Who's a good boy? Effects of dog and owner body weight on veterinarian perceptions and treatment recommendations.

BACKGROUND: Weight bias against persons with obesity impairs health care delivery and utilization and contributes to poorer health outcomes. Despite rising rates of pet obesity (including among dogs), the potential for weight bias in veterinary settings has not been examined. SUBJECTS/METHODS: In two online, 2 × 2 experimental studies, the effects of dog and owner body weight on perceptions and treatment recommendations were investigated in 205 practicing veterinarians (Study 1) and 103 veterinary students (Study 2). In both studies, participants were randomly assigned to view one of four vignettes of a dog and owners with varying weight statuses (lean vs. obesity). Dependent measures included emotion/liking ratings toward the dog and owners; perceived causes of the dog's weight; and treatment recommendations and compliance expectations. Other clinical practices, such as terms to describe excess weight in dogs, were also assessed. RESULTS: Veterinarians and students both reported feeling more blame, frustration, and disgust toward dogs with obesity and their owners than toward lean dogs and their owners (p values < 0.001). Interactions between dog and owner body weight emerged for perceived causes of obesity, such that owners with obesity were perceived as causing the dog with obesity's weight, while lean owners were perceived as causing the lean dog's weight. Participants were pessimistic about treatment compliance from owners of the dog with obesity, and weight loss treatment was recommended for the dog with obesity when presenting with a medical condition ambiguous in its relationship to weight. Veterinarians and students also reported use of stigmatizing terms to describe excess weight in dogs. CONCLUSIONS: Findings from this investigation, with replication, have implications for training and practice guidelines in veterinary medicine.

2014 AAHA weight management guidelines for dogs and cats.

Communicating and implementing a weight management program for dogs and cats can be a challenging endeavor for veterinarians, but a rewarding one. An effective individualized weight loss program provides a consistent and healthy rate of weight loss to reduce risk of disease, prevent malnutrition, and improve quality of life. Weight loss is achieved with appropriate caloric restriction, diet selection, exercise, and strategies to help modify behavior of both the pet and client. This document offers guidelines and tools for the management of weight loss and long-term maintenance of healthy weight.

Correlation of a feline muscle mass score with body composition determined by dual-energy X-ray absorptiometry.

Body condition scoring (BCS) systems primarily assess body fat. Both overweight and underweight animals may have loss of lean tissue that may not be noted using standard BCS systems. Catabolism of lean tissue can occur rapidly, may account for a disproportionate amount of body mass loss in sick cats and can have deleterious consequences for outcome. Therefore, along with evaluation of body fat, patients should undergo evaluation of muscle mass. The aims of the present study were first to evaluate the repeatability and reproducibility of a 4-point feline muscle mass scoring (MMS) system and second to assess the convergent validity of MMS by dual-energy X-ray absorptiometry (DXA). MMS was as follows: 3, normal muscle mass; 2, slight wasting; 1, moderate wasting; 0, severe wasting. For the first aim, forty-four cats were selected for evaluation based on age and BCS, and for the second aim, thirty-three cats were selected based on age, BCS and MMS. Cats were scored by ten different evaluators on three separate occasions. Body composition was determined by DXA. Inter- and intra-rater agreement were assessed using kappa analysis. Correlation between MMS and BCS, age, percentage lean body mass and lean body mass (LBM) was determined using Spearman's rank-order correlation. The MMS showed moderate inter-rater agreement in cats that scored normal or severely wasted (κ = 0.48-0.53). Intra-rater agreement was substantial (κ = 0.71-0.73). The MMS was significantly correlated with BCS (r 0.76, P < 0.0001), age (r - 0.75, P < 0.0001), LBM (g) (r 0.62, P < 0.0001) and percentage LBM (r - 0.49, P < 0.0035). Additional investigation is needed to determine whether the MMS can be refined and to assess its clinical applicability.

Evaluation of the effect of signalment and body conformation on activity monitoring in companion dogs.

OBJECTIVE: To evaluate the effect of signalment and body conformation on activity monitoring in companion dogs. ANIMALS: 104 companion dogs. PROCEDURES: While wearing an activity monitor, each dog was led through a series of standard activities: lying down, walking laps, trotting laps, and trotting up and down stairs. Linear regression analysis was used to determine which signalment and body conformation factors were associated with activity counts. RESULTS: There was no significant effect of signalment or body conformation on activity counts when dogs were lying down, walking laps, and trotting laps. However, when dogs were trotting up and down stairs, there was a significant effect of age and body weight such that, for every 1-kg increase in body weight, there was a 1.7% (95% confidence interval, 1.1% to 2.4%) decrease in activity counts and for every 1-year increase in age, there was a 4.2% (95% confidence interval, 1.4% to 6.9%) decrease in activity counts. CONCLUSIONS AND CLINICAL RELEVANCE: When activity was well controlled, there was no significant effect of signalment or body conformation on activity counts recorded by the activity monitor. However, when activity was less controlled, older dogs and larger dogs had lower activity counts than younger and smaller dogs. The wide range in body conformation (eg, limb or body length) among dogs did not appear to significantly impact the activity counts recorded by the monitor, but age and body weight did and must be considered in analysis of data collected from the monitors.

Usefulness of muscle condition score and ultrasonographic measurements for assessment of muscle mass in cats with cachexia and sarcopenia.

OBJECTIVE: To compare muscle condition scores (MCSs) and muscle ultrasonographic measurements in cats with and without muscle loss and to evaluate repeatability and reproducibility of MCS assessment. ANIMALS: 40 cats of various ages, body condition scores (BCSs), and MCSs. PROCEDURES: A prospective cross-sectional study was conducted. Body weight, BCS, MCS, epaxial muscle height (EMH), vertebral epaxial muscle score (VEMS), and forelimb epaxial muscle score (FLEMS) were assessed in each cat. The MCS for each cat was assessed 3 separate times by each of 5 raters. RESULTS: The MCS was significantly correlated with EMH (r = 0.59), VEMS (r = 0.66), and FLEMS (r = 0.41). For MCS, the overall value of the κ coefficient for interrater agreement (reproducibility) was 0.43 and the overall value of the κ coefficient for intrarater agreement (repeatability) ranged from 0.49 to 0.76. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasonographic measurements of muscle may be useful for assessing muscle loss in individual cats over time. However, for the cats of this study, no advantage was observed for assessment of VEMS or FLEMS over EMH. Substantial repeatability and moderate reproducibility were shown when MCS was used for assessment of muscle mass in cats. Prospective ultrasonographic studies are warranted to evaluate the usefulness of MCS and EMH assessment for evaluation of changes in muscle mass of cats over time.

Evaluation of optimal sampling interval for activity monitoring in companion dogs.

OBJECTIVE-To determine by use of an accelerometer the sampling interval that has the least variable total activity counts from one week to the next in companion (ie, nonlaboratory) dogs. ANIMALS-80 dogs. PROCEDURES-Dogs wore an accelerometer continuously for 2 weeks. Between-dog and within-dog day-to-day variability in total activity counts were evaluated. The changes in counts between week 1 and week 2 were compared for weekdays, weekends, and full weeks. RESULTS-Significant between-dog variability in total activity counts was detected. Within dogs, there was significant day-to-day variability, with highest counts recorded on weekends. In comparison of data from the first week with data from the second week, the greatest differences were in weekend counts (median difference, 21%; range, 0% to 154%) and the smallest differences were in full 7-day counts (median difference, 10%; range, 0% to 74%). Comparison of weekday counts revealed a median change of 12% (range, 0% to 104%). CONCLUSIONS AND CLINICAL RELEVANCE-Significant between-dog variability in total daily activity counts was detected. Within dogs, a full 7-day comparison of total activity counts from one week to the next provided the least variable estimate of the dogs' activity. For dogs in their home environment, the activity monitor may be most useful in following changes in activity over time. For dogs that have no change in routine according to the owner's report, the least variable estimates of activity can be collected by comparing activity in 7-day intervals.

Evaluation of the use of muscle condition score and ultrasonographic measurements for assessment of muscle mass in dogs.

OBJECTIVE: To evaluate repeatability and reproducibility of muscle condition score (MCS) in dogs with various degrees of muscle loss; to compare MCS, muscle ultrasonographic measurements, and quantitative magnetic resonance (QMR) measurements; and to identify cutoff values for ultrasonographic measurements of muscle that can be used to identify dogs with cachexia and sarcopenia. ANIMALS: 40 dogs of various age, body condition score (BCS), and MCS. PROCEDURES: A prospective cross-sectional study was conducted. Body weight, BCS, QMR measurements, thoracic radiographic measurements, and muscle ultrasonographic measurements were assessed once in each dog. The MCS for each dog was assessed 3 separate times by 4 separate raters. RESULTS: For the MCS, overall κ for interrater agreement was 0.50 and overall κ for intrarater agreement ranged from 0.59 to 0.77. For both interrater and intrarater agreement, κ coefficients were higher for dogs with normal muscle mass and severe muscle loss and lower for dogs with mild and moderate muscle loss. The MCS was significantly correlated with age (r = -0.62), vertebral epaxial muscle score (VEMS; r = 0.71), forelimb epaxial muscle score (FLEMS; r = 0.58), and BCS (r = 0.73), and VEMS was significantly correlated (r = 0.84) with FLEMS. Cutoff values for identification of mild muscle loss determined by use of VEMS and FLEMS were 1.124 and 1.666, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: MCS had substantial repeatability and moderate reproducibility for assessment of muscle mass in dogs. Prospective studies of MCS, VEMS, and FLEMS for assessment of muscle mass in dogs are warranted.

Exploring human/animal intersections: converging lines of evidence in comparative models of aging.

At a symposium convened on March 8, 2007 by the Institute on Aging at the University of Pennsylvania, researchers from the University's Schools of Medicine and Veterinary Medicine explored the convergence of aging research emerging from the two schools. Studies in human patients, animal models, and companion animals have revealed different but complementary aspects of the aging process, ranging from fundamental biologic aspects of aging to the treatment of age-related diseases, both experimentally and in clinical practice. Participants concluded that neither animal nor human research alone will provide answers to most questions about the aging process. Instead, an optimal translational research model supports a bidirectional flow of information from animal models to clinical research.

A prospective investigation of the prevalence and prognostic significance of weight loss and changes in body condition in feline cancer patients.

The objectives of this study were to prospectively identify and characterize weight loss and changes in body condition in feline cancer patients and to investigate the prognostic significance of these findings. Fifty-seven cats with neoplasia were evaluated. Body condition was assessed with a nine-point scoring system (BCS) and multiple sites were assessed for muscle and fat mass using four-point scoring systems. Feline cancer patients had a mean BCS of 4.4+/-2.1 kg (1=cachectic, 5=optimal, 9=obese). Fat mass was reduced in both sites assessed in 60% of the patients. Muscle mass was reduced at all three sites assessed in 91% of the patients. Feline cancer patients having a BCS <5 had a median survival time (MST) of 3.3 months compared to that of 16.7 months for cats with a BCS of > or = 5 (P=0.008).

Effects of various diets on the calcium and phosphorus composition of mealworms (Tenebrio molitor larvae) and superworms (Zophobas morio larvae).

OBJECTIVE To evaluate whether the nutritive quality of Tenebrio molitor larvae and Zophobas morio larvae, which are commonly cultured as live food sources, is influenced by 4 commercially available diets used as nutritional substrates; identify which diet best improved calcium content of larvae; and identify the feeding time interval that assured the highest calcium intake by larvae. ANIMALS 2,000 Zophobas morio larvae (ie, superworms) and 7,500 Tenebrio molitor larvae (ie, mealworms). PROCEDURES Larvae were placed in control and diet treatment groups for 2-, 7-, and 10-day intervals. Treatment diets were as follows: wheat millings, avian hand feeding formula, organic avian mash diet, and a high-calcium cricket feed. Control groups received water only. After treatment, larvae were flash-frozen live with liquid nitrogen in preparation for complete proximate and mineral analyses. Analyses for the 2-day treatment group were performed in triplicate. RESULTS The nutrient composition of the high-calcium cricket feed groups had significant changes in calcium content, phosphorus content, and metabolizable energy at the 2-day interval, compared with other treatment groups, for both mealworms and superworms. Calcium content and calcium-to-phosphorus ratios for larvae in the high-calcium cricket feed group were the highest among the diet treatments for all treatment intervals and for both larval species. CONCLUSIONS AND CLINICAL RELEVANCE A 2-day interval with the high-calcium cricket feed achieved a larval nutrient composition sufficient to meet National Research Council dietary calcium recommendations for nonlactating rats. Mealworm calcium composition reached 2,420 g/1,000 kcal at 48 hours, and superworm calcium composition reached 2,070g/1,000 kcal at 48 hours. These findings may enable pet owners, veterinarians, insect breeders, and zoo curators to optimize nutritive content of larvae fed to insectivorous animals.

Evaluation of cats fed vegetarian diets and attitudes of their caregivers.

OBJECTIVE: To determine motivation and feeding practices of people who feed their cats vegetarian diets as well as taurine and cobalamin status of cats consuming vegetarian diets. DESIGN: Cross-sectional study. ANIMALS: 34 cats that had been exclusively fed a commercial or homemade vegetarian diet and 52 cats that had been fed a conventional diet for > or = 1 year. PROCEDURES: Participants were recruited through a Web site and from attendees of a national animal welfare conference. Caregivers of cats in both groups answered a telephone questionnaire regarding feeding practices for their cats. Blood was obtained from a subset of cats that had been fed vegetarian diets. Blood and plasma taurine and serum cobalamin concentrations were measured. RESULTS: People who fed vegetarian diets to their cats did so largely for ethical considerations and were more likely than people who fed conventional diets to believe that there are health benefits associated with a vegetarian diet and that conventional commercial cat foods are unwholesome. Both groups were aware of the potential health problems that could arise from improperly formulated vegetarian diets. All cats evaluated had serum cobalamin concentrations within reference range, and 14 of 17 had blood taurine concentrations within reference range. CONCLUSIONS AND CLINICAL RELEVANCE: Vegetarian diets are fed to cats primarily for ethical considerations. Results of this study should aid practitioners in communicating with and providing advice to such clients.

Disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements.

OBJECTIVE: To estimate disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements. DESIGN: Telephone survey. Sample Population-Dog and cat owners located in 5 geographic areas. PROCEDURES: A telephone survey was administered to dog and cat owners. RESULTS: Of 18,194 telephone calls that were made, 1,104 (6%) were to individuals who owned at least 1 dog or cat and agreed to participate. Information was collected for 635 dogs and 469 cats. Only 14 (1%) respondents indicated that their pet was unhealthy, but 176 (16%) indicated that their pets had 1 or more diseases. The most common diseases were musculo-skeletal, dental, and gastrointestinal tract or hepatic disease. Many owners (n = 356) reported their pets were overweight or obese, but only 3 reported obesity as a health problem in their pets. Owners of 28 (2.5%) animals reported that they were feeding a therapeutic diet, with the most common being diets for animals with renal disease (n = 5), reduced-calorie diets (5), and reduced-fat diets (4). Owners of 107 of 1,076 (9.9%) animals reported administering dietary supplements to their pets. Multivitamins (n = 53 animals), chondroprotective agents (22), and fatty acids (13) were the most common dietary supplements used. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that most dogs and cats reported by their owners to have a health problem were not being fed a therapeutic diet. In addition, the rate of dietary supplement use was lower than that reported for people.

Unconventional diets for dogs and cats.

Food plays a far more complex role in daily life than simply serving as sustenance. Social and cultural factors along with individual beliefs govern people's eating behaviors, and it is likely that these same factors influence their choice of diet and feeding practices for their pets. Some people seek alternatives to conventional commercial pet foods, including commercially available "natural" diets, raw food diets, and vegetarian diets, in addition to a variety of home-prepared diets. Exploring a person's knowledge and beliefs about feeding pets can aid in understanding her or his motives for seeking alternative and may help in changing those practices when it is in the best interest of the pet to do so.

Impact of time-limited feeding and dietary carbohydrate content on weight loss in group-housed cats.

Twenty-four adult cats were transitioned to time-limited feeding and randomized to either a dry low carbohydrate diet (LC) or a dry reduced energy diet (HC). In Trial 1 the LC and HC groups received equal amounts of food (by weight) for 13 weeks. Both groups consumed all food offered, hence the LC group received more energy/day than the HC group. In Trial 2 all cats were fed the LC diet for 12 weeks, but each group received the energy that the opposite group had received in Trial 1. In Trial 1 only the overweight HC cats (body condition score> 6/9) experienced a significant change in body weight (-0.52 +/- 0.08 kg). In Trial 2, LC/Low Calorie overweight cats lost 0.62 +/- 0.10 kg, whereas, the LC/High Calorie normal weight cats gained 0.68 +/- 0.05 kg. In conclusion, body condition and energy intake but not type of diet influenced weight in this cohort of group-housed cats.

Evaluation of body condition and weight loss in dogs presented to a veterinary oncology service.

Cancer cachexia is a well-recognized syndrome in human patients that is characterized by progressive involuntary weight loss. The prevalence of this syndrome in veterinary cancer patients is unknown. This study's objective was to investigate the occurrence of weight loss and cachexia, as characterized by body condition scoring, in dogs presented to a veterinary oncology service. Information collected on 100 dogs included signalment, diagnosis, weight at time of diagnosis, and, when available, weight from a time approximately 12 months before diagnosis. Body condition was assessed by using a 9-point system based on body silhouette and palpation of adipose tissue (4-5 = optimal, 1 = extreme cachexia, 9 = extreme obesity). Muscle wasting was scored based on palpation of skeletal muscle (3 = no wasting, 2 = mild, 1 = moderate, 0 = severe). Only 4% of the dogs exhibited cachexia as defined by a body condition score < or = 3, whereas 29% were classified as markedly overweight (> or = 7). Fifteen percent had evidence of clinically relevant muscle wasting (< or = 1). Body weight from a time before the diagnosis of cancer was available for 64 dogs. At the time of diagnosis, 31% had maintained or gained weight, 31% had lost up to 5%, 14% had lost between 5 and 10%, and 23% had lost >10% of body weight. Overall, the percentage of dogs with signs indicating a decline in nutritional status was less than what has been reported for human cancer patients. Future studies should investigate the extent to which weight loss occurs in canine patients on an appropriate plane of nutrition as well as to establish whether an association exists between poor nutritional status and outcome in canine cancer patients.

Intestinal permeability and absorption in dogs with traumatic injury.

The objectives of this study were to assess the feasibility of using urinary recovery of sugars to evaluate intestinal permeability and absorption in dogs with traumatic injury and to determine if intestinal permeability and absorption are altered in dogs with traumatic injury. After a 6-hour fast, a sugar solution containing lactulose, rhamnose, 3-0-methyl-D-glucose, and xylose was administered via nasoesophageal tube. Urine was collected and quantitated over the 6-hour study period via closed collection urinary catheters. Urinary sugar recoveries were measured by high-pressure anion exchange liquid chromatography and pulsed amperometric detection. Urinary sugar recoveries in the trauma group at 24, 48, and 72 hours after trauma were compared to normal controls. In addition, severity of trauma was compared to urinary sugar recoveries. Twelve client-owned dogs with traumatic injury and 6 healthy controls were enrolled in the study. Lactulose recovery and the lactulose:rhamnose recovery ratio were significantly higher in the trauma group at 48 hours but were no longer different from controls by 72 hours. Xylose recovery was significantly higher in the trauma group when compared to controls at 72 hours, whereas 3-O-methyl-D-glucose recovery was significantly lower in the trauma group at 24 hours. The xylose: 3-O-methyl-D-glucose ratio was higher in the trauma group at all time points. Significant correlation was found between severity of trauma and xylose and 3-O-methyl-D-glucose recoveries 24 hours after injury. Results of this study support the hypothesis that intestinal permeability and absorption are altered in dogs with traumatic injury.

Short chain fatty acids stimulate feline colonic smooth muscle contraction.

The effect of short chain fatty acids (SCFA) on feline colonic smooth muscle contraction was evaluated in vitro. Colonic tissue was obtained from seven healthy male and female adult cats and seven healthy male and female kittens. Longitudinal and circular colonic smooth muscle strips from proximal and distal colon were incubated with SCFA (acetate, butyrate and propionate; 1-100mM). SCFA-induced contractions were compared to responses obtained using maximal concentrations (10(-4)M) of acetylcholine (ACh). The calcium dependence of the SCFA response was investigated by incubating with nifedipine (1 microM) or verapamil (1 microM). Acetate, butyrate and propionate elicited isometric stress responses (0.25-1.98 x 10(4)N/m(2)) in longitudinal, but not circular, smooth muscle from both the proximal and distal colon of adult cats. Maximal responses were attained at 50 and 100mM SCFA. Maximal butyrate and propionate responses were 29 and 19% of the maximal ACh response (10(-4)M), respectively. Acetate was least effective in stimulating contractile responses. Nifedipine and verapamil abolished all responses. Contractile responses in kittens were similar to those observed in adult cats, but were smaller in amplitude. Results of these studies have shown that SCFA stimulate longitudinal colonic smooth muscle contractions in kittens and adult cats in vitro. These SCFA-induced contractions involve activation of calcium influx. These in vitro findings may account for some of the effects of dietary fiber on feline colonic motility in vivo.

Identification and concentration of soy phytoestrogens in commercial dog foods.

OBJECTIVE: To identify and determine the concentrations of phytoestrogens in commercial dog foods. SAMPLE POPULATION: 24 commercial dog foods, including 12 moist or dry extruded commercial dog foods that contained soybeans or soybean fractions and 12 foods without any soybean-related ingredients listed on the label. PROCEDURE: Foods were analyzed for phytoestrogen content, including 4 isoflavones (genistein, glycitein, daidzein, and biochanin A), 1 coumestan (coumestrol), and 2 lignans (secoisolariciresinol and matairesinol) by use of acid-methanol hydrolysis and high-pressure liquid chromatography with UV-absorbance detection. Phytoestrogens were identified and quantified by reference to authentic standards. RESULTS: Isoflavones, coumestans, and lignans were undetectable in diets that did not list soybean-related ingredients on the label. Only 1 of the 12 diets that included soybean or soybean fractions had undetectable concentrations of phytoestrogens and that product contained soy fiber. The major phytoestrogens were the isoflavones daidzein (24 to 615 microg/g of dry matter) and genistein (4 to 238 microg/g of dry matter). CONCLUSIONS AND CLINICAL RELEVANCE: Soybean and soybean fractions are commonly used ingredients in commercial dog foods. Dietary intake of phytoestrogens may have both beneficial and deleterious health effects. Our results indicated that certain commercial dog foods contain phytoestrogens in amounts that could have biological effects when ingested long-term.

Effect of short-chain fatty acids on contraction of smooth muscle in the canine colon.

OBJECTIVE: To determine effects of short-chain fatty acids (SCFA) on canine colonic smooth muscle. SAMPLE POPULATION: Colonic tissue obtained from 14 healthy dogs. PROCEDURE: Short-chain fatty acid (SCFA; acetate, propionate, and butyrate; 1 to 100 mmol/L)-induced contractions were compared with responses obtained with acetylmethylcholine (AMCh; 10(-4) mol/L). Roles of enteric neurons, cholinergic receptors, calcium stores in the sarcoplasmic reticulum, and extracellular calcium in the SCFA-induced responses were investigated by incubating muscle strips with tetrodotoxin (1 micromol/L), atropine (1 micromol/L), ryanodine (10 micromol/L), nifedipine (1 micromol/L), ethylene glycol-bis (beta-aminoethylether)-N,N,N',N'-tetra-acetate (EGTA; 0.1 mmol/L), or an extracellular calcium-depleted (zero extracellular calcium) solution prior to the addition of propionate or butyrate. RESULTS: Incubation with SCFA elicited isometric stress responses (0.25 to 2.15 x 10(4) N/m2) in colonic longitudinal smooth muscle. Maximal responses to butyrate and propionate (50 mmol/L) were 37 and 23%, respectively, of the maximal AMCh response. Acetate was least effective in stimulating contractile responses. Tetrodotoxin and atropine did not affect SCFA-induced contractions. Nifedipine and zero extracellular calcium solution abolished responses to butyrate and propionate, whereas EGTA attenuated (> 60%) but did not abolish those responses. Ryanodine did not affect SCFA-induced contractile responses. The SCFA did not affect colonic circular smooth muscle. CONCLUSIONS AND CLINICAL RESPONSE: The SCFA stimulate longitudinal but not circular colonic smooth muscle contractions via a direct effect on smooth muscle. The mechanism of the SCFA effect appears to involve the influx of extracellular calcium. These findings may account for some of the effects of fiber on canine colonic motility [corrected].

Preventing and managing complications of enteral nutritional support.

Complications of enteral nutritional support include mechanical problems related to the feeding device, gastrointestinal side effects, metabolic disturbances, and infectious complications. Although the sickest patients are often the ones that we feel will most likely benefit from nutritional support, they are generally more challenging to feed and least likely to tolerate complications arising from assisted feeding. Many of the problems that can occur with enteral nutritional support can be anticipated, which may allow them to be avoided or possibly aid in early detection and thereby minimize consequences to the patient. Therefore, knowledge of the types of complications that can occur with enteral nutritional support will aid in the process of deciding whether and how a patient should receive assisted feeding, and what parameters to monitor while a patient is receiving nutritional support.