepatic disease: Soluble fiber sources<\/span><\/li>\n<li><span class=\"garamond-9-5\">Canine diabetes mellitus: Complex CHO sources (whole grains and soluble fibers)<\/span><\/li>\n<li><span class=\"garamond-9-5\">Shortened bowel: Soluble fiber sources.<\/span><\/li>\n<\/ul>\n<p class=\"indent-125\"><strong><span class=\"garamond-bold\">Table 4<\/span><\/strong><span class=\"garamond-9-5\"> outlines appropriate nutrient levels for both healthy pets and those with cancer; <\/span><strong><span class=\"garamond-bold\">Table 5<\/span><\/strong><span class=\"garamond-9-5\"> provides a list of commercial diets that are appropriate for use in veterinary cancer patients.<\/span><\/p>\n<table id=\"table-4\" border=\"0\" cellspacing=\"1\" cellpadding=\"3\">\n<tbody>\n<tr>\n<td colspan=\"5\" align=\"center\">\n<p class=\"brown\"><span class=\"helvbold-9-5\">Table 4. Recommended Nutrient Levels for Diets <\/span><span class=\"helvbold-9-5\">(% Dry Matter Basis)a<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#f9dea8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">NUTRIENT RANGE<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#cfe7b8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">FAT<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#f9dea8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">CHO<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#cfe7b8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">PROTEIN<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#f9dea8\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">N-3 FAb<\/span><\/p>\n<\/td>\n<\/tr>\n<tr bgcolor=\"#faedcf\">\n<td colspan=\"5\" bgcolor=\"#ffffff\">\n<p class=\"left-justified\"><span class=\"greenheader\">Healthy Dogs<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Low<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 5<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">&lt; 25<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 18<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">NRc<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Moderate<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">10\u201315<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">25\u201354<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">18\u201322<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">NR<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">High<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 15<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 55<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 22<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">NR<\/span><\/p>\n<\/td>\n<\/tr>\n<tr bgcolor=\"#faedcf\">\n<td colspan=\"5\" bgcolor=\"#ffffff\">\n<p class=\"left-justified\"><span class=\"greenheader\">Healthy Cats<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Low<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 9<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 24<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt;26<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">NR<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">Moderate<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">11\u201320<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">\u2248 30<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">27\u201330<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">NR<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">High<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 20<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 40<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 30<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">NR<\/span><\/p>\n<\/td>\n<\/tr>\n<tr bgcolor=\"#faedcf\">\n<td colspan=\"5\" bgcolor=\"#ffffff\">\n<p class=\"left-justified\"><span class=\"greenheader\">Canine Cancer Patientsd<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">% Dry matter basis<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">25\u201340<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 25<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">30\u201345<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 5<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">% Metabolizable energy<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">40\u201365<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 20<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">30-40<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\"><\/td>\n<\/tr>\n<tr bgcolor=\"#ffffff\">\n<td colspan=\"5\">\n<p class=\"left-justified\"><span class=\"greenheader\">Feline Cancer Patientse<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">% Dry matter basis<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">25\u201340<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 24<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">40\u201350<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&gt; 2<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvbold-9-5\">% Metabolizable energy<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">40\u201365<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">&lt; 20<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">30\u201345<\/span><\/p>\n<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"5\">\n<p class=\"references\">a. Based on AAFCO minimum nutrient allowances for adult and growth life stages<br \/>\nb. N-3 FA = omega-3 fatty acids, including DHA and EPA<br \/>\nc. NR = Values not reported in AAFCO; suggested N-6:N-3 ratio of 1:1\u20132.5:1<br \/>\nd. Canine values derived from reference 3<br \/>\ne. Feline values extrapolated from canine values; lower dietary fat based on concurrent disease states, such as pancreatitis, hyperlipidemia, and cholangitis.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<hr \/>\n<table id=\"table-5\" border=\"0\" cellspacing=\"1\" cellpadding=\"3\">\n<tbody>\n<tr>\n<td colspan=\"3\" align=\"center\">\n<p class=\"brown\">Table 5. Commercial Diet Types Appropriate for Veterinary Cancer Patientsa<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#f9dea8\">CATEGORY OF DIET<\/td>\n<td align=\"center\" bgcolor=\"#cfe7b8\">CANINE APPROPRIATE<\/td>\n<td align=\"center\" bgcolor=\"#f9dea8\">FELINE APPROPRIATE<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Fish as primary protein source (OTCb)<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">Yes<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">Yes<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Grain-free (not calorie-reduced)<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">Yes<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">Yes<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Kitten<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">No<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">Yes<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Performance<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">Yes<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">No<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Puppy<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">Yes<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">No<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Recovery\/critical care<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">Yes<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">Yes<\/td>\n<\/tr>\n<tr>\n<td bgcolor=\"#faedcf\">Hypoallergenic, diabetic (selected diets)<\/td>\n<td align=\"center\" bgcolor=\"#ecf5e2\">Yesc<\/td>\n<td align=\"center\" bgcolor=\"#faedcf\">Yesd<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\">\n<p class=\"references\">a. These categories of commercial diets fall within the nutrient profiles recommended for veterinary cancer patients.<br \/>\nb. OTC = over the counter<br \/>\nc. Royal Canin Diabetic (canned)<br \/>\nd. Hill\u2019s Prescription Diet d\/d (canned) and m\/d, IAMS Skin &amp; Coat Response LB, Purina DM, Royal Canin Hypoallergenic (canned) and Diabetic (canned)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<hr \/>\n<h3 class=\"indent-125\"><\/h3>\n<h3 class=\"indent-125\"><span class=\"greenheader\">Unconventional Diets<\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Some pet caregivers request alternatives to commercial therapeutic (prescription or OTC) foods. For pets with cancer, home-prepared meals are often recommended, but raw diets are contraindicated, especially in patients undergoing chemotherapy or radiation therapy.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Raw food<\/span><span class=\"garamond-9-5\"> can significantly increase the risk of infection and\/or sepsis in an immunocompromised patient; pets treated with chemotherapy and radiation become severely neutropenic and immunocompromised.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Homemade diets<\/span><span class=\"garamond-9-5\"> can be specifically formulated to address the nutrient needs associated with single or multiple comorbidities when an appropriate commercial diet is not available for pets with cancer. Pet caregivers often perceive the diet preparation process as a way to bond with their pets, especially when pets are experiencing undesired clinical signs associated with their anticancer treatments.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">If a pet caregiver does not feed a commercially prepared diet, emphasize the importance of ensuring the diet fed is nutritionally complete and balanced, which may require the assistance of a board-certified veterinary nutritionist.<\/span><\/p>\n<h3 class=\"left-justified\"><span class=\"greenheader\">Feeding Frequency<\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Providing the daily food allotment in smaller, frequent meals can be beneficial by:<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Enhancing overall nutrient uptake via the GI tract<\/span><\/li>\n<li><span class=\"garamond-9-5\">Minimizing intolerance due to meal volume<\/span><\/li>\n<li><span class=\"garamond-9-5\">Providing a sustained energy source throughout the day<\/span><\/li>\n<li><span class=\"garamond-9-5\">Decreasing stress associated with large meal feeding.<\/span><\/li>\n<\/ul>\n<h3 class=\"left-justified\"><span class=\"greenheader\">Assisted Feeding<\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">As cancer progresses, patients may require assisted feeding to ensure receipt of adequate nutrition. When the pet is not consistently consuming at least 66% of resting energy requirement (RER) calories,<sup>14<\/sup> assisted feeding is indicated. Hand or enteric tube feedings are viable options for general practice and at-home settings. In some cases, constant delivery of nutritional support via an enteric feeding tube is best tolerated, although this method usually requires hospitalization and close monitoring.<\/span><\/p>\n<div class=\"orange-box\">\n<h2 class=\"left-justified\"><span class=\"brown\">What About GMO &amp; Processed Foods?<\/span><\/h2>\n<p class=\"left-justified\">Many clients that have pets with cancer ask about the role of genetically modified organisms (GMO) and\/or processed foods in cancer and their pets&#8217; diets. Unfortunately, the jury is still out on the relationship between GMO\/processed foods and cancer in humans because adequate data is not yet available.<\/p>\n<\/div>\n<h2 class=\"left-justified\"><span class=\"brown\">ADDITIONAL CONSIDERATIONS<\/span><\/h2>\n<h3 class=\"left-justified\"><span class=\"greenheader\">Appetite<\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">The waxing\/waning appetites of patients undergoing therapies for cancer can significantly impact the onset of malnutrition.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Therapeutic appetite stimulants<\/span><span class=\"garamond-9-5\"> are available for pets, including mirtazapine and diazepam.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Specific oral probiotics<\/span><span class=\"garamond-9-5\"> have been noted to enhance food intake in chronically ill cats and dogs; however, these effects are undocumented in veterinary literature. One such product, canine or feline FortiFlora (purinaveterinarydiets .com), is a powdered probiotic suggested for use to protect microbiota prior to, or replenish microbiota following, chemotherapy and\/or radiation therapy.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Acupuncture, acupressure, and directed massage<\/span><span class=\"garamond-9-5\"> are nontraditional approaches to appetite stimulation. The appetite pressure point is located at the juncture of the nasal tissue and hairline on the dorsal aspect of the nose. Gentle, directed pressure for 5 to 10 minutes prior to feeding has been noted to stimulate appetite once food is offered.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-bold\">Dietary fat, protein, and sodium<\/span><span class=\"garamond-9-5\"> are known palatability enhancers for pet food. In patients with hyporexia, higher fat and protein diets that are not sodium restricted may be more enticing. In cases involving concurrent pancreatitis, cholangitis, or hyperlipidemia, restricted dietary fat is recommended.<\/span><\/p>\n<h3 class=\"left-justified\"><span class=\"greenheader\">Taste &amp; Food Aversions<\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">In humans, altered taste is a common side effect of chemotherapy that may be present, but challenging to ascertain, in pets. However, food aversions have been observed in pets undergoing chemotherapy and\/or radiation therapy. To help overcome these aversions:<\/span><\/p>\n<p class=\"tabs-and-bullets\"><span class=\"helvbold-9-5\">\u2022 <\/span><span class=\"garamond-9-5\">Use glass or porcelain feed and water dishes in place of metal dishes, which reduces the metallic taste associated with platinum-based chemotherapies; this taste is often reported by human cancer patients.<sup>15<\/sup><\/span><\/p>\n<p class=\"tabs-and-bullets\"><span class=\"helvbold-9-5\">\u2022 <\/span><span class=\"garamond-9-5\">Alternate the main protein source in the diet, which influences smell and taste and helps overcome aversions.<\/span><\/p>\n<div class=\"orange-box\">\n<h2 class=\"tabs-and-bullets\"><span class=\"brown\">Supplements: Appropriate for Veterinary Cancer Patients?<\/span><\/h2>\n<p class=\"tabs-and-bullets\">Caregivers are often keen to provide immune-enhancing, health-boosting supplements to their pets diagnosed with cancer. Limited evidence-based studies are available to substantiate dosage, duration, timing, or risk versus benefit; therefore, it is best to proceed with caution.Some supplements have been documented through clinical studies in the cancer patient:<br \/>\nOmega-3 fatty acids, which include EPA and DHA, are recommended in various formats:<\/p>\n<ul>\n<li>Omega-3 fatty acids = &gt; 5% dry matter3<\/li>\n<li>Ratio of omega-6 to omega-3 (EPA\/DHA) = 1:1 to 2.5:13<\/li>\n<li>EPA\/DHA = 450 mg\/100 kcal of daily energy requirement (DER); calculated based on Hill&#8217;s Prescription Diet n\/d nutrient profile<\/li>\n<\/ul>\n<p>Antioxidants are contraindicated during ongoing chemotherapy or radiation therapy.<\/p>\n<ul>\n<li>Although oxidant-induced cellular damage is significant following completion of treatment protocol, human studies have reported conflicting results regarding AOX supplementation.<sup><span style=\"font-size: small\">16<\/span><\/sup><\/li>\n<li>To date, no companion animal studies evaluating AOX supplementation have been reported.<\/li>\n<\/ul>\n<p>Glutamine (GLN) is a primary fuel for enterocytes that can become depleted during prolonged anorexic\u2013hyporexic states, especially with associated GI stress. Many tumors exhibit high rates of GLN consumption.<\/p>\n<ul>\n<li>GLN has been shown to improve:<sup><span style=\"font-size: small\">17<\/span><\/sup>\n<ul>\n<li>Protein balance in tumor-bearing animals<\/li>\n<li>Natural killer cell function.<\/li>\n<\/ul>\n<\/li>\n<li>Recommended supplementation following GI surgery = 500 mg GLN\/100 kcal DER<sup><span style=\"font-size: small\">14<\/span><\/sup><\/li>\n<li>No consensus on usefulness of GLN supplementation in nonsurgical cancer patients<\/li>\n<\/ul>\n<p>For further information on the use of nutritional supplements in veterinary medicine, read Surveying Supplements: Current Trends, Research, &amp; Recommendations\u2014in the May\/June 2014 issue of <em>Today&#8217;s Veterinary Practice<\/em>\u2014at tvpjournal.com.<\/p>\n<\/div>\n<h2 class=\"left-justified\"><span class=\"brown\">SUMMARY<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">When nutritional support is overlooked in pets with cancer, malnutrition can develop and jeopardize patient health. While the catabolic\u2013cachectic state in chronic cancer patients is not reversible, progression can be slowed through appropriate nutritional support.<\/span><\/p>\n<ul>\n<li><span class=\"garamond-9-5\">Begin nutritional support at diagnosis, and continue past remission for at least 6 to 9 months, or longer; residual alterations in nutrient metabolism associated with presence of neoplastic cells persist for varying time periods past intervention.<\/span><\/li>\n<li><span class=\"garamond-9-5\">Work closely with the caregiver to develop realistic nutritional support goals.<\/span><\/li>\n<li><span class=\"garamond-9-5\">Assess the pet as often as needed to ensure its needs are being met.<\/span><\/li>\n<li><span class=\"garamond-9-5\">As the pet\u2019s clinical picture changes, revise the nutritional support plan accordingly.<\/span><\/li>\n<\/ul>\n<p class=\"left-justified\"><span class=\"helvetica-9-pt\">AAFCO = American Association of Feed Control Officials; AOX = antioxidants; CHO = carbohydrate; DER = daily energy requirement; DHA = docosahexaenoic acid; EPA = eicosapentaenoic acid; GI = gastrointestinal; GLN= glutamine; GMO = genetically modified organisms; OTC = over the counter; RER = resting energy requirement<\/span><\/p>\n<hr \/>\n<p class=\"references\"><span class=\"author-bio\"><strong><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/c04_Saker.png\"><img decoding=\"async\" class=\"alignleft size-full wp-image-6562\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/07\/c04_Saker.png\" alt=\"c04_Saker\" width=\"100\" height=\"125\" \/><\/a>Korinn E. Saker<\/strong>, MS, DVM, PhD, Diplomate ACVN, is an associate professor of nutrition and director of the nutrition program at North Carolina State University College of Veterinary Medicine. She received her MS in animal nutrition from Clemson University and her DVM from University of Georgia. Following 5 years in mixed animal practice, she completed her PhD and clinical nutrition residency at Virginia Maryland Regional College of Veterinary Medicine.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Korinn E.<\/p>\n","protected":false},"author":1,"featured_media":3044,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":504,"footnotes":""},"categories":[367],"tags":[],"class_list":["post-986","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-july-august-2014","column-nutrition-notes","clinical_topics-nutrition","clinical_topics-oncology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Practical Approaches to Feeding the Cancer Patient 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