Abstract
Objectives
Although less frequently described than in dogs, it is also well recognised in cats that chronic gastrointestinal (GI) disease can fully respond to dietary changes only. So far, no study has assessed how much dietary information can be obtained during veterinary consultations.
Methods
We retrospectively evaluated how much dietary information was available when owners presenting their cats to our gastroenterology (GE) and internal medicine (IM) service between October 2017 and January 2020 were questioned during consultations. Because of the larger IM caseload, for each week the first two cats presenting with chronic GI signs were selected for the IM group. Data from 80 cats presenting for first GE consultations were compared with data from 84 cats presenting with chronic GI signs for first IM consultations.
Results
Referrals comprised 42/80 (53%) GE cats and 53/84 (63%) IM cats. Referral documents mentioned the previously fed diet in 12/42 (29%) GE and 4/53 (8%) IM cats, and response to that previous diet trial was recorded in the referral documents of 4/12 (33%) GE and 3/4 (75%) IM cats. No cat had received more than one previous diet trial. During consultations, owners of 61/80 (76%) GE and 53/84 (63%) IM cats were asked about diet. Irrespective of referral status, previous dietary trials had been performed in 27/61 (44%) GE and 19/53 (36%) IM cats. The specific diet fed at the time of consultation could be named by 37/61 (61%) GE and 11/53 (21%) IM cat owners.
Conclusions and relevance
Overall dietary information gained from referring veterinarians and owners was often incomplete. Although more information could be gained from owners during GE consultations vs IM consultations, awareness of the importance of diet in cats with GI disease still appears to be low among veterinarians and cat owners. Future studies need to assess if more complete dietary information can be obtained at the time of consultations with a prospective study design.
Keywords: Food, diet, enteropathy, gastrointestinal, history
Introduction
Gastrointestinal (GI) disease is common, especially in the elderly cat population.1–3 Although there is no uniform classification scheme for enteropathies, non-neoplastic cases are usually subclassified based on the response to treatment into food-responsive enteropathy and steroid-responsive idiopathic inflammatory bowel disease (IBD).1,3,4 In general, more information on response to diet is available for cats with chronic clinical signs;3–7 however, dietary intervention may also be successful when treating acute diarrhoea. 8 Despite the established importance of diet in the management of GI disease, it has been our clinical experience that the majority of cat owners do not know what diet they have been feeding when asked during consultations. The situation seems to be similar when assessing what dietary information is obtainable from referral documents. Not knowing the cat’s current and previous diets understandably complicates the choice of a new diet and thus may compromise dietary success, which is why we aimed to assess how much dietary information is obtainable from owners during consultations in this study. We hypothesised that basic information (what diet was fed and the response to the diet) would be scarce in referral documents, and that the majority of cat owners would not be able to name diets that had been tried before or were fed at the time of consultation. We further hypothesised that less dietary information would be obtainable from owners presenting their cats to the internal medicine (IM) service vs owners presenting their cats to a gastroenterology (GE) service, a subspecialty of our IM service.
Materials and methods
Case selection and data collection
All data were obtained from the hospital information system (Vetera) at the Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich. Anamnestic information was recorded from cats presented to the GE service for GI signs, as well as from cats presented to the general IM service for GI signs. Cats presenting for a first appointment between October 2017 and January 2020 were included. In order to be selected for the IM group, cats had to present for GI signs, and secondary GI disease (eg, endocrine or renal disease) had to be ruled out. Because of the larger IM caseload, for each week the first two cats presenting with chronic GI signs were selected for the IM group. Demographic data (breed, age, sex, body weight and referral status [yes/no]) were compiled. At our hospital, owners can also schedule an appointment for a second opinion without having been referred. All pretreatments (dietary and medical) for GI signs were recorded. Pretreatment was subdivided into the following categories: dietary, probiotics, antibiotics, corticosteroids or immunosuppressive drugs other than corticosteroids. Available information on previous diet trials and the current diet was extracted from the clinic system. In referred patients, the referral documents were screened for information on previous diet trials and response to diet. Medical records were screened to see if the following questions had been asked: What diet(s) had been fed (name)? How many diets were tried before consultation? For how long had they been tried? What were the responses? Whether the following information could be obtained from our records was also noted: the name of the cat’s current diet, if the diets were home-made or raw meat-based (RMB) and if the cat received any additional foods (eg, cooked chicken or chicken hearts) or treats.
It was further recorded whether a diet had been prescribed by the attending clinician at our hospital and what type of diet it was. Diets were classified as highly digestible, hydrolysed protein or limited ingredient novel protein, according to the manufacturer’s description. Highly digestible diets included Royal Canin Veterinary Diet Sensitivity Control and Gastrointestinal, and Hill’s Prescription Diet i/d. Hydrolysed diets included Royal Canin Veterinary Diet Hypoallergenic and Hill’s Prescription Diet z/d. Limited ingredient novel protein diets included Vet-concept limited-ingredient novel protein (Sana) diets and Hill’s Prescription Diet d/d. ‘Other diet’ refers to any other diet. Microsoft Excel (version 16.35 for Mac) was used for data compilation and the calculation of medians, ranges and percentages.
Results
Study population
Eighty cats were included in the GE group and 84 in the IM group. Demographic details are provided in Table 1. The most common breeds in the GE group were European Shorthair (n = 54; 68%), Bengal (n = 5; 6%) and Maine Coon (n = 3; 4%). The most common cat breeds in the IM group were European Shorthair (n = 50; 60%), Bengal (n = 5; 6%) and British Shorthair (n = 5; 6%).
Table 1.
Demographic details of the study population
| Gastroenterology cats (n = 80) | Internal medicine cats (n = 84) | |
|---|---|---|
| Median (range) age (years) | 13.5 (1–20) | 10 (1–20) |
| Sex | 49 (61%) MC | 50 (60%) males; 45 MC |
| 31 (39%) females; 27 FS | 34 (40%) females; 32 FS | |
| Median (range) body weight (kg) | 4.2 (1.8–7.5) | 4.1 (1–9) |
MN = male castrated; FS = female spayed
Pretreatment
Information on pretreatment can be found in Table 2. Of those cats that received probiotics, a high-dose (minimum 200 billion bacteria) multistrain probiotic 9 had been given to 3/5 (60%) GE cats and none of the IM cats. The other two GE cats had received a combination of a prebiotic with Enterococcus faecium (Protexin Synbiotic D-C), and a probiotic containing E faecium (Purina FortiFlora) had been given to the three cats in the IM group.
Table 2.
Pretreatment, summarised into categories
| Gastroenterology cats (n = 80) | Internal medicine cats (n = 84) | |
|---|---|---|
| Dietary | 6 (8) | 5 (6) |
| Probiotics | 5 (6) | 3 (4) |
| Antibiotics | 17 (21) | 23 (27) |
| Corticosteroids | 17 (21) | 15 (18) |
| Immunosuppressive drugs other than corticosteroids | 0 (0) | 0 (0) |
Data are presented as n (%)
Dietary information available from referring veterinarians
Table 3 outlines information gained from referral documents. All referred cases had chronic GI signs (⩾3 weeks’ duration) from the time the referral was made. None of the referral documents mentioned more than one diet trial for the GI signs.
Table 3.
Diet-related information available from referring veterinarians for cats presenting with chronic gastrointestinal signs
| Gastroenterology cats | Internal medicine cats | |
|---|---|---|
| Number of referred cats | 42/80 (53) | 53/84 (63) |
| Previous diet trial mentioned in referral | 12/42 (29) | 4/53 (8) |
| Response to diet trial mentioned in referral | 4/12 (33) | 3/4 (75) |
Data are presented as n (%)
Dietary information gained during consultation at our hospital
Table 4 outlines what dietary information could be gained during consultations at our hospital. If more than one diet trial had been tried before consultation, no information on the length of or response to those additional diet trials was available.
Table 4.
Dietary information gained from owners of cats with chronic gastrointestinal signs during consultation at our hospital
| Gastroenterology cats | Internal medicine cats | |
|---|---|---|
| Clinician inquired about cat’s diet | 61/80 (76) | 53/84 (63) |
| Previous diet trial performed | 27/61 (44) | 19/53 (36) |
| Median (range) number of previous diet trials | 1 (1–3) | 1 (1–4) |
| Median (range) duration of previous diet trials (weeks) | 4 (2–15) | 5 (1–12) |
| Response to previous diet trials recorded | 23/27 (85) | 8/19 (42) |
| Manufacturer of diet could be named for current diet | 50/61 (82) | 15/53 (28) |
| Specific diet currently fed named | 37/61 (61) | 11/53 (21) |
Data are presented as n (%) unless stated otherwise
Fifty of 61 (82%) GE cat owners and 15/53 (28%) of IM cat owners could only remember the manufacturer (eg, Royal Canin) of the current diet. The actual specific diet (manufacturer and product) currently fed could be named by only 37/61 (61%) GE cat owners and 11/53 (21%) IM cat owners. The available information on what types of diet had been fed are provided in Table 5.
Table 5.
Type of diets fed at the time of consultation at our hospital
| Type of diet | Gastroenterology cats (n = 38) | Internal medicine cats (n = 14) |
|---|---|---|
| Highly digestible diet | 12 (32) | 9 (64) |
| Hydrolysed diet | 11 (29) | 1 (7) |
| Limited ingredient novel protein diet | 2 (5) | 0 (0) |
| Other diet | 13 (34) | 4 (29) |
Data are presented as n (%)
Home-made and RMB diets
The distribution of home-made (ie, owner-cooked ingredients) and RMB diets among diets fed at the time of consultation are provided in Table 6. All RMB diets were home-made.
Table 6.
Home-made and raw meat-based (RMB) diets fed at the time of consultation at our hospital
| Type of diet | Gastroenterology cats (n = 61) | Internal medicine cats (n = 53) |
|---|---|---|
| Home-made diet | 1 (2) | 5 (9) |
| RMB diet | 3 (5) | 3 (6) |
Data are presented as n (%)
Additional foods and treats
Chicken hearts and liver pâté were fed to 4/61 (7%) cats in the GE group and 4/53 (8%) cats in the IM group, while 1/61 (2%) GE cats and 2/53 (4%) IM cats received commercial treats.
Dietary therapy prescribed during hospital consultation
A new diet (ie, diet change) was prescribed to 47/80 (59%) GE cats and 38/84 (45%) IM cats (Table 7).
Table 7.
Type of diets prescribed at consultation at our hospital
| Type of diet | Gastroenterology cats (n = 47) | Internal medicine cats (n = 38) |
|---|---|---|
| Highly digestible diet | 21 (45) | 26 (68) |
| Hydrolysed diet | 17 (36) | 3 (8) |
| Limited ingredient novel protein diet | 5 (11) | 8 (21) |
| Other diet | 4 (9) | 1 (3) |
Data are presented as n (%)
Discussion
In this retrospective study, we investigated how much dietary information could be obtained from referring veterinarians and cat owners when cats were presented to our hospital for the evaluation of chronic GI signs. This question (ie, the amount of dietary information collected during consultations) has not yet been addressed in cats. We conducted this study to highlight an apparent contradiction. On the one hand, it is known that diet alone can control clinical signs in cats with chronic GI diseases;3–5 on the other hand, many owners still do not know what they are feeding when they present their cats for consultations. It is also our experience that it is not only cat owners but also referring veterinarians that underestimate the impact of diet on GI conditions.
At our institution, we offer a separate service within the IM service for patients presenting with GI problems. However, cats with GI disease are also seen by the IM service as, at the time, GE consultations were available only 2 days per week vs 5 days per week for IM consultations. This setting gave us the opportunity to compare dietary information taken at two services with different degrees of specialisation and experience when treating cats with GI disease. In doing so, we could assess how results differ when cats are seen by a larger group of veterinarians with differing interests in IM vs a smaller service led primarily by one internist focused on GE. We assumed that more dietary information would be retrievable from the medical records if referring veterinarians or owners were seeking an appointment with the GE service. Although our data confirmed this, diet was mentioned in referral documents from only 29% of cases referred to the GE service and 8% referred to the IM service. These numbers are even lower than similar data recorded from dogs seen at both services during the same time frame, where diet was mentioned in the referral documents of 53/131 GE dogs (40%) and 14/112 IM dogs (13%). 10 We believe this difference is due to the fact that food-responsive enteropathy is still less frequently described in the literature in cats than in dogs, which consequently affects awareness of the importance of diets in cats.
Referral documents, including a diet history specification section, might help to improve this. Information on the actual response to previously tried diets was more frequently available in the IM group. However, this may have been due to selection bias as diet was mentioned overall in only 4/53 referred IM cases. We assume that one of the reasons for the low percentage of specific mention of how cats had responded to previously tried diets was that as the GI signs still persisted and necessitated a referral, a failed response was obvious and therefore mention of this was not warranted. The fact that none of the referral documents (both GE and IM groups) mentioned more than one previous diet trial may reflect the perception that failure to respond to one diet is synonymous with a general non-responsiveness to diet. However, a prospective study design would be needed to verify this assumption. Another possibility is that cat owners were not willing to pursue further diet trials because they anticipated poor diet compliance and wanted a second opinion or further diagnostic tests performed. In addition, cat owners might not perceive dietary treatment to be as effective as drug treatment in cases of GI disease. Similarly, prospective survey studies are needed to better understand what factors motivate or discourage cat owners to try a new diet in their cats with GI disease.
More owners in the GE group were asked about their cat’s diet (76% vs 63% in the IM group) at our hospital. This means that either 24% of owners seeking a GE consultation were not asked about their cat’s diet, or nothing was recorded in cases where owners did not know what they were feeding. Missing data may have also been due to negligent documentation. Irrespective of referral status, less than half (44%) of the cats in the GE group and approximately one-third (36%) of cats with chronic GI signs seen by the IM service had a previous diet trial recorded. These numbers are again lower than in dogs, where 127/199 (64%) GE and 56/156 (36%) IM dogs had dietary trials performed before consultation at our hospital. 10
Clearly, more information on response to previous diet trials was available from cat owners in the GE group (85%) vs the IM group (42%), which we attribute to the increased awareness of the importance of diet in the GE service vs the general IM service. Again, not recording response rates may have been synonymous with the tacit assumption that GI signs did not improve with the mentioned diet.
The most impressive result of this study is that less than two-thirds (n = 37/61; 61%) of cat owners seeking medical advice from the GE service could, in fact, name the specific diet their cat was fed at the time of consultation. Even worse, only 11/53 (21%) owners in the IM group knew the specific diet currently fed to their cat. Frequently, owners assumed they knew what they were feeding when, in fact, they could recall only the manufacturer of the diet (eg, Purina), not realising that one manufacturer can produce a multitude of different diets. It is not uncommon for the last author to sit together with cat owners in front of the computer screen searching for images of what their cat’s food bag looks like, in an attempt to identify the current diet. Knowing so little about previously fed diets is probably one reason for the frequent selection of a highly digestible or hydrolysed diet for the first diet trial, as aspects such as dietary protein often remained unknown.
Approximately 7% of all cats were fed additional foods besides their diet, and less than 3% received commercial treats. These numbers are lower than what we reported for dogs recently. 10 It is possible that our results are still an underestimation, as we cannot guarantee with a retrospective study design that these questions were routinely asked, especially as treats were fed much more often according to other studies.11,12 Additional foods or treats besides the prescribed diet may be responsible for diet failure. Very few cats were fed home-made diets vs what has been reported for dogs, where 57/199 (29%) GE dogs and 31/156 (20%) IM dogs were fed home-made diets. 10 Similarly, few cats were fed diets containing raw meat, and these numbers are comparable to what has been recently reported for cats. 13
The limitations of our study are those typical of a retrospective study design. Whenever data were unavailable, we did not know whether this was due to the attending clinician not asking all required questions (eg, compliance), negligent documentation, or owners being unable to recall the specific details of the diet fed. It would be interesting to compare our results to those of other institutions, but this is the first study to evaluate the extent of obtainable dietary information during a consultation in cats.
Conclusions
Dietary information gained from referring veterinarians and owners of cats presented for chronic GI signs is often incomplete or lacking. Dietary information was more often complete when cats were presented to the GE service, but this still applied to less than two-thirds of cases. Future studies are needed to assess whether the use of a diet history specification section will improve the amount of obtainable dietary information and to examine what factors motivate or discourage cat owners to try a new diet in their cats with GI disease. We believe that the selection of a new diet is facilitated when more complete dietary information is available at the time of consultation.
Footnotes
Accepted: 15 January 2023
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical approval: The work described in this manuscript involved the use of non-experimental (owned or unowned) animals. Established internationally recognised high standards (‘best practice’) of veterinary clinical care for the individual patient were always followed and/or this work involved the use of cadavers. Ethical approval from a committee was therefore not specifically required for publication in JFMS. Although not required, where ethical approval was still obtained, it is stated in the manuscript.
Informed consent: Informed consent (verbal or written) was obtained from the owner or legal custodian of all animal(s) described in this work (experimental or non-experimental animals, including cadavers) for all procedure(s) undertaken (prospective or retrospective studies). No animals or people are identifiable within this publication, and therefore additional informed consent for publication was not required.
ORCID iD: Peter Hendrik Kook 
https://orcid.org/0000-0002-9492-3484
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