A Research Update for theVeterinarian from the Ralston Purina Company St. Louis, Mo.

, USA

r PurinaResearchReport
Geriatric Nutrition: Protein
D.P. Laflamme, DVM, PhD, DACVN, S.S. Hannah, PhD and R.D. Kealy, PhD

In this issue:

Geriatric Nutrition Restricted protein

diets may predispose older dogs to infections and other health problems.

Page 1

Identifying an optimum dietary level for any nutrient is dependent on defining the area between the minimum amount of the nutrient to maintain health and the

Feline Blood Pressure Purina research

shows that mean blood pressure increases with age. Page 5

Dietary Protein Research methods

influence the answer regarding dietary protein requirements for cats. Page 5

Dietary Fiber Fiber does enhance satiety and reduce voluntary calorie intake in dogs. Page 1

maximum amount of the nutrient that can be tolerated without adverse effects (see figure 1). Severe protein deficiency in dogs results in poor food intake, growth retardation or weight loss, subnormal concentrations of blood proteins, muscle wasting, emaciation and death. Less severe

Effect of Dietary Fiber on Food Intake in Dogs

It is widely accepted that animals eat to meet their energy needs, thus calorie intake and calorie needs are the primary controllers over food intake. However, due to a domestic lifestyle, many pet dogs are overweight. Dietary fiber is well accepted for its beneficial role in helping control calorie intake and aiding satiety in humans attempting to reduce calorie intake. Yet the role of dietary fiber in the management or prevention of obesity in dogs has been controversial. Recently, several studies in dogs have been completed. One study reported no benefit to dietary fiber when dogs were restricted to less than 50% of their maintenance energy requirements.2 However, severe calorie restriction for weight loss is not recommended, as it is more likely to result in weight rebound.5
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deficiency can cause a rough, dull haircoat and compromised function of the immune system. Chronic, marginal intake of protein can result in protein reserves, with decreased protein turnover. Animals maintained with inadequate protein reserves may appear healthy, but are more susceptible to stresses, including increased susceptibility to infectious and cancer causing agents. 1,11
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Figure 1: Nutrient Requirements

DEFICIENT MINIMUM OPTIMUM MARGINAL TOXIC

Death occurs

Deficiency signs minimized

Provides amount to maximize health in normal individuals

Signs attributed to excess

Death occurs

Geriatric Nutrition: Protein

continued from page 1

and eight experiments were grouped by protein content, as percent of dietary metabolizable energy (ME): high (3849% ME), moderate (20-31% ME), low (12-16% ME) and very low (7-9%) protein. Responses in dogs with chronic renal failure were undesirable with the high or very low protein diets. Moderate protein diets (up to 34% of diet or 31% of energy) had no ill effects in dogs with

Protein and Kidney Function

The primary concern regarding excess dietary protein has focused on kidney function. It was suggested by Brenner that excess dietary protein would cause kidney damage, based on work in rodents.2 While subsequent research indicated that the benefits attributed to protein restriction were actually secondary to the reduced calorie intake associated with low protein diets,10, 13 a survey of practicing veterinarians in 1990 indicated that 42% thought excessive protein intake causes kidney damage and 82% thought that geriatric dogs should consume less protein.5 A critical appraisal of related canine research was published by Kronfeld.8 The 27 diets used in four clinical trials

There remains no evidence that protein at any level consistent with complete and balanced nutrition has adverse effects on the kidneys of normal, healthy dogs.

removed were fed dry diets containing either 18% or 34% protein or canned diets containing 22-36% protein on a dry matter basis for four years.4,6 No adverse effects from dietary protein were observed in either study. Similarly, preliminary findings from research conducted at the Purina Pet Care Center in the U.S. indicate that healthy geriatric dogs fed 45% dietary protein have maintained health and body condition, with no evidence of increased kidney damage due to protein intake. There remains no evidence that protein at any level consistent with complete and balanced nutrition has adverse effects on the kidneys of normal, healthy dogs.

Lean Body Mass and Protein Turnover

Reductions in lean body mass are widely recognized to occur with aging. Depletion of lean body mass is important since the skeletal musculature plays an important role in the adaptations or responses to inadequate nutritional conditions and in trauma or infection. Skeletal muscle and skin proteins are the primary source of endogenous proteins involved in protein turnover.

chronic renal failure and were associated with general improvement over dogs fed high or low (less than 16% of energy) protein diets.6-8 Excessive restriction of dietary protein was associated with adverse effects in dogs with chronic kidney failure. In other research, older dogs (age 6 to 8 years) with one kidney

Influence of Diet on Urinary pH in Healthy Dogs

from: Riley HK, et al. 1997 Purina Nutrition Forum

7.5

7.0

6.5

urine pH of dogs fed any of the three diets (Purina Pro Plan Chicken & Rice Formula Dog Adult; Purina CNM DCO-Formula; Hills Prescription Diet c/d) remained moderately acidic throughout the collection period. However, the urine pH of individual dogs varied greatly regardless of diet consumed.

Urine pH

This graph shows that dogs, unlike cats, do not experience a significant post-prandial alkaline tide when fed dry diets. The average

6.0

5.5

5.0 ProPlan Hours post prandial CNM DCO Hill's c/d

0 hours

4 hours

8 hours

80

60

Liver Protein DNA

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Figure 2: The data show that older dogs require more protein to achieve maximum protein stores. The implications of studies such as these are that more protein, not less, will help older dogs deal with commonly encountered stresses.
Old beagles 0.2 0.3 0.4 0.5 0.6 Young beagles

(Adapted from Wannemacher et al 1966)

Protein intake (mg/kg body weight)

Protein turnover is the dynamic process of catabolism and synthesis of endogenous proteins which takes place almost continuously in all cells. Turnover provides a mechanism for the continuous redistribution of amino acids to support immediate synthesis of proteins essential for life. The rate of protein turnover is reduced when protein intake is deficient, and maximized with optimal protein intake. A reduction in protein turnover can lead to decreased immune competence and increased susceptibility to stresses such as infection and injury.

Protein turnover provides the amino acids essential to support cells of the immune system, including lymphocytes, and those involved in tissue repair. Protein turnover also provides amino acids for hepatic gluconeogenesis in order to supply glucose as an obligatory energy substrate required for cells involved in repair and the immune system, and it provides branched chain amino acids that will be oxidized in muscle to serve as an additional energy source for this tissue. Thus, a diminished rate of muscle protein turnover might blunt these functions and compromise the hosts capacity to successfully resist a stressful stimulus.15

Minimum protein requirements have been defined as the lowest level needed to maintain positive nitrogen balance, where nitrogen loss is no greater than nitrogen intake. However, research in dogs shows that this level of intake is not adequate to maintain protein reserves, lean body mass and optimum protein turnover since dogs can maintain positive nitrogen balance in a protein depleted state.1, 14 In this state, animals may appear healthy but are more likely to succumb to infection. These effects will be more pronounced in the older dog due to reduced lean body mass and agerelated reduction in protein turnover.14

Effect of Age on Protein Requirements

The minimum concentration of dietary protein needed to adequately meet the needs of dogs and to maintain protein reserves depends on many factors: lifestage, lifestyle, energy content of the diet, energy needs of the individual dog, and quality of the protein, including amino acid content and bioavailability. In addition to protein quality, calorie intake affects dietary protein need. With lower calorie intake, the percent of

Baby Food Can Cause Heinz Bodies in Cats

Onions and onion powder can cause methemoglobinemia and Heinz bodies in cats. Baby foods are often used to encourage food intake in sick cats, but some baby foods contain onion powder as a flavoring agent. A recent study documented that the onion powder present in some baby foods was enough to cause Heinz bodies to form in cats. Up to 30% of red blood cells developed Heinz bodies within two to three weeks while cats were fed a baby food containing onion powder.
[from Robertson JE, Proc ACVIM 1997]

Dietary Soybean Protein Benefits Intestinal Health

Cats fed soybean protein instead of casein showed improved intestinal integrity following treatment with the chemotherapeutic drug, methotrexate. Cats fed the caseinbased purified diet had increased morbidity, villous atrophy and bacterial translocation. Soybean protein not only protected against villus atrophy, it reduced the number of bacteria entering the mesenteric lymph nodes and was associated with greater levels of trophic gut hormones such as cholecystokin (CCK). [from Marks SL, et al. Proc 1996 Purina Nutrition Forum]
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calories as protein must increase to maintain the same protein intake. Dietary calorie needs vary with breed, age, individual metabolism, and activity level. Older dogs tend to consume fewer calories, thus less food, than younger dogs. Therefore, diets for older dogs should contain a higher percentage of dietary protein in order to meet their needs. Research has shown that older dogs require more protein than young adult dogs to maintain protein reserves.14 In a series of comparisons between young and old beagles, the older dogs required a protein intake of at least 19% of diet calories, using casein protein, while young adult dogs were able to maximize protein reserves with approximately 12% of calories as casein protein (see figure 2). In addition, protein turnover was reduced in the older dogs. This research concluded that 3.75 g casein protein/kg body weight/day was required for the older beagles and 2.5g/kg/day for young adult beagles. When different proteins are used, the amount needed will increase based on amino acid composition and protein digestibility.

Protein quality is most critical near minimal protein intake. Based on these data, it has been recommended that canine geriatric diets contain 20-24% dietary calories as protein.3, 9, 12

Conclusions
Inadequate protein intake causes a reduced rate of protein turnover which may predispose an animal to greater

... diets for older dogs should contain a higher percentage of dietary protein in order to meet their needs.

indicators of protein inadequacy include elevated serum alkaline phosphatase, reduced hematologic values and reduced percentage of lean body mass. Dogs with depleted protein stores are more susceptible to effects of toxins, and may be more susceptible to infectious agents. Therefore, to help maintain lean body mass and promote optimum health, geriatric dogs should receive diets that will provide at least 4 gm of high quality protein/kg body weight per day, or diets that provide at least 20% of calories as protein.
REFERENCES
1. Allison JR, Wannemacher RW, Migliarese JF. J Nutr 1954;52:415. 2. Brenner BM, Meyer TW, Hostetter TH. New Eng J Med 1982;307:652. 3. Buffington CA. Proc 4th Friskies-Carnation Symposium on Canine Disease and Nutrition, Columbus, OH. May, 1991;1 4. Churchill J, Polzin D, Osborne C, T et al. Proceedings ACVIM 1997:675. 5. Finco DR. Proc the Waltham/OSU Symposium on Nephrology and Urology, Columbus, OH. Oct 1992. pp 39. 6. Finco DR, Brown SA, Crowell WA, et al. Am. J. Vet. Res. 1994;55:1282. 7. Finco DR, Brown SA, Crowell WA, et al. Am. J. Vet. Res. 1992;53:2264. 8. Kronfeld DS. Aust. Vet. J. 1994;71:328. 9. Kronfeld DS. Pet Food Industry. 1983:10 10. Masoro EJ. J Nutr 1985;115:842. 11. McCoy JR, Allison JB, Crossley ML, Wannemacher RW. Am J Vet Res 1956;17:90 12. Sheffy BE, Williams AJ. Vet Clin N Am Sm Anim Pract 1981;11:669. 13. Tapp DC, Wortham WG, Addison JR, et al. Lab Invest 1989;60:184. 14. Wannemacher RW, McCoy JR. J. Nutrition 1966;88:66 15. Young VR, Marchine JS. Am J Clin Nutr 1990;51:270-289.

susceptibility to various stresses, including effects of toxic or infectious agents. Increased protein intake can help to maintain lean body mass and promote protein turnover. Geriatric dogs, perhaps because of less efficient protein metabolism, require about 50% more protein than young dogs to maintain their endogenous protein stores. Clinical

Tamm Horsfall Mucoprotein in Feline Urethral Plugs?

adapted from: Westropp JL, et al Proc 1996 Purina Nutr. Forum

Previous studies have shown that cats with a history of lower urinary tract disease have increased concentrations of Tamm Horsfall Mucoprotein (THMP) in their urine, and THMP increases the formation of struvite crystals. A new study evaluated the protein in urethral plugs
obtained from obstructed cats. The plugs were found to consist predominantly of small proteins with a molecular mass less than 65,000 kilodaltons, primarily albumin and albumin fractions. These proteins were also found in higher concentrations in cats with idiopathic lower urinary tract disease, compared to normal cats. Higher albumin and small protein concentrations in urine may arise from degraded serum proteins following urothelial vascular leakage, or from leakage following renal glomerular damage.
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... whole body nitrogen balance remains unsuitable in the determination of dietary protein requirements. Cats have a high obligatory nitrogen loss and a reduced capacity to regulate the activity of the transaminases and urea cycle enzymes after changes in dietary protein intake. Mobilization and subsequent catabolism of amino acids from the lean body mass in the face of a protein deficiency may represent one mechanism by which an animal maintains nitrogen equilibrium on a low dietary protein intake. We examined nitrogen balance and lean body mass in cats fed either 21, 26, 28 or 34% protein in an otherwise similar diet to determine the minimum level of dietary protein required to maintain lean body mass protein stores in the cat. Cats (N=32) were fed one of the four diets following collection of

Effect of Dietary Protein on Nitrogen Balance and Lean Body Mass in Cats*
baseline data including physical examination, body condition scoring and body composition by dual energy X-ray absorptiometry (DEXA). The study lasted 8 weeks during which daily food intake was recorded. On the last four days, total fecal and urine collections were made. Body composition analyses were repeated at the conclusion of the study. Neither calorie nor protein intake showed significant correlations to changes in bodyweight in the subjects. Regression analysis indicated that cats remained in positive nitrogen balance at very low protein intakes. The minimal dietary protein level needed to achieve nitrogen balance was calculated as 1.46 g protein/kg body weight/day. Likewise, a significant correlation between protein intake and change in lean body mass was observed. When using maintenance of lean body mass as an index of dietary protein needs, the calculated requirement was 5.28 g protein/kg body weight/day. Comparing the calculated requirement using nitrogen balance vs. lean body mass determination illustrates the limitations of nitrogen balance data in predictive value of dietary protein requirement. In conclusion, we maintain that whole body nitrogen balance remains unsuitable in the determination of dietary protein requirements.
* Presented at the 1995 Purina Nutrition Forum and published as: Hannah SS, Laflamme DP. Vet Clin Nutr. 1996; 3:30

ResearchAbstracts
Age Related Differences in Feline Blood Pressure*
The incidence of primary and secondary hypertension in the feline population is not known. Nonetheless, several diseases that frequently are recognized in cats can be associated with hypertension, especially renal disease and hyperthyroidism. Measurement techniques and equipment vary somewhat among existing studies; however, systolic pressures > 150 - 170 mmHg, and diastolic pressures > 100 mmHg, generally define a state of hypertension in cats. This study was conducted to define systemic blood pressure by age in cats without clinical signs of disease, and to define important ages where changes occur. Sixty adult cats (30 male, 30 female) ranging in age from 2 - 13 years were chosen for the study. Blood pressure was measured in fasted, unsedated cats, over the right dorsal metatarsal artery. Measurements were taken with a commercially available Doppler flowmeter, using a neonatal pressure cuff and an external mercury manometer. Systolic and diastolic arterial pressures (SAP , DAP) were measured, and mean arterial pressure (MAP) was calculated {MAP = DAP + 1/3(SAP-DAP)}. Fasted hematology, serum biochemistry profile, blood gas profile, serum T3 and T4, and urine pH and specific gravity also were measured. Systolic arterial pressure was significantly lower (p < 0.05) in younger cats (age 2.2 - 3.8 years) compared to older cats (age 9.0 - 13.7 years). Cats of intermediate age had SAP measures significantly higher than younger cats and significantly lower than older cats. DAP and MAP were significantly lower (p < 0.05) in cats aged 2.2 - 3.8 years, compared to the other two age groups. Regression
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... the observed age-dependent increases in systemic blood pressure are related to early renal dysfunction in cats. analysis indicated that SAP , DAP and MAP tended to increase at the rate of 6.1, 8.5 and 7.5 mmHg/year of age, respectively, through age 6.2 years. Few statistically significant correlations were found between blood pressure and any blood, serum, or urine values obtained during the study. Evidence of thyroid disease was found in only two cats. Evidence of renal disease was found in four cats; however, clinical renal measures evaluated are insensitive to early stages of onset and progression of renal disease. An attractive hypothesis for further study is that the observed age-dependent increases in systemic blood pressure are related to early renal dysfunction in cats.
* Presented at the 1995 Purina Nutrition Forum and published as: Lawler DF, Keltner DG, Binns S, Sisson DD. Vet Clin Nutr. 1996;3:29

Effect of Dietary Fiber on Food Intake in Dogs

Average intake, Kcal/kg body weight

100

continued from page 1

80

Two other studies documented a voluntary decrease in calorie intake when dogs fed moderate (9 - 12%) to high (21%) fiber diets. 3, 4 Because satiety is such a complex phenomenon and the effects of fiber provide only one portion of the total control over the desire to eat, experimental design is critical in demonstrating the effects of fiber. The major aspect of food which induces satiation is the energy content. Therefore, the effects of dietary fiber on satiety could be masked if the energy intake were so severely restricted that the effects of fiber would be inadequate to satiate the subject given the physiologic drive to meet energy needs. When daily calorie intake was not restricted, but dogs were offered high fiber, low fat foods, they voluntarily

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40

20

Figure 3: Average calorie intake as influenced by dietary fiber. Dogs fed a low fiber (2%) diet (Group 1) in the morning consumed significantly more total calories for the day than dogs fed a moderate fiber (9%) diet (Group 2) during the morning feeding. Both groups were fed the Control diet (Purina Dog Chow Little Bites), to appetite, during the afternoon feeding period. (Jackson JR, as presented at the 1995 Purina Nutrition Forum)
Group 1 Group 2 PM Total

0 AM PM Total AM

* significantly different from Group 1 for same period, p<0.05

reduced their calorie intake. This was true even when they were subsequently offered a palatable, low fiber food. Under these conditions, fiber was associated with significantly lower total calorie intake. The implications of this are that dietary fiber does provide a satiety effect and can help reduce voluntary calorie intake. In addition to satiety, a high fiber, low fat diet may be beneficial in terms of the composition of weight loss. Dogs fed a high fiber, low fat (27% fiber, 7% fat) diet lost a greater
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percentage of body fat than dogs fed a low fiber, high fat (3% fiber, 18% fat) diet at the same calorie intake.1 The ability of high fiber diets to reduce voluntary food intake and to influence the composition of weight lost suggests that moderate to high fiber diets should be beneficial in canine weight management programs.
References
1. Borne AT, Wolfsheimer KJ, Truett AA, et al. Obesity Res 1996;4:337-345. 2. Butterwick RF, Markwell PJ. AJVR 1997;58:272. 3. Jackson JR, Laflamme DP, Keltner G. Vet Clin Nutr [Abstr] 1995;2:143. 4. Jewell DE, Toll PW. Vet Clin Nutr 1996;3:115. 5. Laflamme DP, Kuhlman G. Nutr Res 1995;15:1019.

PurinaResearchReport

Geriatric Nutrition Feline Blood Pressure Dietary Protein Dietary Fiber

In this issue:

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