Nutritional assessment

WSAVA guideline

Key findings

• Vital signs as printed: 1 Temperature, 2 Pulse, 3 Respiration, 4 Pain assessment, 5 Nutritional assessment [GL2011, Intro].
• Screening = every patient; if no concerns, assessment is complete. Importance of extended evaluation rises with the number and severity of risk factors; "sufficient concern about any one parameter may be enough" [GL2011 pp.2–3].
• Table 1 risk factors (Checklist "MANDATORY"): altered GI function (vomiting, diarrhoea, nausea, flatulence, constipation); previous/ongoing disease; medications and/or dietary supplements; unconventional diet (raw, homemade, vegetarian, unfamiliar); snacks/treats/table food >10% of total calories; inadequate/inappropriate housing; BCS <4 or >5 (9-point); any MCS muscle wasting; unexplained weight change; dental disease; poor skin/haircoat; new disease [GL2011 Table 1; Checklist 2013].
• "OPTIONAL" life factors (closer scrutiny alone, may not trigger extended evaluation): low/high activity, multiple pets, gestation, lactation, age <1 year or >7 years [GL2011 p.3; Checklist 2013].
• Three domains: animal → nutrient-sensitive disorders (intolerances, allergies, organ-specific disease); diet → diet-induced disorders (imbalances, spoilage, contamination, adulteration); feeding/environment → over-/underfeeding, excessive treats, poor husbandry, competitive eating, lack of stimulation — client communication drives behaviour change [GL2011 p.2].
• Extended work-up: CBC (anemia), urinalysis, biochemistry (electrolytes, albumin), fecal culture, targeted nutrient assays for unbalanced diets (taurine, vitamin B12, iron); imaging/endoscopy as indicated; review drugs (e.g., diuretics) and procedures (intestinal resection, drains) causing nutrient loss/malabsorption; assess intake/behaviour changes and integument condition [GL2011 p.5].
• Diet-factor checks: caloric density (kcal per g/can/cup) if BCS off-target; other nutrient sources (treats, table food, supplements, medication vehicles, rawhides); suspect food submitted for testing (aafco.org); AAFCO statement ("formulated to meet" = chemical analysis, caution, vs feeding trials); homemade → board-certified nutritionist; cats need amino acids and arachidonic acid [GL2011 pp.5–6].
• Environment affects nutrition directly: feline lower-urinary-tract signs vary with environment regardless of diet (MEMO studies); competitive eating, coprophagia, obesity linked to environmental + animal + dietary factors; food-dispensing toys may improve welfare [GL2011 p.6].
• Definitions: satisfactory diet = complete, balanced, digestible, palatable, sufficient, safe; life stages = growth, reproduction, adult (AAFCO) [GL2011 p.10].

Recommendations

• Make nutrition the 5th vital assessment; screen every dog and cat every visit

  Guideline standard ("little to no additional time or cost")

• Choose ONE BCS/MCS system used consistently clinic-wide; record the denominator

  Guideline ("panel recommends")

• Trigger extended evaluation when ≥1 Table 1 risk factor present/suspected

  Guideline (Table 1)

• Trained interviewer for the most knowledgeable caregiver; use diet-history forms

  Guideline

• Extended patients: minimum database + targeted nutrient assays (taurine, B12, iron)

  Guideline

• Homemade diets: board-certified nutritionist (ACVN/ECVCN); honor cat amino-acid needs

  Guideline

• Energy: inpatients RER formulas; outpatients label/formula start point (±50% 🐈, ±30% 🐕)

  Guideline (NRC 2006)

• Monitoring plan (intake/appetite, BCS+BW, GI signs, activity); pregnant/lactating/senior/growing more often

  Guideline

• Teach clients BCS/MCS; address adherence barriers (schedule, complexity, finances — OTC options)

  Guideline (client education)

• Diet change: transition over 7–10 days if GI issues; no proven superior method

  Guideline (expert opinion)

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