To feed or not to feed: The importance of nutrition for gastrointestinal cases
What does science tell us about starving or feeding the gut for patients with gastrointestinal disorders?
The rationale for ""starving"" the gut by withholding food is often aimed at giving the gastrointestinal tract a functional rest. However, recent evidence shows that early enteral nutrition can improve patient outcomes. Benefits may include reducing endogenous catabolism, supporting gut mucosal integrity, decreasing bacterial translocation and intestinal inflammation, preventing protein-energy malnutrition, and modulating the immune system.
What are the potential concerns for starved patients?
In addition to the effects of malnutrition such as poor wound healing, immunosuppression, and increased morbidity and mortality, anorexic cats face an added risk: the development of hepatic lipidosis, this risk being especially significant for overweight cats that become acutely anorexic.
Under which circumstances should food be withheld in and for how long?
In cases of intractable vomiting, regardless of the underlying cause, food may be briefly withheld for about 24 hours while the clinician manages vomiting with antiemetic therapy. This approach can help control the patient's fluid and electrolyte losses and reduce the risk of complications, such as food aspiration and subsequent pneumonia from ongoing vomiting and regurgitation.
What would be the recommendations for feeding amounts and frequencies?
It is difficult to define specific feeding amounts for all the patients as this will depend on factors like body weight, body condition score, health status, duration of anorexia and diet factors like energy density. For patients showing signs of malnutrition or experiencing anorexia for more than 5 days, energy delivery should be gradual, for example starting at about 25 to 33% of the patient's resting energy requirement per day and increasing by 25 to 33% every 12 to 24 hours until the resting energy requirement is reached per day. While assessing a patient's gastrointestinal tolerance of refeeding (vomiting, regurgitation, signs of abdominal pain or diarrhea), it may be beneficial to feed the patient small-volume meals more frequently.
How can we select the best diet for patients with gastrointestinal signs?
It is important to first consider the patient's medical history, clinical examination, and diagnostic test results. While therapeutic gastrointestinal diets share common features, such as palatability, specific fibers, and highly digestible ingredients, key differentiators include fiber level, fat content, and energy density. Additionally, patient factors such as appetite, body condition score, food preferences, and the owner's feeding preferences will impact diet choice.
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