BSAVA Nutrition Guide

BSAVA Guide to
Nutrition
Updated August 2023
BRITISH SMALL ANIMAL VETERINARY ASSOCIATION,

Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB
Written by: Georgia Woods-Lee; Edited by: Marge Chandler and Alexander J. German
Delivered by BSAVA to:
ISBN: 978-1-910443-82-8 • First published 2020. Copyright © BSAVA 2023
BRITISH SMALL ANIMAL VETERINARY ASSOCIATION, Woodrow House, 1 TelfordHelena Way, Waterwells
alcantara Business Park, Quedgeley, Gloucester GL2 2AB
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Last updated:
Written by: GeorgiaAugust 2023
Woods-Lee; • www.bsavalibrary.com/nutrition
Edited by: Marge Chandler and Alexander J. German
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Contents
Contributors ii
Introduction iii
Diet types
■ Commercially manufactured diets:
● Veterinary factsheet 1
● Owner factsheet 8
■ Grain-free diets:
■ Home-prepared cooked diets:
■ Raw diets:
■ Plant-based diets:
■ Alternative protein-based diets:
Feeding for specific situations and conditions

■ Hospital nutrition:
■ Critical care nutrition:
■ Adverse reactions to food:
■ Obesity care:
■ Restricted activity:
■ Chronic kidney disease:
Appendix: Glossary of terms 118
While the contributors and the BSAVA have made every effort in preparing the materials included in the Guide to ensure that they are correct, any statements are made
in good faith purely for general guidance and cannot be regarded as a substitute for professional advice. Consequently, no liability can be accepted for loss or expense
incurred (by you or persons that you disseminate the materials to) as a result of relying in particular circumstances on statements made in the Guide. If you spot any
errors or omissions, or have any further comments on the Guide, please contact publications@bsava.com.
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Contributors
Written by:
Georgia Woods-Lee
BSc(Hons) RVN CertCFVHNut VTS (Nutrition)
Institute of Life Course & Medical Sciences and School of Veterinary Science,
University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE
Edited by:
Marge Chandler
DVM MS MANZCVS DipACVN DipACVIM MRCVS
Lasswade, Scotland
Alexander J. German
BVSc PhD CertSAM DipECVIM-CA SFHEA FRCVS
Institute of Life Course & Medical Sciences and School of Veterinary Science,
University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE

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Introduction
Veterinary professionals are often called upon to provide guidance on appropriate nutrition
for animals under their care. Since nutrition is the cornerstone of all good veterinary care, it
should ideally form part of the discussion with every owner seeking advice about their pet.
As veterinary professionals, our advice to our clients should always be based on:
■ Sound scientific evidence, whenever available
■ Excellent clinical reasoning
■ Informed risk management.
Given the wealth of information (and misinformation) available to pet owners, it is the responsibility of veterinary
professionals to assist them in making decisions about what to feed their pet. As well as ensuring that minimum nutritional
requirements are met, the chosen diet should ideally provide optimal nutrition.
For healthy pets, the aim of a diet is to maintain good health and quality of life for as long as possible. However, it is
recognized that nutritional requirements undoubtedly change in times of illness or disease. In recent years, the development of
disease-specific therapeutic diets has significantly increased. These therapeutic diets not only deliver essential nutritional
requirements but can also, through their nutritional adaptations, help to reduce signs of disease and promote recovery from
illness or injury.
An understanding of aetiology and pathogenesis is required to ensure that nutrition is optimized for the condition in
question. Dietary management should be used in conjunction with other therapeutic modalities, including pharmaceutical
agents and surgical interventions.
Whatever the type of food that the pet owner chooses to feed, be it for maintaining health or for management of specific
diseases or conditions, it should meet the following requirements:
■ Complete and balanced nutrition – the diet should provide every nutrient that the pet needs, in the correct quantities
for the pet and not in excessive amounts
■ Digestible – the nutrients must be bioavailable to the pet consuming the food
■ Palatable – the food must be appealing to the pet so that they will consume it
■ Not fed in excess – excessive amounts of energy from any food will lead to obesity. Controlling the amount of food is
strongly advised to maintain an ideal body condition score
■ Safe – the food must be safe to feed, being free of anything that may cause harm to the pet or owner (e.g. toxic
compounds or enteropathogens)
■ Achievable – the recommendation must be within the owner’s financial and time budget
(e.g. feasible for the owner to prepare and feed within the time available).
Sustainability of food sources is also of increasing concern for both humans and pets because, if current consumption
continues, there will be a food shortage within the next 50 years. Further, meat production has a significant carbon footprint,
with a potential negative impact on climate change. As a result, there is an ever-increasing ethical dilemma as to whether it is
appropriate to use foods considered intended for human consumption to feed cats and dogs (Henchion et al., 2017).
References
Henchion M, Hayes M, Mullen AM, Fenelon M and Tiwari B (2017) Future protein supply and demand: strategies and factors
influencing a sustainable equilibrium. Foods 6, 53

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Commercially
manufactured
diets
Commercially manufactured diets, or proprietary diets, have been popular with pet owners for
many years, with the first such diet for dogs being produced here in the UK in 1860. Since this
time, commercially manufactured diets have consistently risen in popularity. Now widely
available, they offer many advantages to pet owners and veterinary professionals alike.
What are commercially manufactured diets?

Commercially manufactured diets are pet foods produced on an industrial scale and widely distributed to stockists for
convenient purchasing. The diets, at every stage of production, are usually subjected to testing and analysis for nutritional
adequacy, product consistency and pathogen elimination – although the extent and nature of this will depend on the diet and
the manufacturing company. Many manufacturers also research dietary formulations, with purpose-formulated diets now
available for specific life stages and medical conditions. This allows optimal nutrition, above the minimal nutritional
requirements, to be delivered to pets (for further information, see factsheets on feeding for specific situations and conditions).
Types of commercially manufactured diet

Commercially manufactured diets are produced in three main forms:
■ Dry, most often in kibble form
■ Wet, of which subtypes can include:
● Chunks in gravy
● Chunks in jelly
● Loaf
● Pate
■ Raw diets (for further information, see ‘Raw diets’).

The forms differ depending on moisture content, intended preservation method and processing methods of the
ingredients.
■ Dry foods:
● Low moisture content – typically 3–11%
● Generally higher starch content – necessary for the kibble to hold its shape
● Produced most commonly via an extrusion method:
− Extrusion uses pressure and temperature to rapidly cook the ingredients (20–60 seconds). It is widely used as it
increases the digestibility and palatability of the food (Case et al., 2000)
− Extrusion is also used to kill pathogenic bacteria
● Sold in bags of varying size (500 g to 15 kg).
■ Wet foods:
● High moisture content – 60–87%
● Available in tins, trays and pouches
● Uses heat and pressure to preserve the ingredients, but each method depends on packaging type.
■ Uncooked:
● Variable moisture content depending on the specific diet:
− Tend to have a higher moisture content (similar to wet foods)

− Dry foods with additional freeze-dried ingredients are also available
● Ingredients are preserved by freezing or freeze-drying before thawing or rehydration prior to feeding.
In the UK and abroad, no matter what the diet, the form that it comes in or the scale of production, commercially
manufactured diets must meet basic standards and criteria for production, packaging, formula reliability and pathogen control.
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BSAVA GUIDE TO NUTRITION Commercially manufactured diets
What are the advantages of feeding a commercially manufactured diet?
Diet claim Available evidence

Assured nutritional ■ Many of the larger pet food manufacturers additionally undertake feeding trials and/or
adequacy laboratory analyses to ensure that their diets deliver complete and balanced nutrition to the pet.
In Europe, a claim that a diet is ‘complete’ can be based on a computer formulation alone
■ Requirements in the UK are set by the European Pet Food Industry Federation (FEDIAF)
■ Nutrition should not be merely adequate; nutrition should be optimal for the pet consuming the
food, meaning that commercially manufactured diets are frequently formulated to a
specification well above basic nutritional requirements
Specialized nutrition ■ Through scientific development, therapeutic diets are now available for a wide range of
conditions, including renal disease, skin disease, diabetes mellitus, obesity and hyperthyroidism
(Commission Regulation, 2020)
■ For some conditions, the correct therapeutic diet can eliminate clinical signs of the disease
■ For further information, see factsheets on feeding for specific situations and conditions
Assured safety ■ More than 50 individual pieces of EU legislation govern the production of commercially
manufactured diets (Food Standards Agency, 2017)
■ Foods should:
● Be high quality
● Be free from pathogens
● Deliver complete and balanced nutrition
■ Occasional failures in pathogen control procedures have been documented in a small number
of cases, including:
● Salmonella spp. – found in uncooked commercially manufactured diets (Food Standards
Agency, 2018a; 2019b)

● Listeria – found in uncooked commercially manufactured diets (Food Standards Agency,
2019a)
● Mycobacterium bovis – found in uncooked commercially manufactured cat food (O’Halloran
et al., 2019)
■ Occasional formulation errors, where nutrients have not been correctly balanced, have been
recorded, including:
● Low thiamine levels in cat food – dry kibble (Pet Food Manufacturers’ Association, 2015)
● Excess vitamin D – canned food (Food Standards Agency, 2018; Hill’s Pet Nutrition, 2019)
■ Very occasionally, fatal toxic components have been found in a very small number of cases,
including:
● Melamine contamination of a large number of commercially manufactured diets in North
America in 2007 (US Food and Drug Administration, 2007). No pet foods were affected
outside North America
■ Compared with other diet types (e.g. home-prepared raw diets or home-prepared cooked
diets), pathogenic infection and nutritional imbalances are far less frequent, especially when
considering the number of pets fed this type of diet annually
■ It is estimated that 95% of dog owners and 98% of cat owners are thought to feed their pet a
commercially manufactured diet as part of or as the whole diet (PDSA, 2019)
Advantages of the ■ Dry kibble:

different diet types ● Cost-effective
● Proportionally less packaging quantity needed
− More environmentally friendly than wet products

● Can be produced in large volumes rapidly
● Distribution can be quick and effective, so foods are conveniently available to pet owners
● Suitable for pets who prefer to have food constantly available, as it spoils less rapidly than
fresh or wet foods

■ Wet products:
● Increased palatability due to high moisture content. This can be advantageous for picky eaters,
but some pets may have a preference for other diet types (e.g. dry)
● Higher moisture intake, which is advantageous for:
− Cats in their senior years

− Pets with specific diseases requiring increased water intake (e.g. renal disease or lower
urinary tract disease) (Case, 2010). For further information, see factsheets on feeding for
specific situations and conditions
● Often sold in single-serving packages, so food waste is low and fresh food can be given at
each meal, promoting consistent palatability. However, this produces more packaging waste
● Cat owners prefer to provide mixed food to their cats, with 50% of cats now being fed some
wet and some dry foods daily (PDSA, 2019) ➟

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Advantages of the ■ Uncooked:
different diet types ● Commercially manufactured uncooked products have some advantages over home-
continued prepared raw diets or home-prepared cooked diets, as they undergo freezing or freeze-
drying, which decreases the Campylobacter colony count. However, this process will not
completely eradicate Campylobacter or other pathogens, some of which are unaffected by
freezing (Van Bree et al., 2018). The freezing of uncooked pet foods does not guarantee
food safety, as is commonly thought
● High-pressure pasteurization is also used to reduce pathogenic risk; however, further
research is required to determine its efficacy

● For further information, see ‘Raw diets’
Low preparation time ■ No need for significant preparation of food

■ No cooking required
Good digestibility ■ All commercially manufactured diets should meet the minimum levels for digestibility. This can
be tested during feeding trials
■ Wet products are typically highly digestible, whilst dry foods are typically less digestible
Product consistency ■ Recipes for commercially manufactured diets should be created by professional formulators
trained in the commercial formulation of pet foods. Ideally, the formulation should have been
developed in consultation with an appropriately qualified individual
● Appropriate qualifications include:
− PhD in animal nutrition

− Diploma from the American College of Veterinary Nutrition (ACVN)
− Diploma from the European College of Veterinary Comparative Nutrition (ECVCN)
● Many of the larger pet food manufacturers employ such individuals full time
■ Some formulations are fixed formula recipes, whereby manufacturers guarantee product
consistency, so there is no variation between batches
■ Others use variable formula (or open formula) diets, which are less expensive since raw
materials can be varied based on cost and availability:
● Constituents of the diet may change from batch to batch, reflecting variations in the cost
and availability of ingredients to the producer

● Although uncommon, variations in ingredients can have negative effects on pets who are
less tolerant of dietary changes, potentially resulting in digestive disturbances

■ Information on the type of formula used should be easily obtained from the manufacturer or
the pet food label (WSAVA Interpreting Food Labels, 2020)
Good pet satisfaction ■ Satisfaction with the diet is guaranteed by many commercially manufactured diet producers,
through:
● Product consistency
● High palatability
Conveniently ■ Commercially manufactured diets can be purchased readily from various outlets (including pet
purchased and stored shops and supermarkets) and online
■ Commercially manufactured diets are packaged to protect the food from damage wherever
possible and to ensure ease of storage once in the pet owner’s home
Variety ■ A wide variety of types are available

■ A wide variety of flavours are available
■ Pet owners are easily able to choose a flavour or type that their pet prefers
Cost-effective ■ When compared with all other diet types (including raw diets and home-prepared cooked
diets), commercially manufactured diets in a dry form are the most cost-effective
■ Wet-diet types are often more expensive than dry-diet types, but are still significantly cheaper
than a home-prepared cooked diet (depending on the diet types used for comparison). For
further information, see ‘Home-prepared cooked diets’
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What are the disadvantages of feeding a commercially manufactured

diet?
Disadvantage claim Available evidence
The high calorie content of dry ■ Dry commercially manufactured diets usually have a greater energy content on a
food is to blame for pet obesity gram-for-gram basis than wet diets, which increases the risk of overconsumption if
portions are not accurately measured out
■ An association between feeding dry food and overweight status has been identified in
two studies in cats (Beynen, 2015; 2018) although other studies have shown no
association
■ Associations between overweight status and both free-choice feeding and leaving
food out all day have also been reported (Roberts et al., 2018)
■ Dry food should therefore be portioned out using digital scales and fed according to
the manufacturer’s feeding guidelines. Caution should be exercised when leaving dry
food out in case this leads to overfeeding. The pet should also be weighed and
assessed for body condition score regularly throughout life; although this would apply
for any diet type
Processed foods are bad for ■ There is some emerging evidence that ultra-processed foods might have detrimental
humans, so must be bad for effects on human health, including associations with cancer and obesity (Hall et al.,
pets too 2019; Schnabel et al., 2019) but further work is required to determine the reasons for
such associations
Ultra-processed foods are ■ Commercially manufactured pet foods are not equivalent to ultra-processed foods in
harmful humans because they are designed to be complete and balanced to meet
maintenance energy requirements
Processed foods are ‘unnatural’ ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or at least 95%)
– dogs and cats should eat from the source material (e.g. of vegetable or animal origin). This is not an official or
only ‘natural’ foods regulated definition (Regulation, 2008)
■ Therefore, depending on the ingredients used, commercially manufactured diets
can also be defined as ‘natural’ in accordance with the above guidance
Commercially manufactured ■ There is no evidence for these claims

diets cause adverse behaviours
(e.g. jumping up, digging,
chewing and hyperactivity)
Commercially manufactured ■ Although a handful of products each year will be recalled (as with most human food
diets are often recalled as they products), the threat of imbalance or deficiency is significantly less when compared
contain ‘toxic’ ingredients with either home-prepared cooked or raw diets
■ Truly toxic components in pet foods have been found in only extremely rare cases
(see above)
Commercially manufactured ■ Although marketing terms are allowed, these are regulated and limited so as not to
diets are sold using clever mislead the pet owner
marketing and cannot be trusted
Additives and preservatives in ■ The additives and preservatives used to preserve pet foods, as with all other
commercially manufactured ingredients, have until recently been under the strict control of the European
diets are bad Commission (EC). Each one has been thoroughly tested for safety and is continually
monitored. Now that the UK has left the European Union, new standards are being set
in accordance with the EC
■ The presence of preservatives adds to convenience, because a reasonable shelf life
(i.e. for a number of months or beyond) of commercially manufactured diets is
expected by pet owners. Without preservatives this would not be possible
■ Additives also include vitamins and minerals, which make these diets complete and
balanced
Dogs and cats cannot digest ■ There is no evidence for this

the carbohydrate content of ■ Both cats and dogs can effectively utilize carbohydrates in their diet (Morris et al.,
commercially manufactured 1977; Axelson et al., 2013)
diets ■ In addition, raw materials that deliver carbohydrates are a source of many essential
nutrients to pets. Materials rich in carbohydrates can also be useful sources of
proteins, essential fatty acids, vitamins, minerals and fibre (Kendal et al., 1982)
Commercially manufactured ■ There is no scientific evidence to support this claim

diets cause cancer
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Commercially manufactured ■ To date, there is no scientific evidence to support this claim
diets have increased the ■ Further, the regular mechanical cleaning of a pet’s teeth with a brush and appropriate
incidence of dental disease pet toothpaste is the best way to maintain good dental health
The cooking process of ■ Whilst some ingredients can be destroyed by cooking, the bioavailability of other
commercially manufactured ingredients can be increased
diets destroys the nutrients in ■ Although some damage may occur during cooking, especially to proteins, the
the ingredients, causing manufacturing process means that any deficiency is accounted for and adjustments
deficiencies are made so a complete and balanced diet is still delivered
■ Vitamins are also added to account for any changes that occur during the cooking
process
Wet food should not be left ■ Due to its high moisture content, wet food should not be left out for more than 30
out for pets who prefer to feed minutes, as it will start to spoil
ad libitum
The cost of wet food is higher ■ Feeding dry commercially manufactured diets is the most economical, whilst feeding
wet products alone is considerably more expensive and might be prohibitive for some
owners (e.g. those with large or giant breeds). That said, the cost of feeding a
commercially available wet food is usually less than that associated with feeding a
home-prepared cooked or raw diet
Problems with compliance ■ As with any diet, owner compliance will vary
■ Since commercially manufactured diets should be correctly balanced, there is
reduced concern regarding nutritional deficiency if guidelines are poorly complied
with
■ Problems may arise if a commercially manufactured diet is fed in excess (may
contribute to pet obesity)
■ Adherence to the manufacturer’s feeding guidelines is therefore recommended to
prevent under- or overfeeding. However, it should be remembered that there will be
considerable variation in the number of calories required by each individual pet
■ Food should also be correctly portioned out each day using digital scales
■ Treats and snacks will unbalance the diet and add calories, which are not accounted
for in the recommended amount to feed on the label
Can commercially manufactured diets provide balanced nutrition?

Yes, provided that:
■ The recipe has been designed, overseen or approved by an appropriately qualified person. Commercial manufacturers
should be able to provide, on request, information on who has designed, overseen or approved the diet’s formulation
■ Nutritional adequacy has been confirmed, ideally through feeding trial or laboratory analysis.
What safety measures are there for feeding commercially manufactured

diets?
Hygiene
Basic hygiene is essential for the safe feeding of any diet and the following should be routine to decrease the risk of secondary
bacterial contamination:
■ Containers and packaging should be inspected for any damage or contamination that may affect the food
■ Any product with damaged packaging should not be purchased or should be discarded
■ Basic hand washing after handling pet food and bowls should be observed
■ Hand hygiene and regular cleaning of preparation areas and bowls should always be observed.
Considerations for feeding commercially manufactured diets in healthy

dogs and cats
Commercially manufactured diets are complete and balanced and, provided that the correct amount is fed, can be a healthy
option for dogs and cats.
Considerations for feeding commercially manufactured diets in dogs

and cats with various diseases
Many different diseases have specific nutritional requirements and there are therapeutic diets available to manage such
diseases and their specific requirements. Optimal nutrition during a disease state may be pivotal to the survival of the
individual. For example: ➟
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■ Renal disease:
● Renal disease requires a diet low in phosphorus. Phosphorus restriction has been proven to prolong life for such
patients (Polzin, 2019)

■ Obesity:
● Commercially manufactured diets specifically designed for weight loss are widely available. The best of these diets
restrict the number of calories delivered by the food without compromising nutrition. They are also frequently
formulated to keep the pet satisfied during the weight-loss process. Diets higher in protein and fibre have been
shown to be the most effective (Weber et al., 2007; Bissot et al., 2009; German et al., 2010). To formulate a home-
prepared cooked diet or a raw diet that fulfils the same criteria is challenging, and should ideally be undertaken only
by a suitably qualified person
● ‘Light diets’ have a marginal calorie restriction compared with a standard maintenance diet. They often contain
slightly greater amounts of dietary fibre. These diets are suitable for those predisposed to weight gain. They are also a
suitable choice for any pet whose activity level is decreased. It is not advisable to use these diets for any pet that is
≥10% above their ideal weight
● For cases where an adverse food reaction is suspected, hydrolysed diets or novel protein diets can be used to
perform either an elimination feeding trial or for long-term management of clinical signs, whether dermatological or
gastrointestinal (Biourge, 2004)
For further information, see factsheets on feeding for specific situations and conditions.
How to talk to owners about commercially manufactured diets

Remember:
■ Most pet owners want to do what is best for their pet
■ With the evidence available to us as veterinary professionals, and without prejudice, we must give the best advice that we
can to ensure the pet receives a complete and balanced diet
■ As there is a huge variety of products available and no one can be expected to know in great detail about each product
or manufacturer – of which there are many new ones each year – guidance for owners on how to choose a diet is very
helpful for the individual
■ The most important thing about choosing a diet is that it delivers complete and balanced nutrition and that it is
appropriate for the pet’s age, lifestyle, body condition and disease state, if present.
Conclusion
Feeding commercially manufactured diets can offer optimal nutrition to patients without high costs, with low pathogen risk and
with nutritional adequacy assurance. However, care should be taken, particularly with dry food, to ensure that it is not fed to excess.
Further information
Feeding trials
During feeding trials, the faeces of the participants fed the selected diet are analysed to determine digestibility. In the UK, the
European Pet Food Industry Federation (FEDIAF) provides the nutrient guidelines that should be adhered to. Although
conducting feeding trials is very expensive, it is recognized as the gold-standard method for determining nutrient availability.
Laboratory analysis of commercially manufactured diets
It is also possible for manufacturers to analyse the ingredients in the recipe used to create the diet in a laboratory setting to
ensure that it contains the necessary nutrient levels – but there are some limitations to this method. The main limitation is that
this method will not assess the level of bioavailability of the nutrient being consumed. In addition, manufacturers may only test
the macronutrients within the diet, as testing for specific amino acids, vitamins and minerals is expensive. Without knowing
whether the intended recipient of the diet can digest and utilize the nutrients present, complete and balanced nutrition cannot
be guaranteed to the same degree as for those diets tested by feeding trial. Smaller commercially manufactured diet producers
will typically formulate their diets in this way. Many small pet food manufacturers only use computer formulation software,
without any laboratory analysis of the diet.
References
Axelson E, Ratnakumar A, Arendt ML et al. (2013) The genomic signature of dog domestication reveals adaptation to a starch-
rich diet. Nature 495, 360–364
Beynen AC (2015) Dry foods for cats. Creature Companion July, 54–55
Beynen AC (2018) Cat food composition and caloric intake. Dier-en-Arts 8/9, 186–189
Biourge V (2004) Diagnosis of adverse reactions to food in dogs: efficacy of a soy-isolate hydrolyzate-based diet. Journal of
Nutrition 134, 2062S-2064S
Bissot T, Servet E, Vidal S et al. (2009) Novel dietary strategies can improve the outcome of weight loss programmes in obese
client-owned cats. Journal of Feline Medicine and Surgery 12, 104–112
Case LP (2010) Chronic renal failure. In: Canine and Feline Nutrition, 3rd edn, ed. L Case et al., pp. 418–420. Mosby Elsevier,
Philadelphia
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Case LP, Carey DP, Hirakawa DA and Daristotle L (2000) Canine and Feline Nutrition, 2nd edn. Mosby Elsevier, Philadelphia
Commission Regulation (EU) 2020/354 (2020) Establishing a list of intended uses of feed intended for particular nutritional
purposes and repealing Directive 2008/38/EC. [Available from: https://eur-lex.europa.eu/legal-content/EN/
TXT/?uri=CELEX:32020R0354]
Food Standards Agency (2017) Business Guidance – Pet Food. [Available from: www.food.gov.uk/business-guidance/pet-food]
Food Standards Agency (2018a) Avondale Pet Foods Ltd recalls Just Natural Chicken and Tripe because Salmonella has been
found in the produce. [Available from: www.food.gov.uk/news-alerts/alert/fsa-prin-71-2018]
Food Standards Agency (2018b) Sainsbury’s recalls a range of its pet food pouch selections due to high levels of vitamin D.
[Available from: www.food.gov.uk/news-alerts/alert/fsa-prin-25-2018]
Food Standards Agency (2019a) Raw Treat Pet Food Ltd recalls frozen raw beef, chicken, lamb, and chicken and tripe pet food
due to the presence of Listeria monocytogenes. [Available from: www.food.gov.uk/news-alerts/alert/fsa-prin-36-2019]
Food Standards Agency (2019b) Raw Treat Pet Food Ltd recalls varieties of frozen raw pet food due to the presence of
Salmonella. [Available from: www.food.gov.uk/news-alerts/alert/fsa-prin-38-]
German AJ, Holden SL, Bissot T, Morris PJ and Biourge V (2010) A high protein high fibre diet improves weight loss in obese
dogs. The Veterinary Journal 183, 294–297
Hall KD, Ayuketah A, Brychta R et al. (2019) Ultra-processed diets cause excess calorie intake and weight gain: an inpatient
randomized controlled trial of ad libitum food intake. Cell Metabolism 30, 1–11
Hill’s Pet Nutrition (2019) Important voluntary product recall information. [Available from www.hillspet.co.uk/productlist]
Kendall PT and Holme DW (1982) Studies on digestibility of soya bean products, cereal, cereal and plant by products in the diet
of dogs. Journal of the Science of Food and Agriculture 33, 813–820
Morris GJ, Trudell J and Pencovic T (1977) Carbohydrate digestion by the domestic cat (Felis catus). British Journal of Nutrition
37(3), 365–373
O’Halloran C, Ioannidi O, Reed N et al. (2019) Tuberculosis due to Mycobacterium bovis in pet cats associated with
feeding a commercial raw food diet. Journal of Feline Medicine and Surgery 21(8), 667–681
Pet Food Manufacturers’ Association (2015) Pets at Home recall. [Available from: www.pfma.org.uk/news/pets-at-home-recall]
PDSA (2019) PDSA Animal Wellbeing Report (PAW) Report. [Available from: www.pdsa.org.uk/media/7420/2019-paw-report_
downloadable.pdf]
Polzin D (2019) International Renal Interest Society–Diets for Cats with Chronic Kidney Disease (CKD). [Available from: http://
www.iris-kidney.com/education/protein_restriction_feline_ckd.html]
Regulation (EU) 1334/2008 of the European Parliament and Council (2008) On flavourings and certain food ingredients with
flavouring properties for use in and on foods and amending Council Regulation (EEC) No. 1601/91, Regulations (EC) No.
2232/96 and (EC) No. 110/2008 and Directive 2000/13/EC. [Available from: https://eur-lex.europa.eu/legal-content/EN/
TXT/?qid=1585739671020&uri=CELEX:32008R1334]
Roberts MT, Bermingham EN, Cave NJ et al. (2018) Macronutrient intake of dogs, self-selecting diets varying in composition
offered ad libitum. Journal of Animal Physiology and Animal Nutrition 102, 568–575
Schnabel L, Kesse-Guyot E, Alles B et al. (2019) Association between ultra-processed food consumption and risk of mortality
among middle-aged adults in France. Journal of the American Medical Association: Internal Medicine 179(4), 490–498
US Food and Drug Administration (2007) Melamine Pet Food Recall. [Available from: www.fda.gov/animal-veterinary/recalls-
withdrawals/melamine-pet-food-recall-frequently-asked-questions]
Van Bree FPJ, Bokken GCAM, Mineur R et al. (2018) Zoonotic bacteria and parasites found in raw meat-based diets for cats and
dogs. Veterinary Record 182(2), 50
Weber M, Bissot T, Servet E et al. (2007) A high-protein, high-fiber diet designed for weight loss improves satiety in dogs.
Journal of Veterinary Internal Medicine 21, 1203–1208
WSAVA Global Nutrition Toolkit. [Available from: https://wsava.org/wp-content/uploads/2020/01/WSAVA-Global-Nutrition-
Toolkit-English.pdf]
WSAVA Interpreting Food Labels. [Available from: www.wsava.org/wp-content/uploads/2020/01/Nutrition-Label-EU-16_9.pdf]
Useful websites
The European Pet Food Industry
www.fediaf.org
Pet Food Manufacturers Association (PFMA)
www.pfma.org.uk
World Small Animal Veterinary Association (WSAVA)
www.wsava.org
Last updated
August 2023

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OWNER FACTSHEET
Commercially
manufactured diets
Introduction
Commercially manufactured diets have been popular for many years, with the first produced in 1860 in the UK. In light of the
wide variety of diets now available, we as veterinary professionals would like to provide guidance about the advantages and
disadvantages of such foods.
Our advice to pet owners should always be based on:
This is so we can help you make decisions about what to feed your pet. As well as ensuring that minimum nutritional
requirements are met, the chosen diet should ideally provide optimal (or ideal) nutrition to promote the good health of your pet.
Whatever the type of food you wish to feed, it should meet the following requirements:
■ Complete and balanced nutrition – the diet should provide every nutrient that your pet needs, in the correct quantities
■ Palatable – the food must be appealing to your pet so that they will consume it
strongly advised to maintain an ideal body condition score. Further information on body condition scoring is available
from the World Small Animal Veterinary Association (WSAVA) (www.wsava.org)
■ Safe – the food must be safe to feed, being free of anything that may cause harm to you or your pet (e.g. toxic
compounds or organisms (pathogens) that cause disease)
■ Achievable – the recommendation must be within your financial and time budget.
continues, there will be a food shortage within the next 50 years.
What are commercially manufactured diets?

Commercially manufactured diets are pet foods produced on an industrial scale and widely distributed to stockists for convenient
purchasing. The diets, at every stage of production, are usually subjected to testing and analysis for nutritional adequacy, product
consistency and pathogen elimination – although the extent and nature of this will depend on the diet and the manufacturing
company. Many manufacturers also research dietary formulations, with purpose-formulated diets now available for specific life
stages and medical conditions. This allows optimal nutrition, above the minimum nutritional requirements, to be delivered to pets.
Types of commercially manufactured diet

Commercially manufactured diets are produced in three main forms:
■ Dry, most often in kibble form
■ Wet, of which subtypes can include:
● Chunks in gravy
● Chunks in jelly ➟
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●Loaf
●Pate
■ Uncooked, raw diets.
The forms differ depending on moisture content, intended preservation method and processing methods of the
ingredients.
■ Dry foods:
● Low moisture content – typically 3–11%
● Generally higher starch content – necessary for the kibble to hold its shape
● Produced most commonly via an extrusion method:
− Extrusion uses pressure and temperature to rapidly cook the ingredients (20–60 seconds). It is widely used as it
increases the digestibility and palatability of the food
− Extrusion is also used to kill pathogenic bacteria
● Sold in bags of varying size (500 g to 15 kg).
■ Wet foods:
● High moisture content – 60–87%
● Available in tins, trays and pouches
● Uses heat and pressure to preserve the ingredients, but each method depends on packaging type.
■ Uncooked:
● Variable moisture content depending on the specific diet:
− Tend to have a higher moisture content (similar to wet foods)

− Dry foods with added freeze-dried ingredients are also available
● Ingredients are preserved by freezing or freeze-drying before thawing or rehydration prior to feeding.
In the UK and abroad, no matter what the diet, the form that it comes in or the scale of production, commercially
manufactured diets must meet basic standards and criteria for production, packaging, formula reliability and pathogen control.
What are the advantages of feeding a commercially manufactured diet?

Assured nutritional ■ Many of the larger pet food manufacturers additionally undertake feeding trials and/or
adequacy laboratory analyses to ensure that their diets deliver complete and balanced nutrition to your
pet. In Europe, a claim that a diet is ‘complete’ can be based on a computer formulation
alone
■ Requirements in the UK are set by the European Pet Food Industry Federation (FEDIAF)
■ Nutrition should not be merely adequate; nutrition should be optimal for the pet consuming
the food, meaning that commercially manufactured diets are frequently formulated to a
specification well above basic nutritional requirements
Specialized nutrition ■ Through scientific development, therapeutic diets are now available for a wide range of
conditions, including renal disease, skin disease, diabetes mellitus, obesity and
hyperthyroidism
■ For some conditions, the correct therapeutic diet can eliminate signs of the disease
Assured safety ■ More than 50 individual pieces of EU legislation govern the production of commercially
manufactured diets
■ Foods should:
● Be high quality
● Be free from pathogens
● Deliver complete and balanced nutrition
■ Occasional failures in pathogen control procedures have been documented in a small

number of cases, including:
● Salmonella spp. – found in uncooked commercially manufactured diets
● Listeria – found in uncooked commercially manufactured diets
● Mycobacterium bovis – found in uncooked commercially manufactured cat food
■ Occasional formulation errors, where nutrients have not been correctly balanced, have been
recorded, including:
● Low thiamine levels in cat food – dry kibble
● Excess vitamin D – wet food
■ Very occasionally, fatal toxic components have been found in a very small number of cases,
including:
● Melamine contamination of a large number of commercially manufactured diets in North
America in 2007. No pet foods were affected outside North America

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Assured safety continued ■ Compared with other diet types (e.g. raw diets or home-prepared cooked diets), pathogenic
infection and nutritional imbalances are far less frequent, especially when considering the
number of pets fed this type of diet annually
■ It is estimated that 95% of dog owners and 98% of cat owners are thought to feed their pet a
commercially manufactured diet as part of or as the whole diet
Advantages of the ■ Dry kibble:

different diet types ● Cost-effective
● Proportionally less packaging quantity needed
− More environmentally friendly than wet products

● Can be produced in large volumes rapidly
● Distribution can be quick and effective, so foods are conveniently available
● Suitable for pets who prefer to have food constantly available, as it spoils less rapidly than
fresh or wet foods

■ Wet products:
● Increased palatability due to high moisture content. This can be advantageous for picky
eaters, but some pets may have a preference for other diet types (e.g. dry)
● Higher moisture intake, which is advantageous for:
− Cats in their senior years

− Pets with specific diseases requiring increased water intake (e.g. kidney disease or lower
urinary tract disease)
● Often sold in single-serving packages, so food waste is low and fresh food can be given at
each meal, promoting consistent palatability. However, this produces more packaging
waste
● Cat owners have been found to prefer to provide mixed food to their cats, with 50% of
cats now thought to be fed some wet and some dry foods daily
■ Uncooked:
● Commercially manufactured uncooked products have some advantages over home-
prepared raw diets or home-prepared cooked diets, as they undergo freezing or freeze-
drying, which decreases the Campylobacter colony count. However, this process will not
completely eradicate Campylobacter or other pathogens, some of which are unaffected
by freezing. The freezing of uncooked pet foods does not guarantee food safety, as is
commonly thought
● High-pressure pasteurization is also used to reduce pathogenic risk; however, further
research is required to determine its efficacy
Low preparation time ■ No need for significant preparation of food

■ No cooking required
Good digestibility ■ All commercially manufactured diets should meet the minimum levels for digestibility. This
can be tested during feeding trials
■ Wet products are typically highly digestible, whilst dry foods are typically less digestible
Product consistency ■ Recipes for commercially manufactured diets should be created by professional
formulators trained in the commercial formulation of pet foods. Ideally, the formulation
should have been developed in consultation with an appropriately qualified individual
● Appropriate qualifications include:
− PhD in animal nutrition

− Diploma from the American College of Veterinary Nutrition (ACVN)
− Diploma from the European College of Veterinary Comparative Nutrition (ECVCN)
● Many of the larger pet food manufacturers employ such individuals full time
■ Some formulations are fixed formula recipes, whereby manufacturers guarantee product
consistency, so there is no variation between batches
■ Others use variable formula (or open formula) diets, which are less expensive since raw
materials can be varied based on cost and availability:
● Constituents of the diet may change from batch to batch, reflecting variations in the
cost and availability of ingredients to the producer

● Although uncommon, variations in ingredients can have negative effects on pets who
are less tolerant of dietary changes, potentially resulting in digestive disturbances

■ Information on the type of formula used should be easily obtained from the manufacturer
or the pet food label
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Good pet satisfaction ■ Satisfaction with the diet is guaranteed by many commercially manufactured diet producers,
through:
● Product consistency
● High palatability
Conveniently purchased ■ Commercially manufactured diets can be purchased readily from various outlets (including
and stored pet shops and supermarkets) and online
■ Commercially manufactured diets are packaged to protect the food from damage wherever
possible and to ensure ease of storage in your home
Variety ■ A wide variety of types are available

■ A wide variety of flavours are available
■ This is so you can easily choose a flavour or type your pet prefers
Cost-effective ■ When compared with all other diet types (including raw diets and home-prepared cooked
diets), commercially manufactured diets in a dry form are the most cost-effective
■ Wet-diet types are often more expensive than dry-diet types, but are still significantly cheaper
than a home-prepared cooked diet (by 4 to 30 times, depending on the diet types used for
comparison)
What are the disadvantages of feeding a commercially manufactured

diet?
The high calorie content of dry ■ Dry commercially manufactured diets usually have a greater energy content on a
food is to blame for pet obesity gram-for-gram basis than wet diets, which increases the risk of overconsumption if
portions are not accurately measured out
■ An association between feeding dry food and overweight status has been identified in
two studies in cats, although other studies have shown no association
■ Associations between overweight status and both free-choice feeding and leaving food
out all day have also been reported
■ Dry food should therefore be portioned out using digital scales and fed according to the
manufacturer’s feeding guidelines. Caution should be exercised when leaving dry food out
in case this leads to overfeeding. Your pet should also be weighed and assessed for body
condition score regularly throughout life; although this would apply for any diet type
Processed foods are bad for ■ There is some emerging evidence that ultra-processed foods might have detrimental
humans, so must be bad for effects on human health, including associations with cancer and obesity, but further
pets too work is required to determine the reasons for such associations. Commercially
Ultra-processed foods are manufactured pet foods are not equivalent to ultra-processed foods in humans
harmful because they are designed to be complete and balanced to meet maintenance energy
requirements
Processed foods are ‘unnatural’ ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or at least 95%)
– dogs and cats should eat from the source material (e.g. of vegetable or animal origin). This is not an official or
only ‘natural’ foods regulated definition
■ Therefore, depending on the ingredients used, commercially manufactured diets can
also be defined as ‘natural’ according to the above definition
Commercially manufactured ■ There is no evidence for these claims

diets cause adverse behaviours
(e.g. jumping up, digging,
chewing and hyperactivity)
Commercially manufactured ■ Although a handful of products each year will be recalled (as with many human food
diets are often recalled as they products), the threat of imbalance or deficiency is significantly less when compared
contain ‘toxic’ ingredients with either home-prepared cooked or raw diets
■ Truly toxic components in pet foods have been found in only extremely rare cases
(see above)
Commercially manufactured ■ Although marketing terms are allowed, these are regulated and limited so as not to
diets are sold using clever mislead pet owners
marketing and cannot be
trusted
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Additives and preservatives in ■ The additives and preservatives used to preserve pet foods, as with all other ingredients,
commercially manufactured are under the strict control of the European Commission (EC). Each one has been
diets are bad thoroughly tested for safety and is continually monitored. Now that the UK has left the
European Union, new standards are being set in accordance with the EC
■ The presence of preservatives adds to the convenience of a reasonable shelf life (i.e. for
a number of months or beyond). Without preservatives this would not be possible
■ Additives also include vitamins and minerals, which make these diets complete and
balanced
Dogs and cats cannot digest ■ There is no evidence for this

the carbohydrate content of ■ Both cats and dogs can effectively utilize carbohydrates in their diet
commercially manufactured ■ In addition, raw materials that deliver carbohydrates are a source of many essential
diets nutrients to pets. Materials rich in carbohydrates can also be useful sources of proteins,
essential fatty acids, vitamins, minerals and fibre
Commercially manufactured ■ There is no scientific evidence to support this claim

diets cause cancer
Commercially manufactured ■ To date, there is no scientific evidence to support this claim

diets have increased the ■ Further, the regular mechanical cleaning of your pet’s teeth with a brush and
incidence of dental disease appropriate pet toothpaste is the best way to maintain good dental health
The cooking process of ■ Whilst some ingredients can be destroyed by cooking, the bioavailability of other
commercially manufactured ingredients can be increased
diets destroys the nutrients in ■ Although some damage may occur during cooking, especially to proteins, the
the ingredients, causing manufacturing process means that any deficiency is accounted for and adjustments are
deficiencies made so a complete and balanced diet is still delivered
Wet food should not be left out ■ Due to its high moisture content, wet food should not be left available to your pet for
for pets who prefer to feed ad more than 30 minutes, as it will start to spoil
libitum
The cost of wet food is higher ■ Feeding dry commercially manufactured diets is the most economical, whilst feeding
wet products alone is considerably more expensive and might be prohibitive for some
owners (e.g. those with large or giant breeds). That said, the cost of feeding a
commercially available wet food is usually less than that associated with feeding a
home-prepared cooked diet or raw diet
Problems with sticking to ■ As with any diet, compliance will vary

instructions (compliance) ■ As commercially manufactured diets should be correctly balanced, there is reduced
concern regarding nutrient deficiency or excess if the guidelines are poorly complied
with
■ Problems may arise if a commercially manufactured diet is fed in excess (may
contribute to pet obesity)
■ Adherence to the manufacturer’s feeding guidelines is therefore recommended to
prevent under- or overfeeding. However, it should be remembered that there will be
considerable variation in the number of calories required by each individual pet
■ Food should also be correctly portioned out each day using digital scales
■ Treats and snacks will unbalance the diet and add calories, which are not accounted for
in the recommended amount to feed on the label
Can commercially manufactured diets provide balanced nutrition?

Yes, provided that:
■ The recipe has been designed, overseen or approved by an appropriately qualified person. Commercial manufacturers
should be able to provide, on request, information on who has designed, overseen or approved the diet’s formulation
■ Nutritional adequacy has been confirmed, ideally through feeding trial or laboratory analysis
■ Extra foods or treats are not given in amounts that unbalance the diet.
What safety measures are there for feeding commercially manufactured

diets?
Hygiene
Basic hygiene is essential for the safe feeding of any diet and the following should be routine to decrease the risk of
bacterial contamination: ➟
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■ Containers and packaging should be inspected for any damage or contamination that may affect the food
■ Any product with damaged packaging should not be purchased or should be discarded
■ Basic hand washing after handling pet food and bowls should be observed
Considerations for feeding commercially manufactured diets in healthy

dogs and cats
Commercially manufactured diets are complete and balanced and, provided that the correct amount is fed, can be a healthy
option for dogs and cats.
Considerations for feeding commercially manufactured diets in dogs

and cats with various diseases
Many different diseases have specific nutritional requirements and there are therapeutic diets available to manage such
diseases and their specific requirements. Optimal nutrition during a disease state may be pivotal to the survival of the individual.
For example:
■ Kidney disease:
● Kidney disease requires a diet low in phosphorus. Phosphorus restriction has been proven to prolong life for such
patients
■ Obesity:
● Commercially manufactured diets specifically designed for weight loss are widely available. The best of these diets
restrict the number of calories delivered by the food without compromising nutrition. They are also frequently
formulated to keep your pet satisfied during the weight-loss process. Diets higher in protein and fibre have been
shown to be the most effective. To formulate a home-prepared cooked diet or a raw diet that fulfils the same criteria
is extremely challenging, and should not be attempted by anyone other than an appropriately qualified individual
● ‘Light diets’ have a marginal calorie restriction compared with a standard maintenance diet. They often contain
slightly greater amounts of dietary fibre. These diets are suitable for those predisposed to weight gain. They are also a
suitable choice for any pet whose activity level is decreased. It is not advisable to use these diets for any pet that is
≥10% above their ideal weight
● For cases where an adverse food reaction is suspected, hydrolysed diets or novel protein diets can be used to
perform either an elimination feeding trial or for long-term management of clinical signs, whether dermatological or
gastrointestinal.
Conclusion
Feeding commercially manufactured diets has become increasingly popular in recent years. Therefore, it is important that you
consider all the pros and cons when making decisions about what to feed your pet, no matter the diet type. Decisions will be
made ‘on balance’ for your individual pet. Provided assurance of nutritional adequacy is confirmed, commercially manufactured
diets can be fed safely. However, care should be taken, particularly with dry food, to ensure that it is not fed to excess. If you
are in any doubt, please seek advice from your veterinary practice.
Last updated
August 2023

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Grain-free
diets
Grain-free diets are becoming increasingly popular with owners. Consequently, veterinary
professionals need to provide guidance about the advantages and disadvantages of such
foods, as recent work has questioned the safety of their use.
What are grain-free diets?

Grain-free diets must not contain the following grains:
■ Wheat
■ Barley
■ Rice
■ Maize
■ Sorghum
■ Spelt
■ Bulgar
■ Farro
■ Millet
■ Oats
■ Rye
■ Malt
■ Brewer’s yeast
■ Wheat starch
■ Triticale (a wheat/rye hybrid).
For pet owners, this is often a source of confusion, as a diet that is grain-free is not necessarily carbohydrate-free. Other
carbohydrate sources (e.g. potato) are frequently used in grain-free diets. Similarly, grains contain different types of gluten,
some of which may not be of concern, even for those pets known to have an adverse food reaction to glutens. As a result, a
blanket approach is often taken and all grains are excluded, meaning that a number of other nutrients which grains deliver are
also restricted when there may be no requirement to do so (Pezzali et al., 2020).
Although owners might have concerns about feeding grains, carbohydrates or gluten, evidence of harm is limited. However,
there are concerns arising from restricting grains in pet diets.
Types of grain-free diet

■ Commercially produced by many UK pet food manufacturers in wet or dry forms.
■ Home-prepared:
● Similar to raw diets, grain-free home-prepared cooked diets comprise ingredients in a form that can be easily
purchased from supermarkets and grocery stores. For further information, see ‘Home-prepared cooked diets’.
Why do owners choose to feed grain-free diets?

Proponents of grain-free diets choose them over other available diets as they believe that they are a ‘healthier option’ for their
pet in various ways (Clinical Nutrition Service, 2016). The decision is often based on limited scientific evidence.

Grain-free diets do not contain gluten, ■ It is true that eliminating gluten-containing grains from the diet will eliminate
which is a known cause of food gluten. However, there is limited evidence that gluten is bad for pets or that it
intolerance, making the pet unwell makes them unwell, except in cases of specific adverse food reactions, which are
➟
rare (Batt et al., 1982). For further information, see ‘Adverse reactions to food’
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BSAVA GUIDE TO NUTRITION Grain-free diets

Cats and dogs are carnivores and, as ■ Whilst dogs are in the order Carnivora, they are nutritionally omnivorous and are
such, are not designed to eat grains fully equipped to extract nutrients from grain sources in their diets
– feeding diets akin to those eaten by ■ Despite cats being obligate carnivores (meaning they require meat, poultry and
their wild ancestors is more ‘species fish in their diet), they also have the ability to digest grains and obtain nutrients,
appropriate’ and therefore more just to a lesser extent than dogs (Morris et al., 1977)
‘natural’ ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or at least
95%) from the source material (e.g. of vegetable or animal origin). This is not an
official or regulated definition (Regulation, 2008)
Grains cause ‘allergies’, so avoiding ■ There is no evidence that grains alone will cause adverse food reactions.
them will prevent itchy skin and However, some pets might suffer adverse food reactions involving grains, in a
digestive problems similar manner to reactions against other ingredients (e.g. beef, dairy or fish)
■ For further information, see ‘Adverse reactions to food’
Grains are only in pet food as ‘fillers’; ■ Grains can be useful sources of proteins, essential fatty acids, vitamins, minerals
they don’t benefit the pet and fibre. Digestibility is typically high when included in pet foods (Kendall and
Holme, 1982)
Foods containing grains are harder to ■ There is no evidence that the cooked grains included in pet foods are harder to
digest than meat-based products digest than the other components and they have even been shown to be
nutritionally valuable (Kendall and Holme, 1982). However, some uncooked whole
grains may be harder to digest when compared with meat-based products
What are the advantages of feeding a grain-free diet?

For further information, see ‘Adverse reactions to food’.
Evidence-based advantages
■ Food elimination trials.
■ Management of skin disease in the case of adverse reactions to food.
■ Management of gastrointestinal signs in the case of adverse reactions to food.
■ One disease known to require a grain-free diet is paroxysmal gluten-sensitive dyskinesia (Lowrie et al., 2015):
● Mainly affects Border Terriers
● It is a distressing neurological disorder for both the dog and the owner as the dog remains awake and aware
throughout abnormal limb movement episodes

● Clinical signs range from mild abnormal movement of one limb, affecting function or coordination, to severe, where
dogs collapse and abnormal movement affects the entire body

● Dietary gluten elimination has been shown to improve clinical signs, making a gluten-free diet an important
component in the management of this disease.

What we know about adverse reactions to food and diet
■ A true adverse food reaction accounts for only 1% of skin disease cases seen in practice, making it uncommon (Case et
al., 2000). An adverse food reaction is the third most common reason for skin disease after flea allergy and atopy (Case
et al., 2000).
■ Food-associated gastrointestinal disease is common in cats and dogs, but only a minority of cases are proven to be the
result of a genuine immune-mediated food hypersensitivity (i.e. allergy). Instead, most arise through other pathogenetic
mechanisms (e.g. intolerances). For these reasons, the term ‘adverse food reaction’ is preferred to ‘food allergy’.
■ The main concern regarding feeding grains relates to the perceived risk of an allergy to glutens and gliadins (Case et al.,
2000). Although adverse reactions to these components do occur, the most common foods associated with adverse
food reactions in cats and dogs are beef, soya and dairy products (August, 1985; Hodgkins, 1991; Harvey, 1993). Despite
this, owners increasingly believe that their pets have food allergies that would benefit from a grain-free diet.

A grain-free diet will prevent a pet ■ This is likely to be the case only for pets that already have an adverse
developing signs of skin or gastrointestinal reaction to food. However, both gastrointestinal and skin diseases are often
disease, especially in certain breeds multifactorial, therefore such diets might not completely resolve the
clinical signs of a particular case
Owners believe that their pet’s health, ■ There is no published evidence to support such claims, although there are
digestive system and/or skin improves after anecdotal reports of cases improving after starting a grain-free diet.
starting a grain-free diet Provided that the diet is complete and balanced, grain-free diets could be
an appropriate choice, not least if owners are convinced that it is beneficial
■ However, there have been some recent concerns regarding the safety of
feeding some grain-free diets
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Diagnosis of an adverse food reaction

The gold-standard method for determining the source of an adverse food reaction is a properly designed exclusion-diet trial
(Case et al., 2000). The following steps should be taken:
■ Choose a diet that is either:
● Hydrolysed – a process to reduce protein size so as not to trigger an immune response. If for any reason a
hydrolysed diet cannot be fed, the use of a diet that has not been fed for the past 6–12 months is indicated
● Novel – containing one protein and one carbohydrate source that the pet has never eaten previously
● Purified – a process of removal of the parts that are likely to cause an adverse reaction, although this is difficult to
achieve. This can be a commercially produced diet or one produced carefully by an appropriately qualified individual
■ Feed this diet exclusively, and with complete compliance, for 2 weeks for pets with gastrointestinal signs and 6–10
weeks for pets with skin signs
■ At the end of the trial, the pet should be re-challenged with its previous diet, whilst monitoring closely for the recurrence
of clinical signs
■ If clinical signs return quickly, this suggests an adverse food reaction to one of the ingredients within that food, and the
pet should be returned to the diet used in the trial
■ Once the clinical signs have subsided again, the pet can be re-challenged with one ingredient at a time and the response
monitored
■ By taking this systematic approach, the problem ingredient will be identified and thereafter can be eliminated from the
diet
■ Some pet owners may be reluctant to re-challenge their pet with its previous diet. Thus, provided that the elimination
diet is complete and balanced, this can be fed long term.
Serology testing
Although serology testing for ingredients that may cause concern is available, this is unreliable. Elimination-feeding trial
remains the gold-standard method of determining adverse food reactions (Jeffers et al., 1991).
What are the disadvantages of feeding a grain-free diet?

Although both dogs and cats can reportedly do well on grain-free diets, there have been some reports of health problems
developing, most notably dilated cardiomyopathy (DCM) in dogs (Freeman et al., 2018). However, the exact causal factors and
pathogenetic mechanisms remain unclear and, indeed, questions have arisen as to whether the absence of grains is the
problem. Rather, since many grain-free diets are made by recently established food companies, it is possible that wider
formulation problems are the cause. In addition, it was found that the same ingredients repeatedly appeared in the top four
components listed in the diets of the affected dogs, and since many of the affected dogs improved after switching to a
non-grain-free diet, this has led to the suspicion that the diet is the cause. As the pathophysiology is not yet fully understood,
further work is required to improve our understanding and to determine the risks; caution is therefore advisable. Unless there is
a proven adverse reaction to food that requires a grain-free diet, it might be safer to avoid such diets until the current concerns
regarding DCM are resolved. This is currently under investigation.
Can grain-free diets provide balanced nutrition?

Yes, it is possible to create grain-free diets that are complete and balanced; however, in light of recent concerns regarding the
safety of such diets, caution is advised.
Commercially prepared grain-free diet recipes should be created by professional formulators trained in the commercial
formulation of pet foods. Ideally, the formulation should have been developed in consultation with an appropriately qualified
individual.
■ Appropriate qualifications include:
● PhD in animal nutrition
● Diploma from the American College of Veterinary Nutrition (ACVN)
● Diploma from the European College of Veterinary Comparative Nutrition (ECVCN).
In the case of home-prepared cooked diets that are also grain-free, it is recommended that the recipe be designed,
overseen or approved by a diplomate of either the ACVN or the ECVCN. Provided that the recipe and supplement
recommendations are followed carefully, these can provide complete and balanced nutrition.
What safety measures are there for feeding grain-free diets?

Commercially produced grain-free diets
■ Containers and packaging should be inspected for any damage or contamination that may affect the food.
■ Any product with damaged packaging should not be purchased or should be discarded.
■ Basic hand washing after handling the pet food and bowls should be observed.
■ Regular appointments with a veterinary surgeon to ensure adequate cardiac function.
Home-prepared grain-free diets
■ For further information on preparation, storage and reheating safety, see ‘Home-prepared cooked diets’. ➟
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Considerations for feeding grain-free diets in healthy dogs and cats

■ To feed a grain-free diet correctly an appropriate product should be selected that has been specifically formulated for
the desired life stage.
■ If the grain-free diet is home prepared, an appropriately qualified individual should be consulted or approved recipes and
supplements fed. This is especially important if the pet is young or senior in years.
Considerations for feeding grain-free diets in dogs and cats with various
diseases
■ Grain-free diets are essential only in a minority of cases.
■ Key examples include adverse reactions to food proved to be caused by gluten (e.g. as determined by an exclusion-diet
trial).
■ Some grain-free diets might be detrimental to pets that do not require them.
Grain-free diets in a hospital environment – the rules

Commercially produced grain-free diets should pose a low risk within the veterinary practice, but home-prepared grain-free
diets may pose a greater risk. For further information, see ‘Home-prepared cooked diets’ and ‘Hospital nutrition’.
How to talk to owners about grain-free diets

Remember:
■ Veterinary professionals should separate what has been proven from advice we may be able to give based on clinical
experience and reasoning
■ When talking to owners about grain-free diets it is important to understand their motivations, correct any
misconceptions and give them the correct tools to be able to feed an optimal diet to their pet.
Conclusion
Feeding grain-free diets has become increasingly popular in recent years, so it is important that veterinary professionals are
aware both of the available options and the pros and cons when advising pet owners of the best diet to feed their pet.
Decisions will often be made ‘on balance’ for the individual. Advice based on good evidence should be given and any
recommendation must ensure that the minimum requirements are met to ensure complete and balanced nutrition.
References
August JR (1985) Dietary hypersensitivity in dogs: cutaneous manifestations, diagnosis and management. Compendium on
Continuing Education for the Practicing Veterinarian 7, 469–477
Batt RM, Carter MW and McLean L (1982) Morphological and biochemical studies of a naturally occurring enteropathy in the
Irish setter dog: comparison with coeliac disease in man. Research in Veterinary Science 37(3), 339–346
Clinical Nutrition Service (2016) Grain-free diets – big on marketing, small on truth. [Available from: https://vetnutrition.tufts.
edu/2016/06/grain-free-diets-big-on-marketing-small-on-truth/]
Freeman LM, Stern JA, Fries R, Adin DB and Rush JE (2018) Diet-associated dilated cardiomyopathy in dogs: what do we know?
Journal of the American Veterinary Medical Association 253(11), 1390–1394
Harvey RG (1993) Food allergy and dietary intolerance in dogs: a report of 25 cases. Journal of Small Animal Practice 34,
175–179
Hodgkins E (1991) Food allergy in cats: considerations, diagnosis and management. Pet Vet 24, 8
Jeffers JG, Shanley and Meyer EK (1991) Diagnostic testing of dogs for food hypersensitivity. Journal of the American Veterinary
Medical Association 198, 245–250
Kendall PT and Holme DW (1982) Studies on the digestibility of soya bean products, cereal, cereal and plant by-products in the
diet of dogs. Journal of the Science of Food and Agriculture 33, 813–820
Lowrie M, Garden OA, Hadjivassiliou M et al. (2015) The clinical and serological effect of a gluten-free diet in Border Terriers
with epileptoid cramping syndrome. Journal of Veterinary Internal Medicine 29(6), 1564–1569
37(3), 365–373
Pezzali JG, Acuff HL, Henry W et al. (2020) Effects of different carbohydrate sources on taurine status in healthy Beagle dogs.
Journal of Animal Science, doi: 10.1093/jas/skaa010
➟
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Useful websites
www.fediaf.org
www.pfma.org.uk
Tufts University – Clinical Nutrition Service
https://vetnutrition.tufts.edu/2017/01/food-allergies/
www.wsava.org
Last updated
August 2023

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OWNER FACTSHEET
Grain-free diets
Introduction
Grain-free diets are becoming increasingly popular and, as a consequence, we as veterinary professionals would like to provide
guidance about the advantages and disadvantages of such foods.
What are grain-free diets?

Grain-free diets must not contain the following grains:
■ Wheat
■ Barley
■ Rice
■ Maize
■ Sorghum
■ Spelt
■ Bulgar
■ Farro
■ Millet
■ Oats
■ Rye
■ Malt
■ Brewer’s yeast
■ Wheat starch
■ Triticale (a wheat/rye hybrid). ➟
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This can often be a source of confusion, as a diet that is grain-free is not necessarily carbohydrate-free. Other carbohydrate
sources (e.g. potato) are frequently used in grain-free diets. Similarly, grains contain different types of gluten, some of which
may not be of concern, even for those pets known to have an adverse food reaction to glutens. As a result, a blanket approach
is often taken and all grains are excluded, meaning that a number of other nutrients which grains deliver are also restricted
when there may be no requirement to do so.
Although there may be concerns with feeding grains, carbohydrates or gluten, evidence of harm is limited. However, there
are concerns arising from restricting grains in pet diets.
Types of grain-free diet

■ Commercially produced by many UK pet food manufacturers in wet or dry forms.
■ Home-prepared:
● Similar to raw diets, grain-free home-prepared cooked diets comprise ingredients in a form that can be easily
purchased from supermarkets and grocery stores.
Why are pet owners choosing to feed grain-free diets?

Proponents of grain-free diets choose them over other available diets as they believe that they are a ‘healthier option’ for their
pet in various ways. The following are the claims made and the available evidence for these claims.

Grain-free diets do not contain ■ It is true that eliminating gluten-containing grains from the diet will eliminate
gluten, which is a known cause of gluten. However, there is limited to no evidence that gluten is bad for pets or that
food intolerance, making pets it makes them unwell, except in cases of specific adverse food reactions (often
unwell called a ‘food allergy’), which are rare
Cats and dogs are carnivores and, as ■ Whilst dogs are in the order Carnivora, they are nutritionally omnivorous and are
such, are not designed to eat grains fully equipped to extract nutrients from grain sources in their diets
– feeding diets akin to those eaten ■ Despite cats being obligate carnivores (meaning they require meat, poultry and
by their wild ancestors is more fish in their diet), they also have the ability to digest grains and obtain nutrients,
‘species appropriate’ and therefore just to a lesser extent than dogs
more ‘natural’ ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or at least
95%) from the source material (e.g. of vegetable or animal origin). This is not an
official or regulated definition
Grains cause ‘allergies’, so avoiding ■ There is no evidence that grains alone will cause adverse food reactions. However,
them will prevent itchy skin and some pets may suffer adverse food reactions involving grains, in a similar manner
digestive problems to reactions against other ingredients (e.g. beef, dairy or fish)
Grains are only in pet food as ‘fillers’; ■ Grains can be useful sources of proteins, essential fatty acids, vitamins, minerals
they don’t benefit the pet and fibre. Digestibility is typically high (>90%) when included in pet foods
Foods containing grains are harder ■ There is no evidence that the cooked grains included in pet foods are harder to
to digest than meat-based products digest than the other components and they have even been shown to be
nutritionally valuable. However, some uncooked whole grains may be harder to
digest when compared with meat-based products
What are the advantages of feeding a grain-free diet?

Evidence-based advantages
■ Food elimination trials (see section on ‘Diagnosis of an adverse food reaction’ for further information).
■ Management of skin disease in the case of adverse reactions to food.
■ Management of gastrointestinal signs in the case of adverse reactions to food, specifically grains or gluten.
■ One disease known to require a grain-free diet is paroxysmal gluten-sensitive dyskinesia:
● Mainly affects Border Terriers
● It is a distressing neurological disorder for both the dog and the owner as the dog remains awake and aware
throughout abnormal limb movement episodes

● Clinical signs range from mild abnormal movement of one limb, affecting function or coordination, to severe, where
dogs collapse and abnormal movement affects the entire body

● Dietary gluten elimination has been shown to improve clinical signs, making a gluten-free diet an important
component in the management of this disease. ➟

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What we know about adverse reactions to food and diet

■ A true adverse food reaction accounts for only 1% of skin disease cases seen in practice, making it uncommon. An
adverse food reaction is the third most common reason for skin disease after flea allergy and atopy.
■ Food-associated gastrointestinal disease is common in cats and dogs, but only a minority of cases are proven to be the
result of a genuine immune-mediated food hypersensitivity (i.e. allergy). Instead, most arise through other mechanisms
(e.g. intolerances). For these reasons, the term ‘adverse food reaction’ is preferred to ‘food allergy’.
■ The main concern regarding feeding grains relates to the perceived risk of an allergy to glutens and gliadins. Although
adverse reactions to these components do occur, the most common foods associated with adverse food reactions in
cats and dogs are:
● Beef
● Soya
● Dairy products.

A grain-free diet will prevent a pet ■ This is likely to be the case only for pets that already have an adverse reaction
developing signs of skin or to food. However, both gastrointestinal and skin diseases are often
gastrointestinal disease, especially in multifactorial, therefore such diets might not completely resolve the signs that
certain breeds are seen
Improved pet health, digestive system ■ There is no published evidence to support such claims, although there are
and/or skin after starting a grain-free anecdotal reports of cases improving after starting a grain-free diet
diet ■ However, there have been recent concerns regarding the safety of feeding
some grain-free diets
Diagnosis of an adverse food reaction

The gold-standard method for determining the source of an adverse food reaction is a properly designed exclusion-diet trial.
Your veterinary surgeon will follow the steps below:
■ Choose a diet that is either:
● Hydrolysed – a process to reduce protein size so as not to trigger an immune response. If for any reason a
hydrolysed diet cannot be fed, the use of a diet that has not been fed for the past 6–12 months is chosen
● Novel – containing one protein and one carbohydrate source that your pet has never eaten previously
● Purified – a process of removal of the parts that are likely to cause an adverse reaction, although this is difficult to
achieve. This can be a commercially produced diet or one produced carefully by an appropriately qualified individual
■ Instruct you to feed this diet exclusively, and with complete compliance, for 2 weeks for pets with gastrointestinal signs
and 6–10 weeks for pets with skin signs
■ At the end of the trial, your pet should be re-challenged with its previous diet and monitored for the recurrence of
clinical signs
■ If clinical signs return quickly, this suggests an adverse food reaction to one of the ingredients within that food, and your
pet will be returned to the diet used in the trial
■ Once the clinical signs have subsided again, your pet could be re-challenged with one ingredient at a time and the
response monitored
■ By taking this systematic approach, the problem ingredient will be identified and thereafter can be eliminated from your
pet’s diet
■ Some pet owners may not wish to re-challenge their pet with its previous diet. Thus, provided that the elimination diet is
complete and balanced, this can be fed long term.
NB: An exclusion diet trial should never be undertaken without the help and guidance of your veterinary surgeon.
Blood testing
Although blood (serology) testing for ingredients that may cause concern is available, this is unreliable. Elimination-feeding trial
remains the gold-standard method of determining adverse food reactions.
What are the disadvantages of feeding a grain-free diet?

Although both dogs and cats can reportedly do well on grain-free diets, there have been some reports of health problems
developing, most notably a heart condition (dilated cardiomyopathy, DCM) in dogs. However, the exact causal factors and
mechanisms remain unclear and, indeed, questions have arisen as to whether the absence of grains is the problem.
Rather, since many grain-free diets are made by recently established food companies, it is possible that wider formulation
problems are the cause. In addition, it was found that the same ingredients repeatedly appeared in the top four components
listed in the diets of the affected dogs, and since many of the affected dogs improved after switching to a non-grain-free
diet, this has led to the suspicion that the diet is the cause. Unless there is a proven adverse reaction to food that requires
a grain-free diet, it might be safer to avoid such diets until the current concerns regarding DCM are resolved. This is
currently under investigation. ➟
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Can grain-free diets provide balanced nutrition?

Yes, it is possible to create grain-free diets that are complete and balanced; however, in light of recent concerns regarding the
safety of such diets, caution is advised.
Commercially prepared grain-free diet recipes should be created by professional formulators trained in the commercial
formulation of pet foods. Ideally, the formulation should have been developed in consultation with an appropriately qualified
individual.
In the case of home-prepared cooked diets that are also grain-free, it is recommended that the recipe be designed,
overseen or approved by a diplomate of either the ACVN or the ECVCN. Provided that the recipe and supplement
recommendations are followed carefully, these can provide complete and balanced nutrition.
What safety measures are there for feeding grain-free diets?

Commercially produced grain-free diets
■ Containers and packaging should be inspected for any damage or contamination that may affect the food.
■ Any product with damaged packaging should not be purchased or should be discarded.
■ Basic hand washing after handling the pet food and bowls should be observed.
■ Regular appointments with your veterinary surgeon to ensure adequate heart function.
Home-prepared grain-free diets
■ For further information on preparation, storage and reheating safety, see ‘BSAVA Guide to Nutrition – Home-prepared
cooked diets’ factsheet.
Considerations for feeding grain-free diets in healthy dogs and cats

■ To feed a grain-free diet correctly, an appropriate product should be selected that has been specifically formulated for
the desired life stage.
■ If the grain-free diet is home prepared, an appropriately qualified individual should be consulted or approved recipes and
supplements fed. This is especially important if the pet is young or senior in years.
Considerations for feeding grain-free diets in dogs and cats with various
diseases
■ Grain-free diets are essential only in a minority of cases.
■ As described above, some grain-free diets might be detrimental to pets that do not require them.
Conclusion
Feeding grain-free diets has become increasingly popular in recent years. Therefore, it is important that you consider all the
pros and cons when making decisions about what to feed your pet, no matter the diet type. Decisions will be made ‘on
balance’ for your individual pet. Provided assurance of nutritional adequacy is confirmed, grain-free diets can be safely fed. If
you are in any doubt, please seek advice from your veterinary practice.
Last updated
August 2023

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Home-prepared
cooked diets
Home-prepared cooked diets are becoming increasingly popular with owners and,
consequently, veterinary professionals need to provide guidance about the advantages and
What are home-prepared cooked diets?

Home-prepared cooked diets comprise cooked ingredients, with the exception of some uncooked vegetables, fruits and nuts.
Depending on the home-prepared cooked diet type, the following specific ingredients may be included:
■ Meat
■ Fish
■ Poultry
■ Green or yellow vegetables
■ Root vegetables
■ Eggs
■ Dairy products
■ Cereals
■ Oils
■ Nuts
■ Seeds
■ Fruits.
Similar to raw diets, home-prepared cooked diets comprise ingredients that can be easily purchased and, with the exception of
some dairy products and oils, have undergone limited processing.
Types of home-prepared cooked diet

Home-prepared cooked diet recipes are widely available, but not all such diets are created equally.
■ Home-prepared recipes:
● The recipe source may vary and often includes:
− Books
− Magazines
− Online content
− Copy produced by veterinary professionals or nutritionists
● Caution is needed, as not all recipes will deliver complete and balanced nutrition. It is important to ascertain the
qualifications of the person who created the recipe

− Appropriate qualifications include:
• PhD in animal nutrition
• Diploma from the American College of Veterinary Nutrition (ACVN)
• Diploma from the European College of Veterinary Comparative Nutrition (ECVCN)
● Most recipes are designed to be fed with a nutritional supplement. The appropriate supplement type and amount to
feed to ensure that the food is complete and balanced should be clearly stated on the recipe
● Although some recipes are intended to be fed without supplements, it can be more difficult to ensure that they are
appropriately balanced and most are not.

■ No specific recipe:
● Owners may not follow a recipe, but feed the pet according to its own preferences.
NB: recipe assessment is always advised.
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BSAVA GUIDE TO NUTRITION Home-prepared cooked diets
Recently, concerns have arisen regarding the nutritional adequacy of home-prepared cooked diet recipes. In a study
assessing 200 different home-prepared cooked diet recipes that were not created by an appropriately qualified person:
■ 94% of the diets had a deficiency of one essential nutrient
■ 84% of the diets had a deficiency of more than one essential nutrient (Fell, 2013).
What are the advantages of feeding a home-prepared cooked diet?

Clinical indications
■ Food elimination trials:
● It can often be easier to design an appropriate short-term elimination-diet trial if a home-prepared cooked diet is
used. Trials typically last for 2–10 weeks and, if appropriately conducted, can be used for diagnosing adverse
reactions to food (Jeffers et al., 1991)
● If used for short periods, such diets need not be complete and balanced
● If the home-prepared cooked diet successfully resolves the clinical signs, it can then be considered for long-term
feeding, but only if it is suitably balanced by an appropriately qualified individual.

■ Home-prepared cooked diets can be used in cases where no other appropriate diet is available; for example, where
there is a proven adverse reaction to food and no suitable commercially available diet exists. Again, it is strongly advised
to ensure that the recipe used is created by an appropriately qualified person, so that it is safe for long term use. For
further information, see ‘Adverse reactions to food’.
■ Cases with multiple concurrent diseases:
● In some instances, a suitable diet for the individual’s needs may not be available; for example, a case with renal
disease and concurrent adverse food reaction to certain ingredients. In such cases, a home-prepared cooked diet
can be tailored specifically to the pet’s individual needs
● As this may be extremely challenging, it should be attempted only by an appropriately qualified individual.
Evidence for the benefits of home-prepared cooked diets

Owners often choose to feed a home-prepared cooked diet because it gives them more control over what their pet eats,
including the source of the ingredients. Advocates also believe that such diets are a healthier option than a commercially
produced diet. However, there is currently no evidence to support these perceived benefits.
The main advantages that are suggested include:

Improved palatability ■ Depending on the formulation, home-prepared cooked diets often have
a greater moisture content and might also contain more fat and protein.
Foods that the pet likes are generally chosen. Improved palatability is
therefore expected
■ This may be an advantage for picky eaters
■ This may be a disadvantage for pets prone to obesity
The diet is cooked (versus a raw diet which is ■ The cooking of ingredients in home-prepared cooked diets reduces the
uncooked) risk of pathological infection compared with feeding diets that are
uncooked
■ For further information, see ‘Raw diets’
Proponents of home-prepared cooked diets also report the following (albeit unpublished) advantages from their clinical
experience:

A more ‘natural’ food can be fed, and owners ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or
may feel that this is better for the pet at least 95%) from the source material (e.g. of vegetable or animal origin).
This is not an official or regulated definition (Regulation, 2008)
■ Therefore, depending on the ingredients used, commercially
manufactured diets can also be defined as ‘natural’ in accordance with
the above guidance
More appropriate for dogs and cats due to its ■ Although there is some emerging evidence that ultra-processed foods
unprocessed content may be of concern in humans (Schnabel et al., 2019) further work in this
area is needed. However, in general, pet foods would not be considered
to be ultra-processed by the definitions used for human food

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The diet need not contain carbohydrates/ ■ A study has shown that over the many years of dog
gluten/wheat: domestication, their dietary needs have changed and their digestive
■ Carbohydrates are thought by some to be capabilities have adapted to accommodate living as companions (Axelson
indigestible and even harmful to pets et al., 2013)
■ Carbohydrates are responsible for dietary ■ Unlike their ancestors, domesticated dogs can readily digest
intolerances carbohydrates; indeed, 10 of the 36 genomic differences between these
species are involved in carbohydrate digestion (Axelson et al., 2013)
■ Studies have now shown that cats can also utilize carbohydrates, but to a
lesser extent than dogs. This means that carbohydrates can form part of
a nutritious diet (Morris et al., 1977)
■ Adverse food reactions are rare and may be protein or carbohydrate
related, although they are most commonly found to be associated with
the protein components of the diet (August, 1985; Hodgkins, 1991;
Harvey, 1993). For further information, see ‘Adverse reactions to food’
It should be noted that many home-prepared cooked diets will contain carbohydrates, gluten and/or wheat. For further
information on the inclusion of grains in pet foods, see ‘Grain-free diets’.

Reduced incidence of gastrointestinal signs ■ There is no published scientific evidence
Improved stool volume due to feeding a diet ■ No scientific study evidence

without perceived ‘fillers’ ■ However, a smaller stool volume would be expected if the home-
prepared cooked diet contained a lower fibre content than a
commercially prepared diet
Improved stool quality ■ No scientific study evidence
Improved breath odour ■ No scientific study evidence
Eliminated gas or bloat risk ■ The suggested mechanism is that home-prepared cooked diets contain a
decreased amount of soluble and insoluble carbohydrates. While such
a mechanism is plausible, there is currently no published evidence to
support it
Fewer food allergies or reduced skin ■ No scientific study evidence, anecdotal evidence only. An improvement
complaints when switching to a home-prepared cooked diet would be expected in
animals with an adverse reaction to food, provided that the component
associated with the clinical signs is not fed
Improved recovery from illness ■ No scientific study evidence

■ Nutrition should be tailored to the illness and a home-prepared cooked
diet might not be appropriate for conditions such as renal disease
where protein and phosphorus restriction is vital (Ross et al., 1982; Finco
el al., 1992)
Increased energy levels ■ No scientific study evidence
Improved behaviour ■ No scientific study evidence
Improved immunity ■ No scientific study evidence
The same diet can be fed at all life stages ■ This would be possible only if the recipe was created by an appropriately
qualified individual and was appropriate for all life stages, including
growth and reproduction
There is little evidence for many of the claims. Further studies in all of these areas are essential to provide robust scientific
evidence for veterinary professionals to be able to deliver the best advice on nutrition.
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What are the disadvantages of feeding a home-prepared cooked diet?

Cost
■ The cost of feeding a home-prepared cooked diet is significantly greater than other types of diet, especially
commercially produced dry foods (e.g. kibble); see below for an example of relative costs.
■ Increased feeding costs are due to the costs of sourcing the ingredients (usually from local supermarkets or grocers) and
specific supplements that are essential for completing the nutritional profile of these diets. These costs are in addition to
the cost of the diet formulation creation by an appropriately qualified individual.
■ For large breeds of dog, these costs may quickly become prohibitive.
Cooking and preparation time
■ Home-prepared cooked diets require the cooking of ingredients every 1–2 days. It takes significantly longer to prepare
each meal than it would for pre-prepared foods, and many owners will find this commitment difficult to maintain.
■ Even if batch-cooked and frozen, the meals still take time to thaw, reheat and cool compared with other diet types
which can be ready in seconds.
Pathogenic infection
■ Compared with feeding a raw diet, the risk from pathogens is less, making it safer overall.
■ However, care is still required when meals have been pre-prepared, because incorrect cooking, cooling, thawing and
reheating can result in bacterial growth, which may lead to a potential risk of food poisoning.
Excess or deficiency
■ When feeding a home-prepared cooked diet, it is difficult for the owner to ensure that what they are feeding is a
complete and balanced diet for their pet.
■ Research studies have assessed the nutritional adequacy of home-prepared cooked diets:
● Two such studies looking at 94 commonly available recipes for home-made diets (both cooked and uncooked) for
pets with medical conditions found them all to be inadequate (Heize et al., 2012; Larsen et al., 2012)
● A third study of 200 different recipes for maintenance diets for dogs found that 95% were deficient in at least one
essential nutrient, and 84% had multiple deficiencies (Stockman et al., 2013).
■ Clinical signs associated with conditions that are caused by feeding an unbalanced diet can take a considerable period of
time to appear. At this point the damage may be irreversible.
● Deficiencies of certain nutrients include insufficient calcium in the diet:
− Occurs when an all-meat, table-scrap or all organ-meat diet is fed

− These diets, being very low in calcium, cause hypocalcaemia resulting in nutritional secondary
hyperparathyroidism. This is a very painful condition leading to significant bone loss through demineralization
and multiple pathological bone fractures (Bennet, 1976; Hintz and Schryver, 1987).
■ Although there are no published studies on prevalence, the risk of nutrient deficiencies causing overt clinical signs in
otherwise healthy adult dogs and cats appears to be rare. However, such deficiencies are more frequently reported in
growing animals. As a result, caution should be exercised when feeding such diets to animals that have not yet reached
skeletal maturity.
■ Appropriate feeding trials are performed for good quality commercial diets. When a home-prepared cooked diet is
provided, the food trial is being performed on the owner’s pet.
■ Nutrient interactions and bioavailability cannot be determined for home-prepared cooked diets.
■ If a vitamin supplement is added to the recipe prior to cooking, many of the vitamins can be destroyed by the cooking
process.
Reduced digestibility
■ Although the cooking of ingredients, especially proteins, can reduce digestibility, this is only a minor reduction and can
be easily compensated without the pet having to consume the diet in excess to meet their nutritional needs. Cooking
can also increase the digestibility of many other ingredients.
■ The methods of cooking, or overcooking, some ingredients may alter the nutritional content, so using a recipe
formulated by an appropriately qualified person is always recommended.
■ Even though reduced digestibility is undesirable, the benefits of cooking the ingredients and avoiding pathogenesis are a
significant advantage for both the pet’s and owner’s health.
Compliance
■ As with any diet, the level of compliance from owners will vary.
■ As it is harder to balance a home-prepared cooked diet, the margin for error may be smaller and so mistakes leading to
deficiency are easier to make.
■ It is important to impress on pet owners the need for excellent compliance while feeding a home-prepared cooked diet,
to ensure that the diet being fed each day is complete and sufficiently balanced.
Can home-prepared cooked diets provide balanced nutrition?

Yes, provided that the recipe has been designed, overseen or approved by an appropriately qualified person and the recipe and
supplement recommendations are followed carefully.
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What safety measures are there for feeding home-prepared cooked diets?
Hygiene
■ Basic hygiene is essential for the safe feeding of a home-prepared cooked diet to prevent pathogen infection.
■ At purchase, inspect the ingredient packaging for damage or contamination. If damaged, the ingredient should not be
purchased or should be discarded. Damaged ingredients should not be fed to the pet.
■ Hands should be washed before, periodically during and after food preparation.
■ Preparation areas and surfaces should be cleaned after food is prepared.
■ Clean food bowls should be used for each meal.
■ Bowls and utensils should be washed after feeding.
■ Bowls or plates for pet use should be kept separate from the ones used by the owners.
Cooling, storing and reheating a home-prepared cooked diet
■ To prevent bacterial growth and subsequent food poisoning, care should be taken with cooling the cooked foods.
■ Uneaten cooked meals can be stored and reheated at a later date, provided that:
● Food is cooled to room temperature completely before it is covered and refrigerated
● Foods should not be cooled in the refrigerator because this can increase the refrigerator’s temperature, increasing
the risk of spoilage of other foods

● Food should be stored in a sealed container in either the refrigerator or freezer
● When needed, food must be reheated only once
● On reheating, food should be piping hot throughout and allowed to cool to an edible temperature before being fed
to the pet.
Considerations for feeding home-prepared cooked diets in healthy dogs

and cats
To feed a home-prepared cooked diet correctly for any stage of life, an appropriately qualified individual should be consulted
and only approved recipes and supplements fed. This is especially important if the pet is young (i.e. still growing) or intended to
be involved in reproduction, when nutritional requirements differ from those of an adult.
Considerations for feeding home-prepared cooked diets in dogs and

cats with various diseases
To feed a home-prepared cooked diet correctly for pets who have a disease, especially a disease that requires nutritional
alteration, an appropriately qualified individual should be consulted and only approved recipes and supplements fed. For further
information, see factsheets on feeding for specific situations and conditions.
Home-prepared cooked diets in a hospital environment – the rules

As more of our patients are being fed home-prepared cooked diets, it is important to consider the affect that this may have in a
veterinary hospital.
■ Preparing food as the owner would at home is often impractical. Discussion with the owner regarding alternatives will be
necessary.
■ Owners may need or want to cook and bring food in daily for their pet. Each veterinary practice might wish to create and
enforce their own policy on this, as the sources of ingredients and hygiene during preparation cannot be guaranteed.
■ Pathogen risk is low but, as with any food, basic hygiene rules should apply.
■ There should be no need to isolate a patient fed a home-prepared cooked diet on this basis alone, unlike those fed a raw
diet where the risk of pathogenic infection to other patients and staff is higher.
For further information about feeding in the veterinary hospital, see ‘Hospital nutrition’.
How to talk to owners about home-prepared cooked diets

Remember:
■ When talking to owners about home-prepared cooked diets, it is important to understand their motivations, correct any
misconceptions and provide them with appropriate guidance so that they can feed their pet optimally and safely.
Conclusion
Feeding home-prepared cooked diets has become increasingly popular in recent years. It is therefore important that we first
educate ourselves on the available options, and then consider all the pros and cons when advising pet owners of the best diet
to feed their pet. Decisions will often be made ‘on balance’ for the individual. Advice based on good evidence, wherever
available, should be given each time, and any recommendation must ensure that minimum requirements are met. In such
cases, home-prepared cooked diets can provide complete, balanced and safe nutrition.
➟
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Costs of feeding a home-prepared diet compared with a commercially

produced diet
Example
Species: Canine Age: 8 years old Weight: 12 kg
Food preferences: Fish (cod) and brown rice
Cost of diet formulation:
£185
For the formulation to be created by an appropriately qualified individual (prices may vary).
Cost of diet ingredients:
£177 per month
Price based on sourcing ingredients from high-street supermarkets and using unbranded or own-branded items.
Cost of supplement:
£26.69 per month
Cost of shipping:
£66.02 one off price per shipment
Total cost of feeding the home-prepared cooked diet:
£454.71 for the first month, £203.69 per month thereafter.
Comparative cost of feeding a commercially produced wet food:
£37.20 per month
Price based on Pedigree® Adult complete dog food tins.
Comparative costs of feeding a commercially produced dry food:
£8.40 per month
Price based on Pedigree® Adult complete dry food.
References
Axelson E, Ratnakumar A, Arendt ML et al. (2013) The genomic signature of dog domestication reveals adaptation to a starch-
rich diet. Nature 495, 360–364
Bennet D (1976) Nutrition and bone disease in dogs and cats. Veterinary Record 98, 313–320
Fell A (2013) Homemade dog food recipes can be risky business, study finds. [Available from: https://www.ucdavis.edu/news/
homemade-dog-food-recipes-can-be-risky-business-study-finds/]
Finco DR, Brown SA, Crowell WA et al. (1992) Effects of dietary phosphorus and protein in dogs with chronic renal failure.
American Journal of Veterinary Research 53(12), 2264–2271
Harvey RG (1993) Food allergy and dietary intolerance in dogs: a report of 25 cases. Journal of Small Animal Practice 34, 175–179
Heize CR, Gomez FC and Freeman LM (2012) Assessment of commercial diets and recipes for home prepared diets
recommended for dogs with cancer. Journal of the American Veterinary Medical Association 241, 1453–1460
Hintz HF and Schryver HF (1987) Nutrition and bone development in dogs. European Journal of Companion Animal Practice 1,
44–47
Jeffers JG, Shanley and Meyer EK (1991) Diagnostic testing of dogs for food hypersensitivity. Journal of the American Veterinary
Larsen JA, Parks EM, Heinze CR and Fascetti AJ (2012) Evaluation of recipes for home prepared diets for dogs and cats with
chronic kidney disease. Journal of the American Veterinary Medical Association 240, 532–538
37(3), 365–373
Ross LA, Finco DR and Crowell WA (1982) Effect of phosphorus restriction on the kidneys of cats with reduced renal mass.
Schnabel L, Kesse-Guyot E, Alles B et al. (2019) Association between ultra-processed food consumption and risk of mortality
among middle-aged adults in France. Journal of the American Medical Association: Internal Medicine 179(4), 490–498
Stockman J, Fascetti AJ, Kass PH and Larsen JA (2013) Evaluation of recipes of home-prepared maintenance diets for dogs.
Journal of the American Veterinary Medical Association 242, 1500–1505
Useful websites
www.fediaf.org
www.pfma.org.uk
www.wsava.org
Last updated
August 2023
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OWNER FACTSHEET
Home-prepared cooked diets

Introduction
Home-prepared cooked diets are becoming increasingly popular and, as a consequence, we as veterinary professionals would
like to provide guidance about the advantages and disadvantages of such foods.
What are home-prepared cooked diets?

Home-prepared cooked diets comprise cooked ingredients, with the exception of some uncooked vegetables, fruits and nuts.
Depending on the home-prepared cooked diet type, the following specific ingredients may be included:
■ Meat
■ Fish
■ Poultry
■ Green or yellow vegetables
■ Root vegetables
■ Eggs
■ Dairy products
■ Cereals
■ Oils
■ Nuts
■ Seeds
■ Fruits.
Similar to raw diets, home-prepared cooked diets comprise ingredients that can be easily purchased and, with the
exception of some dairy products and oils, have undergone limited processing. ➟
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Types of home-prepared cooked diet

Home-prepared cooked diet recipes are widely available, but not all such diets are created equally.
■ Home-prepared recipes:
● The recipe source may vary and often includes:
− Books
− Magazines
− Online content
− Copy produced by veterinary professionals or nutritionists
● Caution is needed, as not all recipes will deliver complete and balanced nutrition. It is important to ascertain the
qualifications of the person who created the recipe

− Appropriate qualifications include:
• PhD in animal nutrition
• Diploma from the American College of Veterinary Nutrition (ACVN)
• Diploma from the European College of Veterinary Comparative Nutrition (ECVCN)
● Most recipes are designed to be fed with a nutritional supplement. The appropriate supplement type and amount to
feed to ensure that the food is complete and balanced should be clearly stated on the recipe
● Although some recipes are intended to be fed without supplements, it can be more difficult to ensure that they are
appropriately balanced and studies have shown most are not.

■ No specific recipe:
● A recipe may not be followed, rather the pet is fed according to its own preferences.
NB: Recipe assessment by an appropriately qualified person is always advised.
What are the advantages of feeding a home-prepared cooked diet?

Advantages in a clinical (or veterinary) situation
■ Food elimination trials to rule out foods that may cause an adverse reaction (often called a ‘food allergy’):
● Trials typically last for 2–10 weeks and, if appropriately conducted, remain the gold standard for the diagnosis of
adverse reactions to food

● If used for short periods, such diets need not be complete and balanced
● If the home-prepared cooked diet successfully resolves the clinical signs, it can then be considered for long-term
feeding, but only if it is suitably balanced by an appropriately qualified individual.

■ Home-prepared cooked diets can be used in cases where no other appropriate diet is available; for example, where
there is a proven adverse reaction to food and no suitable commercially available diet exists. Again, it is strongly advised
to ensure that the recipe used is created by an appropriately qualified person, so that it is safe for long term use.
Evidence for the benefits of home-prepared cooked diets
As a pet owner, you may choose to feed a home-prepared cooked diet because it gives you more control over what your pet
eats, including the source of the ingredients. Advocates also believe that such diets are a healthier option than a commercially
produced diet. However, there is currently no evidence to support these perceived benefits.
The proposed main advantages and the evidence for these claims include:

Improved palatability ■ Depending on the formulation, home-prepared cooked diets often have a greater
moisture content and might also contain more fat and protein. Foods that the pet likes
are generally chosen. Improved palatability is therefore expected
■ This may be an advantage for picky eaters
■ This may be a disadvantage for pets prone to obesity
The diet is cooked (versus a raw ■ The cooking of ingredients in home-prepared cooked diets significantly reduces the
diet which is uncooked) risk of pathological infection compared with feeding diets that are uncooked
Proponents of home-prepared cooked diets also report the following (albeit unpublished) advantages from their clinical
experience:

A more ‘natural’ food can be fed, ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or at least 95%)
and owners may feel that this is from the source material (e.g. of vegetable or animal origin). This is not an official or
better for the pet regulated definition
■ Therefore, depending on the ingredients used, commercially manufactured diets can
also be defined as ‘natural’ in accordance with the above guidance
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More appropriate for dogs and ■ Although there is some emerging evidence that ultra-processed foods may be of
cats due to its unprocessed concern in humans, further work in this area is needed. However, in general, pet foods
content would not be considered to be ultra-processed by the definitions used for human
food
The diet need not contain ■ A study has shown that over the many years of dog domestication, their dietary needs
carbohydrates/gluten/wheat: have changed and their digestive capabilities have adapted to accommodate living as
■ Carbohydrates are thought by companions
some not to be digestible and ■ Unlike their ancestors, domesticated dogs can readily digest carbohydrates
even harmful to pets ■ Studies have now shown that cats can also utilize carbohydrates, but to a lesser extent
■ Carbohydrates are thought by than dogs. This means that carbohydrates can form part of a nutritious diet for cats
some to be responsible for ■ Adverse reactions to food are rare and may be protein or carbohydrate related,
dietary intolerances although they are most commonly found to be associated with the protein
components of the diet
It should be noted that many home-prepared cooked diets will contain carbohydrates, gluten and/or wheat.

Reduced incidence of ■ There is no published scientific evidence
gastrointestinal signs
Improved stool volume due to ■ No scientific study evidence

feeding a diet without perceived ■ The smaller stool volume in pets fed home-prepared cooked diets may be due to the
‘fillers’ typically low fibre content
Improved stool quality ■ No scientific study evidence
Eliminated gas or bloat risk ■ The suggested mechanism is that home-prepared cooked diets contain a decreased
amount of soluble and insoluble carbohydrates. While such a mechanism is plausible,
there is currently no published evidence to support it
Fewer ‘food allergies’ or reduced ■ No scientific study evidence; anecdotal evidence only. Switching to a home-prepared
skin complaints cooked diet might plausibly resolve clinical signs of an adverse reaction to food,
provided that the component associated with the signs is not fed

■ Nutrition should be tailored to the illness and a home-prepared cooked diet might not
be appropriate for conditions such as kidney disease where protein and phosphorus
restriction is vital
The same diet can be fed at all ■ This would be possible only if the recipe was created by an appropriately qualified
life stages individual and was appropriate for all life stages, including growth and reproduction
What are the disadvantages of feeding a home-prepared cooked diet?

Cost
■ The cost of feeding a home-prepared cooked diet is significantly greater than other types of diet, especially
commercially produced dry foods (e.g. kibble). Although exact costs vary depending upon the ingredients, as an owner
you may typically expect to spend at least twice, and sometimes over 10 times, the cost of an equivalent commercially
manufactured diet.
■ The higher costs are due to:
● Sourcing the ingredients (usually from local supermarkets or grocers)
● Specific supplements that are essential for completing the nutritional profile of these diets
● The cost of the diet formulation creation by an appropriately qualified individual.
■ For large breeds of dog, especially, these costs may quickly become prohibitive. ➟
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Cooking and preparation time

■ Home-prepared cooked diets require the cooking of ingredients every 1–2 days. It takes significantly longer to prepare
each meal than it would for pre-prepared foods, and this commitment can be difficult to maintain.
■ Even if batch-cooked and frozen, the meals still take time to thaw, reheat and cool compared with other diet types
which can be ready in seconds.
Pathogenic infection
■ Compared with feeding a raw diet, the risk from pathogens is lower, making it safer overall.
■ However, care is still required when meals have been pre-prepared, because incorrect cooking, cooling, thawing and
reheating can result in bacterial growth, leading to a potential risk of food poisoning.
■ When feeding a home-prepared cooked diet, it is difficult for you to ensure that what you are feeding is a complete and
balanced diet for your pet.
■ Research studies assessing the nutritional adequacy of home-prepared cooked diets have found some concerning
results:
● Two studies looking at 94 commonly available recipes for home-made diets (both cooked and uncooked) for pets
with medical conditions found them all to be inadequate

● A third study of 200 different recipes for maintenance diets for dogs found that 95% were deficient in at least one
essential nutrient, and 84% had multiple deficiencies.

■ Although there are no published studies on prevalence, the risk of nutrient deficiencies causing clinical signs in otherwise
healthy adult dogs and cats appears to be rare. However, such deficiencies are more frequently reported in growing
animals. As a result, caution should be exercised when feeding such diets to pets that have not yet reached skeletal
maturity.
■ Appropriate feeding trials are performed for good quality commercial diets. When a home-prepared cooked diet is
provided, the food trial is being performed on your pet.
■ Nutrient interactions and bioavailability cannot be determined for home-prepared cooked diets.
■ If a vitamin supplement is added to the recipe prior to cooking, many of the vitamins can be destroyed by the cooking
process.
Reduced digestibility
■ Although the cooking of ingredients, especially proteins, can reduce digestibility, this is only a minor reduction and can
be easily compensated without the pet having to consume the diet in excess to meet their nutritional needs. Cooking
can also increase the digestibility of many other ingredients.
■ The methods of cooking, or overcooking, some ingredients may alter the nutritional content, so using a recipe
formulated by an appropriately qualified person is always recommended.
■ Even though reduced digestibility is undesirable, the benefits of cooking the ingredients and avoiding pathogens/
infectious agents are a significant advantage for both your and your pet’s health.
Sticking to the instructions (compliance)
■ As it is harder to balance a home-prepared cooked diet, the margin for error may be smaller and so mistakes leading to
deficiency are easier to make.
■ Excellent compliance when feeding a home-prepared cooked diet is essential, to ensure that the diet being fed each day
is complete and sufficiently balanced.
Can home-prepared cooked diets provide balanced nutrition?

Yes, provided that the recipe has been designed, overseen or approved by an appropriately qualified person and the recipe and
supplement recommendations are followed carefully.
What safety measures are there for feeding home-prepared cooked

diets?
Hygiene
■ Basic hygiene is essential for the safe feeding of a home-prepared cooked diet to prevent pathogen infection.
purchased or should be discarded. Damaged ingredients should not be fed to your pet.
■ Hands should be washed before, periodically during and after food preparation.
■ Preparation areas and surfaces should be cleaned after food is prepared.
■ Bowls and utensils should be washed after feeding.
■ Bowls or plates for pet use should be kept separate from the ones you use.
Cooling, storing and reheating a home-prepared cooked diet
■ To prevent bacterial growth and subsequent food poisoning, care should be taken with cooling the cooked foods.
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■ Uneaten cooked meals can be stored and reheated at a later date, provided that:
● Food is cooled to room temperature completely before it is covered and refrigerated
● Foods should not be cooled in the refrigerator because this can increase the refrigerator’s temperature, increasing
the risk of spoilage of other foods

● Food should be stored in a sealed container in either the refrigerator or freezer
● When needed, food must be reheated only once
● On reheating, food should be piping hot throughout and allowed to cool to an edible temperature before being fed
to your pet.
Considerations for feeding home-prepared cooked diets in healthy dogs

and cats
To feed a home-prepared cooked diet correctly for any stage of life, an appropriately qualified individual should be consulted
and only approved recipes and supplements fed. This is especially important if your pet is young (i.e. still growing) or in its
senior years, when its nutritional requirements differ from that of an adult.
Considerations for feeding home-prepared cooked diets in dogs and

To feed a home-prepared cooked diet correctly for pets who have a disease, especially a disease that requires nutritional
alteration, an appropriately qualified individual should be consulted and only approved recipes and supplements fed.
Conclusion
Feeding home-prepared cooked diets has become increasingly popular in recent years. Therefore, it is important that you
consider all the pros and cons when making decisions about what to feed your pet, no matter the diet type. Decisions will be
made ‘on balance’ for your individual pet. Provided assurance of nutritional adequacy is confirmed, home-prepared cooked
diets can be safely fed. If you are in any doubt, please seek advice from your veterinary practice.
Last updated
August 2023

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Raw diets
Raw diets (also known as raw meat-based diets, ‘biologically appropriate raw food’ or ‘BARF’
diets) are becoming increasingly popular with owners and, consequently, veterinary
professionals need to provide guidance about the advantages and disadvantages of such foods.
What are raw diets?

Raw diets predominately comprise uncooked ingredients, although different components can vary. Raw diets may contain:
■ Meat
■ Fish
■ Poultry
■ Bones
■ Meat by-products (offal)
■ Unpasteurized milk
■ Uncooked egg
■ Fruit and vegetables
■ Nuts and seeds
■ Oils
■ Cereals
■ Supplements.
Types of raw diet

■ Home-prepared:
● Feeding to a recipe
● No recipe; any available food is fed.
■ Prey-model – whole animal carcases are fed.

■ Commercially manufactured – within this category, various types are offered, including:
● Fresh
● Frozen
● Freeze-dried
● Carbohydrate premix with a raw protein source
● Kibble with freeze-dried raw pieces
● Diets with a raw-meat coating.
NB: Recipes may not be complete and balanced. Commercially prepared raw diet recipes should be created by professional
formulators trained in the commercial formulation of pet foods. Ideally, the formulation should also have been developed in
consultation with an appropriately qualified individual.
In the case of home-prepared raw diets, it is recommended that the recipe be designed, overseen or approved by a
diplomate of either the ACVN or the ECVCN.
What are the advantages of feeding a raw diet?

Evidence-based advantages of raw diets
■ Currently, there is insufficient published scientific evidence confirming many of the suggested benefits of raw diets.
However, there is some emerging evidence for the following:
● Dental benefits from chewing raw bones with meat:
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BSAVA GUIDE TO NUTRITION Raw diets
− There is some evidence to suggest that the texture of chewing raw bones with meat could be beneficial for dental
calculus. However, there is no evidence that it improves oral health or prevents plaque, periodontitis or tooth loss
(Marx et al., 2016). Bones, raw or cooked, can also pose a risk of dental fractures, oesophageal obstructions and
foreign bodies.
● Improvement in coat quality (Billinghurst, 1993):
− It has been suggested that this might be the result of feeding a diet with an increased fat content. Of course, any
benefits of feeding a high-fat diet should be balanced against potential risks (e.g. increased risk of obesity and
pancreatitis).
● Improved digestibility:
− This is partially true in that diets based on raw meat are typically more digestible than dry proprietary food, but not
necessarily wet proprietary food (Freeman et al., 2013)
− Digestibility varies depending on the nutrient (Hamper et al., 2016).
● Improved palatability (Regulation, 2008):
− Food with a greater moisture content will be more palatable to some dogs and high protein is more palatable for
cats. This may be an advantage for picky eaters, but could be a disadvantage for pets prone to obesity.
Proponents of raw diets also report the following advantages from their clinical experience:

A ‘natural’ food is fed, and owners may feel ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or
that this is better for the pet at least 95%) from the source material (e.g. of vegetable or animal origin).
This is not an official or regulated definition (Regulation, 2008)
■ Therefore, depending on the ingredients used, commercially
manufactured diets can also be defined as ‘natural’ in accordance with
the above guidance
More appropriate for dogs. As wolves are ■ A study has shown that, over the many years of dog domestication, their
similar to dogs, the sort of diet that they dietary needs have changed and they have adapted their digestive
consume is thought to be more appropriate capabilities to live as companions (Axelsson et al., 2013). The typical
for dogs than processed kibble or canned lifespan of wolves is shorter than that of domesticated dogs and,
food although many factors are responsible for mortality in wolves and dogs,
this evidence is not consistent with a significant benefit for raw food over
proprietary food. Therefore, further work is required before any perceived
advantages of a so-called ‘ancestral diet’ can be clarified
Does not contain carbohydrate/gluten/ ■ Unlike wolves, domesticated dogs can readily digest carbohydrates:
wheat: indeed, 10 of the 36 genomic differences between these species are
■ Carbohydrates are thought not to be involved in carbohydrate digestion (Axelsson et al., 2013)
digestible and may even be harmful to ■ Studies have shown that cats can also utilize carbohydrates, but to a
pets lesser extent than dogs (Morris et al., 1977)
■ Carbohydrates are responsible for dietary ■ True dietary intolerances are rare and generally assumed to be related to
intolerances the protein component rather than carbohydrate components of a diet
(August, 1985; Hodgkins, 1991; Harvey, 1993). For further information, see
‘Adverse reactions to food’
Reduced occurrence of gastrointestinal signs ■ There is no published scientific evidence for this claim
Improved protein digestibility ■ True for some but not all proteins. If raw egg is given, the avidin in the
egg white binds to the amino acid biotin, making the proteins in the diet
unavailable and therefore much less digestible (Case et al., 2000)
Improved stool volume due to feeding a diet ■ No scientific study evidence

without perceived ‘fillers’ ■ The smaller stool volume in pets fed raw diets may be due to the lower
fibre content (Vester et al., 2010; Freeman et al., 2013)
■ There are no such things as ‘fillers’ in pet foods. Fillers are thought to
be the low-quality ingredients listed as carbohydrate or starch sources
in pet foods. They have also been described as ‘cereal’ or even as the
‘sawdust content’ of proprietary foods. It is thought that other than
acting as a ‘bulking’ agent, they offer little or no nutritional benefit and,
in some cases, may even cause harm (Dogs Naturally, 2020). It is also
thought that they cause dilution of the nutrition within the diets and are
present only to bring costs down (Purina, 2017). There is no scientific
evidence of this. There is, however, evidence that carbohydrate sources
can deliver nutrients that can be easily utilized by dogs and cats and
form part of a nutritious diet (Kendall and Holme, 1982)
Improved stool quality ■ No scientific study evidence, although stool volume is often less due to
raw diets typically having a lower fibre content
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BRITISH SMALL ANIMAL VETERINARY ASSOCIATION, Woodrow House, 1Helena Telford Way, Waterwells
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Reduced risk of obesity ■ No scientific study evidence

■ 65% of dogs in the UK are either overweight or have obesity (German et
al., 2018). There has been a limited number of studies looking at the
associations between obesity and diet type, but thus far results have been
inconsistent and variable. Further work is therefore needed in order to
determine the associations between diet type and obesity in cats and dogs
■ Dogs prefer a higher fat and higher protein diet and, if this is fed ad
libitum, dogs will overconsume and gain weight (Roberts et al., 2018)
Reduced hair shedding ■ No scientific study evidence
Eliminated gas or bloat risk ■ The suggested mechanism is that raw diets contain a decreased content
of soluble and insoluble carbohydrate. While such a mechanism is
plausible, there is currently no published evidence to support it
Fewer food allergies and reduced skin ■ No scientific study evidence; anecdotal evidence only. Switching to a raw
complaints diet might plausibly resolve signs of an adverse reaction to food, provided
that the component associated with the clinical signs is eliminated
Reduced pancreatitis incidence ■ No scientific study evidence
Prevents parasites ■ No scientific study evidence
Lower veterinary costs overall ■ No scientific study evidence

■ Nutrition should be tailored to the illness and a raw diet might not be
appropriate for conditions such as renal disease, where phosphorus
restriction is important (Ross et al., 1982; Finco et al., 1992)
Reduced body odour ■ No scientific study evidence
Reduced faecal odour ■ Raw diets may reduce flatulence. This is thought to be due to having
typically less fermentable fibre (Ugarte et al., 2004)
■ However, as a result of having less fermentable fibre, raw diets might
result in decreased short-chain fatty acid production. This may be
detrimental to the pet because short-chain fatty acids are essential for
large intestinal health
The same diet can be fed at all life stages ■ No scientific study evidence. Furthermore, some commercial producers
of raw diets make different products for different life stages
■ Homemade BARF-type diets are advertised as ‘all-life’ products. This
implies that the recipe is suitable for young, old, pregnant, lactating,
healthy or sick individuals. However, this is not necessarily advisable and
any recipe should be formulated for the life stage of the pet, ideally by an
appropriately qualified individual
Fewer trips to the veterinary practice ■ No scientific study evidence
Increased mobility for older pets ■ No scientific study evidence
Overall, there is little evidence for many of the claims made, meaning further studies are required for veterinary professionals
to deliver the best advice.
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What are the disadvantages of feeding a raw diet?

Risk of multidrug-resistant bacteria
■ Associated risks are to:
● The pet
● The owners and their extended family – especially young, old and immunosuppressed individuals
● Veterinary and hospital staff.
■ Multidrug-resistant bacteria of particular concern include (Bos et al., 2019):

● Escherichia coli (E. coli)
● Meticillin-resistant Staphylococcus pseudintermedius (MRSP).
Risk of pathogenic infection (Davies et al., 2019)
Pathogen type Available evidence

Salmonella spp. ■ Between 4% and 10% of chicken produced and sold in the UK for human consumption
carries Salmonella spp. Amounts found on imported chicken are higher still (Food
Standards Agency, 2003)
■ Many studies have confirmed the transmission of Salmonella to pets in the
contaminated meats that they are fed (Caraway et al., 1959; Stone et al., 1993; Cantor et
al., 1997; Clark et al., 2001; Joffe and Schlesinger, 2002)
■ Simple cleaning of food bowls at home with soap and water or in a dishwasher is not
sufficient to eliminate this pathogen
■ Although uncommon, cases of zoonotic infection of Salmonella to pet owners have been
linked to feeding a raw diet to the family pet (Minnesota Department of Health, 2018)
■ Most pets that become infected with Salmonella become asymptomatic carriers, but
studies have shown that they will still shed the bacteria in their saliva and faeces for 7
days after each infectious incident (Verma et al., 2007)
E. coli ■ This pathogen was found in 60% of raw diets tested – both home-made and
commercially produced (Freeman and Michel, 2001; Strohmeyer et al., 2006)
■ Human deaths have been reported from handling raw dog food contaminated with
E. coli (Davies et al., 2019)
Clostridium spp. ■ Although the pathogenic nature of Clostridium spp. remains unclear, 20% of
commercially produced raw diets were found to carry these bacteria (Weese et al., 2005)
Campylobacter jejuni ■ This pathogen is present in 50–70% of all chicken sold for human consumption in the
UK (Food Standards Agency, 2016)
■ Acute polyradiculoneuritis in dogs (a neurological disorder) is thought to be triggered by
pathogenic infection of Campylobacter deriving from contaminated food fed to pets
(Martinez-Anton et al., 2018)
Toxoplasma gondii spp. ■ This pathogen is especially dangerous for pregnant women (as it causes fetal
abnormalities) and for immunosuppressed individuals
■ Women are advised to avoid direct contact with their cat’s faeces and litter tray (as this is
where the spread of the pathogen is most likely) during pregnancy (Gov.uk, 2008)
■ As the prevalence of Toxoplasma in cats is greater when fed a raw diet, this should be
given further consideration if living with at-risk individuals (Smielewska-Los et al., 2002;
Dubey et al., 2005; Lopes et al., 2008)
Listeria spp. ■ This pathogen is widely found in meat products sold for human consumption (Food
Standards Agency, 2019a). Raw meat-based pet-food products have been withdrawn for
containing dangerous levels of this pathogen (Food Standards Agency, 2019b)
■ Infection with Listeria spp. in humans causes a range of clinical signs from flu-like to
fatal meningitis and abortion during pregnancy
Mycobacterium bovis ■ Found in uncooked commercially manufactured raw cat food (O’Halloran et al., 2019)
Other pathogens found in raw ■ All pose a health risk to all groups of people having contact with the pet
diets include:
■ Yersinia enterocolitica
■ Tuberculosis
■ Tularaemia
■ Echinococcus multilocularis
Concerns regarding the risks of pathogenic infection from raw diets have been frequently raised. A recent online survey
taking a closer look at pet owners’ perceptions of feeding raw diets and the incidence of infection, has suggested that the
risks appear to be low, although not negligible (Anturaniemi et al., 2019). ➟
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Facts about pathogens

■ Although not common, cases of pets suffering with Salmonella and other pathogens have been reported (Caraway et al.,
1959; Stone et al., 1993; Cantor et al., 1997; Clark et al., 2001; Joffe and Schlesinger, 2002).
■ Risks to owners arise not only from the handling of uncooked food, but also from handling the pet – namely, contact
with the pet’s saliva, fur, urine and faeces are points of concern. Pathogens are shed by the pet during urination and
defecation. During grooming, the pet may spread pathogens to their coat via their saliva.
■ Pathogens may also be shed asymptomatically into the environment where the pet lives or has contact with, which
might be a further source of spread.
■ 21–48% of home-prepared and commercially produced raw diets tested were found to have pathogenic contamination
(Weese et al., 2005; Finley et al., 2008).
■ Freezing does not eliminate all pathogens that may be harmful. For example, it does decrease Campylobacter colony
counts, but will not eradicate completely Campylobacter or other pathogens, some of which are unaffected by freezing.
The freezing of pet foods does not guarantee food safety, as is commonly thought (Finley et al., 2008).
■ High hydrostatic pressure processing or high-pressure pasteurization is a process used by some commercial raw diet
producers to reduce pathogen risk. However, it does not completely eradicate all pathogens and it is thought that it may
lead to pathogenic resistance (Van Bree et al., 2018).
■ Some proponents of raw diets argue that the risk of pathogens from raw feeding is no greater than from any foods
intended for human consumption. However, while there is undoubtedly a risk, it is arguably reduced because such food
is usually cooked when consumed by humans. Furthermore, the risks associated with feeding raw food arise not only
from the food but also from owner contact with the pet.
■ Some proponents of raw feeding argue that contamination of pet food with pathogens is more common with
conventional commercial foods, which are cooked. While this might be correct when examining the absolute number of
pet food withdrawals, this is because such foods are much more commonly fed. Relatively speaking, many more come
from raw-food manufacturers.
■ Based on available evidence, the risk of pathogenic infection should be considered when recommending a raw diet.
Arguably, the potential risk to human health may be more of a concern than the risk to dogs and cats consuming raw
diets. The prevalence of such infections is unknown, as it is not frequently reported, or in some cases the cause may
not be associated with the pet or its food. Therefore, owners who wish to feed a raw diet should be strongly advised
to take adequate precautions to reduce this risk.
Potential concerns from specific ingredients
Although known to be rare, there are some potential risks associated with specific types of food. It is important that owners
wishing to feed a raw diet recognize these risks.
■ Raw egg – contains avidin, which binds to the B vitamin biotin making it unavailable. This may result in protein deficiency
(Case et al., 2000).
■ Raw fish (e.g. sea bream) or raw shellfish (e.g. scallops) – contains thiaminase, which destroys thiamine (a B vitamin)
causing protein deficiency (Case et al., 2000).
■ Liver – fed in large quantities can cause hypervitaminosis A, due to the large amounts of vitamin A stored in liver tissue
(Case et al., 2000).
■ Trachea or gullet – if fed can cause hyperthyroidism, as the thyroid gland is often also consumed.
■ When feeding a raw diet, especially if preparing it at home, it is very difficult for the pet owner to ensure that they are
feeding a complete and balanced diet to their pet.
■ Research looking to determine nutritional adequacy of home-prepared foods, both cooked and uncooked, has found
some concerning results:
● In one study where 95 different raw diets were examined (Dillitzer et al., 2000):
− 60% had a significant imbalance

− 40% had a minor imbalance or were balanced
● In two similar studies examining 94 commonly available recipes for home-prepared diets (both cooked and
uncooked) for pets with medical conditions all were found to be inadequate (Heinze et al., 2012; Larsen et al., 2012)
● In a further study of 200 different recipes for maintenance diets, 95% were deficient in at least one essential nutrient,
and 84% had multiple deficiencies (Stockman et al., 2013).

● Deficiencies of certain nutrients include low calcium in the diet:

hyperparathyroidism. This is a very painful condition leading to significant bone loss through demineralization and
multiple pathological bone fractures (Bennett, 1976; Hintz and Schryver, 1987).
■ Although there are no published studies on prevalence, the risk of obvious nutrient deficiencies in adult dogs and cats
appears to be rare. However, such deficiencies are more frequently reported in growing animals. As a result, caution
should be exercised when feeding such diets to animals that have not yet reached skeletal maturity.
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Compliance
■ As with any diet, compliance from owners will vary.
■ As it is harder to balance a raw diet, the margin for error may be reduced.
■ Arguably, the greatest concern comes from home-prepared raw diets. Not only are the recipes often unbalanced to
begin with, but it is often difficult for owners to be fully compliant with the recipe.
Can raw diets provide balanced nutrition?

Yes, provided that the recipe has been designed, overseen or approved by an appropriately qualified person.
What safety measures are recommended to ensure that raw diets are fed
responsibly?
Excellent hygiene
Taking excellent hygiene precautions is essential for the safe feeding of raw diets. They should include the following:
purchased or should be discarded.
■ Hand washing should commence:
● After food preparation
● After touching the pet.
■ Preparation areas and surfaces should be cleaned with disinfectant immediately after food is prepared.
■ Bowls, floors and utensils should be disinfected immediately after feeding has finished.
■ Bowls or plates for pet use should be kept separate from the ones used by the owners. Washing of bowls and plates
alone is not enough to eliminate bacteria such as Salmonella (Weese and Rousseau, 2006).
■ Correct storage of foods will reduce the cross-contamination risk:
● Any uncooked meats should be refrigerated in a sealed container
● Uncooked meats should be stored away from human food (i.e. at the bottom of the refrigerator or, ideally, in a
separate refrigerator – although this does not appear to be a contributing factor to the incidence of infection
according to a recent study) (Anturaniemi et al., 2019).
■ Care is needed when handling pets and areas that the pet has contact with, especially areas used for elimination:
● Studies have shown that pets infected with pathogenic bacteria can shed them into the environment (Davies et al.,
2019). Therefore, the following precautions should be observed:

− Wear gloves or wash hands immediately after any handling or contact with urine or faeces
− Swift disinfection of areas within the home where inappropriate elimination has occurred
− Fastidious clearing or cleaning of elimination areas within the owner’s garden
− High general levels of environmental cleanliness and regular washing of bedding are also advisable, although
further work is needed to ascertain whether washing would be sufficient for pathogen removal
− Consideration should also be given to taking dogs to public areas, which may be difficult or impossible to clean
(i.e. should these dogs be prevented from eliminating in public areas?).
How to defrost frozen uncooked food safely
■ Defrost uncooked foods in sealed containers or in the pet’s bowl, ensuring that it is covered.
■ Defrost uncooked foods on the bottom shelf of the refrigerator (ideally in a refrigerator that is separate from that storing
food for human consumption).
■ Do not refreeze thawed uncooked foods.
■ Thaw juice will contain nutrients and should not be discarded but fed to the pet in the meal.
■ Further storage of defrosted food must be in a sealed container and refrigerated.
Method of feeding
Due to its high moisture content and potential for pathogenic contamination, it is not advisable to feed raw diets on an ad
libitum basis. As with any food, an appropriate daily ration (based on the maintenance energy requirement of the dog or cat)
should be fed in meals, with uneaten food being removed after 30 minutes, disposed of and never reoffered to the pet.
Monitoring
It has been suggested that pets fed a raw diet should have regular tests to screen for nutrient deficiency. Tests should include
biochemistry (including thyroxine concentrations), haematology and urinalysis. Adults should be tested every 6 to 12 months
(Freeman et al., 2013).
Considerations for feeding raw diets in healthy dogs and cats

■ Dietary requirements can vary greatly between the different life stages and, arguably, no one diet will provide optimal
nutrition for all stages.
■ It is strongly advised to seek the advice of an appropriately qualified person before feeding a raw diet to growing animals.
This is likely the life stage where optimal nutrition is most critical.
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Considerations for feeding raw diets in dogs and cats with various
diseases
Many different diseases have specific nutritional requirements, meaning that a raw diet may not be appropriate in such
circumstances. For example:
■ Chronic kidney disease (CKD):
● CKD requires a diet with restricted phosphorus content, while protein restriction should be considered at later stages
(Polzin, 2019).This is extremely difficult to achieve with a raw diet, since protein and phosphorus content can be very high
■ Obesity:
● Behavioural research indicates that dogs rarely regulate their food intake and will commonly overeat, especially when
offered foods they find palatable (Roberts et al., 2018). The greater fat and protein content of raw diets may mean
such diets are overconsumed if fed ad libitum, leading to unwanted weight gain. While some cats will regulate their
own intake (Beynen, 2015; 2018), typically they consume more when fed higher protein diets
● To avoid this, measured amounts of food, weighed carefully daily, should be fed
● Regular monitoring of bodyweight is also essential to prevent obesity. Cats and dogs should be weighed every
2 weeks when transitioning to a new diet, with food intake adjusted until bodyweight is stable. They should then be
weighed regularly thereafter (e.g. at least every 6 months to identify animals at risk of gradual weight gain)
■ Immune compromise:
● Pets that may be immunocompromised include those with neoplasia and hyperadrenocorticism, as well as those
being treated with corticosteroids.

Raw diets in a hospital environment – the rules

As more of our patients are being fed raw diets, it is important to consider the potential impact that this may have in a
veterinary hospital. Many large hospitals and referral centres have adopted the following rules to reduce the risks to staff and
other patients:
■ No raw diets allowed into the hospital in order to:
● Reduce risk to immunocompromised patients
● Reduce cross-contamination risks to staff and other animals
■ Patients consuming a raw diet at home may need to be isolated:

● Pets can shed pathogens asymptomatically for 7 days after eating contaminated meats.
For further information about feeding in the veterinary hospital, see ‘Hospital nutrition’.
How to talk to owners about raw diets

Remember:
■ When talking to owners about raw diets, it is important to understand their motivations, correct any misconceptions, and
provide them with appropriate guidance so that they can feed their pet optimally and safely.
Conclusion
The feeding of raw diets has become increasingly popular in recent years and it is therefore vitally important that we first
educate ourselves on the available options, and then consider all the pros and cons when advising pet owners of the best diet
to feed their pet. Decisions will often be made ‘on balance’ for the individual. Advice based on good evidence should be given
each time and any recommendation must ensure that minimum requirements are met.
References
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food: a comprehensive internet-based survey. Veterinary Record 185, 658
Axelsson E, Ratnakumar A, Arendt ML et al. (2013) The genomic signature of dog domestication reveals adaptation to a
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Bennett D (1976) Nutrition and bone disease in the dog and cat. Veterinary Record 98, 313–320
Beynen AC (2015) Dry foods for cats. Creature Companion July, 54–55
Beynen AC (2018) Cat food composition and caloric intake. Dier-en-Arts Nr 8/9, 186–189
Billinghurst I (1993) Give your dog a bone: the practical common-sense way to feed dogs for a long healthy life. Bridge
Printery, Alexandria NSW, Australia
Bos M, Broadfoot F, Healey K et al. (2019) UK Veterinary Antimicrobial Resistance and Sales Surveillance. [Available from: https://
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Cantor GH, Nelson Jr S, Vanek JA et al. (1997) Salmonella shedding in racing sled dogs. Journal of Veterinary Diagnostic
Investigation 9(4), 447–448
Caraway CT, Scott AE, Roberts NC and Hauser GH (1959) Salmonellosis in sentry dogs. Journal of the American Veterinary
Clark C, Cunningham J, Ahmed R et al. (2001) Characterization of Salmonella associated with pig ear dog treats in Canada.
Journal of Clinical Microbiology 39(11), 3962–3968
Davies RH, Lawes JR and Wales AD (2019) Raw diets for dogs and cats: a review with particular reference to microbiological
hazards. Journal of Small Animal Practice 60, 329–339
Dillitzer N, Becker N and Kienzle E (2011) Intake of minerals, trace elements and vitamins in bone and raw food rations in adult
dogs. British Journal of Nutrition 106, S53–S56
Dogs Naturally (2020) Raw feeding dogs: 10 simple rules to get started. [Available from: www.dogsnaturallymagazine. com/
raw-feeding-primer]
Dubey JP, Hill DE, Jones JL et al. (2005) Prevalence of viable Toxoplasma gondii in beef, chicken and pork from retail meat
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Finco DR, Brown SA, Crowell WA et al. (1992) Effects of dietary phosphorus and protein in dogs with chronic renal failure.
Finley R, Reid-Smith R, Ribble C et al. (2008) The occurrence and antimicrobial susceptibility of Salmonellae isolated from
commercially available canine raw food diets in three Canadian cities. Zoonosis and Public Health 55, 462–469
Food Standards Agency (2003) UK-wide Survey of Salmonella and Campylobacter contamination of fresh and frozen chicken
on retail sale. [Available from: www.food.gov.uk]
Food Standards Agency (2016) A UK wide microbiological survey of Campylobacter contamination in fresh whole chilled
chickens at retail sale. [Available from: https://www.food.gov.uk/sites/default/files/media/document/retail_survey_
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Food Standards Agency (2019a) Listeria cases being investigated. [Available from: https://www.food.gov.uk/news-alerts/ news/
listeria-cases-being-investigated]
Food Standards Agency (2019b) Raw Treat Pet Food Ltd recalls frozen raw beef, chicken, lamb, and chicken and tripe pet food
due to the presence of Listeria monocytogenes. [Available from: https://www.food.gov.uk/news-alerts/alert/fsa-
prin-36-2019]
Freeman LM, Chandler ML, Hamper BA and Weeth LP (2013) Current knowledge about the risks and benefits of raw meat-
based diets for dogs and cats. Journal of the American Veterinary Medical Association 243(11), 1549–1558
Freeman LM and Michel KE (2001) Evaluation of raw food diets for dogs. Journal of the American Veterinary Medical
Association 218, 705–709 (Erratum published in Journal of the American Veterinary Medical Association 218, 1582)
German AJ, Woods GRT, Holden SL et al. (2018) Dangerous trends in pet obesity. Veterinary Record 182, 25
Gov.uk (2008) Toxoplasmosis: diagnosis, epidemiology and prevention. [Available from: www.gov.uk/guidance/ toxoplasmosis]
Hamper BA, Kirk CA and Bartges JW (2016) Apparent nutrient digestibility of two raw diets in domestic kittens. Journal of Feline
Medicine and Surgery 18(12), 991–996
Harvey RG (1993) Food allergy and dietary intolerance in dogs: a report of 25 cases. Journal of Small Animal Practice 34,
175–179
Heinze CR, Gomez FC and Freeman LM (2012) Assessment of commercial diets and recipes for home-prepared diets
Hintz HF and Schryver HF (1987) Nutrition and bone development in dogs. European Journal of Companion Animal Practice 1,
44–47
Joffe DJ and Schlesinger DP (2002), Preliminary assessment of the risk of Salmonella infection in dogs fed raw chicken diets.
Canadian Veterinary Journal 43(6), 441–442
Kendall PT and Holme DW (1982) Studies on digestibility of soya bean products, cereal, cereal and plant by-products in the diet
of dogs. Journal of the Science of Food and Agriculture 33, 813–820
Larsen JA, Parks EM, Heinze CR and Fascetti AJ (2012) Evaluation of recipes for home-prepared diets for dogs and cats with
Lopes AP, Cardoso L and Rodrigues M (2008) Serological survey of Toxoplasma gondii infection in domestic cats from north-
eastern Portugal. Veterinary Parasitology 155, 184–189
Martinez-Anton L, Marenda M, Firestone SM et al. (2018) Investigation of the role of Campylobacter infection in suspected
acute polyradiculoneuritis in dogs. Journal of Veterinary Internal Medicine 32(1), 352–360
Marx FR, Machado GS, Pezzali JG et al. (2016) Raw beef bones as chewing items to reduce dental calculus in Beagle dogs.
Australian Veterinary Journal 94(1–2), 18–23
Minnesota Department of Health (2018) Salmonella cases linked to raw meat dog food. [Available from: www.health.state.
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37(3), 365–373
O’Halloran C, Ioannidi O, Reed N et al. (2019) Tuberculosis due to Mycobacterium bovis in pet cats associated with feeding a
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Roberts MT, Bermingham EN, Cave NJ et al. (2018) Macronutrient intake of dogs, self-selecting diets varying in composition
offered ad libitum. Journal of Animal Physiology and Animal Nutrition 102(2), 568–575
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Ross LA, Finco DR and Crowell WA (1982) Effect of phosphorus restriction on the kidneys of cats with reduced renal mass.
Smielewska-Los E, Rypula K and Pacon J (2002) The influence of feeding and maintenance system on the occurrence of
Toxoplasma gondii infections in dogs. Polish Journal of Veterinary Sciences 5, 231–234
Stockman J, Fascetti AJ, Kass PH et al. (2013) Evaluation of recipes of home-prepared maintenance diets for dogs. Journal of
the American Veterinary Medical Association 242, 1500–1505
Stone GG, Chengappa MM, Oberst RD et al. (1993) Application of polymerase chain reaction for the correlation of Salmonella
serovars recovered from Greyhound faeces with their diet. Journal of Veterinary Diagnostic Investigation 5(3), 378–385
Strohmeyer RA, Morley PS, Hyatt DR et al. (2006) Evaluation of bacterial and protozoal contamination of commercially available
raw meat diets for dogs. Journal of the American Veterinary Medical Association 228, 537–542
Ugarte C, Guilford WG, Markwell P and Lupton E (2004) Carbohydrate malabsorption is a feature of feline inflammatory bowel
disease but does not increase clinical gastrointestinal signs. Journal of Nutrition 8, 2068S
Van Bree FPJ, Bokken GCAM, Mineur R et al. (2018) Zoonotic bacterial and parasites found in raw meat-based diets for cats and
dogs. Veterinary Record 182(2), 50
Verma AK, Sinha DK and Singh BR (2007) Salmonellosis in apparently healthy dogs. Journal of Veterinary Public Health 5(1),
37–39
Vester BM, Burke SL, Liu KJ et al. (2010) Influence of feeding raw or extruded feline diets on nutrient digestibility and nitrogen
metabolism of African wildcats (Felis lybica). Zoo Biology 29, 676–686
Weese JS, Rousseau J and Arroyo L (2005) Bacteriological evaluation of commercial canine and feline raw diets. Canadian
Veterinary Journal 46, 513–516
Weese JS and Rousseau J (2006) Survival of Salmonella Copenhagen in food bowls following contamination with
experimentally inoculated raw meat: effects of time, cleaning and disinfection. The Canadian Veterinary Journal 47(9),
887–889
Useful websites
www.fediaf.org
Food Standards Agency
● Campylobacter
www.food.gov.uk/safety-hygiene/campylobacter
● Listeria
www.food.gov.uk/safety-hygiene/listeria
● Pet Food – Business Guidance
www.food.gov.uk/business-guidance/pet-food
● Salmonella
www.food.gov.uk/safety-hygiene/salmonella
Gov.uk
● Raw pet foods: handling and preventing infection
www.gov.uk/guidance/raw-pet-foods-handling-and-preventing-infection
www.pfma.org.uk
World Small Animal Veterinary Association (WSAVA) – factsheets
www.wsava.org
● The Savvy Cat Owner’s Guide: Nutrition on the Internet
● The Savvy Dog Owner’s Guide: Nutrition on the Internet
● Selecting the Best Food for your Pet
Last updated
August 2023

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OWNER FACTSHEET
Raw diets
Introduction
Raw diets (also known as raw-meat-based diets, ‘biologically-appropriate raw food’ or ‘BARF’ diets) are becoming increasingly
popular. As a consequence, we as veterinary professionals would like to provide guidance about the advantages and
What are raw diets?

Raw diets predominately comprise uncooked ingredients, although different components can vary. Raw diets may contain:
■ Meat
■ Fish
■ Poultry
■ Bones
■ Meat by-products (offal)
■ Unpasteurized milk
■ Uncooked egg
■ Fruit and vegetables
■ Nuts and seeds
■ Oils
■ Cereals
■ Supplements. ➟
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Types of raw diet

■ Home-prepared:
● Feeding to a recipe
● No recipe; any available food is fed.
■ Prey-model – whole animal carcases are fed.

■ Commercially manufactured – within this category, various types are offered, including:
● Fresh
● Frozen
● Freeze-dried
● Carbohydrate premix with a raw protein source
● Kibble with freeze-dried raw pieces
● Diets with a raw-meat coating.
NB: Recipes may not be complete and balanced. Commercially prepared raw diet recipes should be created by professional
formulators trained in the commercial formulation of pet foods. Ideally, the formulation should also have been developed in
consultation with an appropriately qualified individual.
In the case of home-prepared raw diets, it is recommended that the recipe be designed, overseen or approved by a
diplomate of either the ACVN or the ECVCN.
What are the advantages of feeding a raw diet?

Evidence-based advantages of raw diets
■ Currently, there is insufficient published scientific evidence confirming many of the suggested benefits of raw diets.
However, there is some emerging evidence for the following:
● Dental benefits from chewing raw bones with meat:
− There is some evidence to suggest that the texture of chewing raw bones with meat could be beneficial for dental
calculus (tartar). However, there is no evidence that it improves oral health or prevents plaque, periodontitis or tooth
loss. Bones, raw or cooked, can also pose a risk of dental fractures, oesophageal obstructions and foreign bodies
● Improved coat quality:
− It has been suggested that this might be the result of feeding a diet with an increased fat content. Of course, any
benefits of feeding a high-fat diet should be balanced against potential risks (e.g. increased risk of obesity and
pancreatitis)
● Improved digestibility:
− This is partially true in that diets based on raw meat are typically more digestible than dry proprietary food, but not
necessarily wet proprietary food
− Digestibility varies depending on the nutrient
● Improved palatability:
− Food with a greater moisture content will be more palatable to some dogs and high protein is more palatable for
cats. This may be an advantage for picky eaters, but could be a disadvantage for pets prone to obesity.
Proponents of raw diets also report the following advantages from their experience:

‘Natural’ food is fed and this may be ■ Guidance for the term ‘natural’ is that it must be obtained exclusively (or at least
better for the pet 95%) from the source material (e.g. of vegetable or animal origin). This is not an
official or regulated definition
More appropriate for dogs. As wolves ■ Studies have shown that, over the many years of dog domestication, their dietary
are similar to dogs, the sort of diet needs have changed and they have adapted their digestive capabilities to live as
that they consume is thought to be companions. The typical lifespan of wolves is shorter than that of domesticated
more appropriate for dogs than dogs and, although many factors are responsible for mortality in wolves and
processed kibble or canned food dogs, this evidence is not consistent with a significant benefit for raw food over
proprietary food. Therefore, further work is required before any perceived
advantages of a so-called ‘ancestral diet’ can be clarified
Does not contain carbohydrate/ ■ Unlike wolves, domesticated dogs can readily digest carbohydrates: indeed, 10 of
gluten/wheat: the 36 genomic differences between these species are involved in carbohydrate
■ Carbohydrates are thought not to digestion
be digestible and may even be ■ Studies have shown that cats can also utilize carbohydrates, but to a lesser
harmful to pets extent than dogs
■ Carbohydrates are thought to be ■ True dietary intolerances are rare and generally assumed to be related to the
responsible for dietary intolerances protein part of the diet rather than the carbohydrate part of the diet
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Reduced occurrence of ■ There is no published scientific evidence for this claim
gastrointestinal signs
Improved protein digestibility ■ True for some but not all proteins. If raw egg is given, the protein portion (avidin)
within the egg binds to the amino acid (protein) biotin in the other food portions,
making the proteins in the diet unavailable and therefore much less digestible
Improved stool volume due to ■ No scientific study evidence

feeding a diet without perceived ■ The smaller stool volume in pets fed raw diets may be due to the lower fibre
‘fillers’ content
■ There are no such thing as ‘fillers’ in pet foods. Fillers are thought to be the
low-quality ingredients listed as carbohydrate or starch sources in pet foods.
They have also been described as ‘cereal’ or even as the ‘sawdust content’ of
proprietary foods. It is thought that other than acting as a ‘bulking’ agent, they
offer little or no nutritional benefit and, in some cases, may even cause harm. It is
also thought that they cause dilution of the nutrition within the diets and are
present only to bring costs down. There is no scientific evidence of this. There is,
however, evidence that carbohydrate sources can deliver nutrients that can be
easily utilized by dogs and cats and form part of a nutritious diet, rather than
being a useless component
Improved stool quality ■ No scientific study evidence, although stool volume is often less due to raw diets
typically having a lower fibre content
Reduced risk of obesity ■ No scientific study evidence

■ 65% of dogs in the UK are either overweight or have obesity. There has been a
limited number of studies looking at the associations between obesity and diet
type, but thus far results have been inconsistent and variable. Further work is
therefore needed in order to determine the associations between diet type and
obesity in cats and dogs
■ Dogs prefer a higher fat and higher protein diet and, if this is fed ad libitum, dogs
will overconsume and gain weight
Reduced hair shedding ■ No scientific study evidence
Eliminated gas or bloat risk ■ The suggested mechanism is that raw diets contain a decreased content of
soluble and insoluble carbohydrate. While such a mechanism is plausible, there is
currently no published evidence to support it
Fewer food allergies and reduced ■ No scientific study evidence; anecdotal evidence only. Switching to a raw diet
skin complaints might plausibly resolve signs of an adverse reaction to food, provided that the
component associated with the clinical signs is eliminated
Reduced pancreatitis incidence ■ No scientific study evidence
Prevents parasites ■ No scientific study evidence
Lower veterinary costs overall ■ No scientific study evidence

■ Nutrition should be tailored to the illness and a raw diet might not be appropriate
for conditions such as kidney disease, where phosphorus restriction is important
Reduced body odour ■ No scientific study evidence
Reduced faecal odour ■ Raw diets may reduce flatulence. This is thought to be due to having typically
less fermentable fibre in a raw diet
■ Fermentable fibre in the diet produces short-chain fatty acids in the large
intestine (gut). Given that raw diets contain less fermentable fibre, this may result
in decreased short-chain fatty acid production. This may be detrimental to the
pet because short-chain fatty acids are essential for large intestinal health

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The same diet can be fed at all life ■ No scientific study evidence. Furthermore, some commercial producers of raw
stages diets make different products for different life stages
■ Homemade biologically appropriate raw food (BARF)-type diets are advertised as
‘all-life’ products. This implies that the recipe is suitable for young, old, pregnant,
lactating, healthy or sick individuals. However, this is not necessarily advisable
and any recipe should be formulated for the life stage of the pet, ideally by an
appropriately qualified individual
Fewer trips to the veterinary practice ■ No scientific study evidence
Increased mobility for older pets ■ No scientific study evidence
Overall, there is little evidence for many of the claims made, meaning further studies are required.
What are the disadvantages of feeding a raw diet?

Risk of multidrug-resistant bacteria
■ Associated risks are to:
● The pet
● The owners and their extended family – especially young, old and immunosuppressed individuals
● Veterinary and hospital staff.
■ Multidrug-resistant bacteria of particular concern include:

● Escherichia coli (E. coli)
● Meticillin-resistant Staphylococcus pseudintermedius (MRSP).
Risk of pathogenic infection

Salmonella spp. ■ Between 4% and 10% of chicken produced and sold in the UK for human
consumption carries Salmonella species
■ Many studies have confirmed the transmission of Salmonella to pets in the
contaminated meats that they are fed
■ Simple cleaning of food bowls at home with soap and water or in a dishwasher is
not sufficient to eliminate this pathogen
■ Although uncommon, cases of zoonotic infection of Salmonella to pet owners have
been linked to feeding a raw diet to the family pet
■ Most pets that become infected with Salmonella species become asymptomatic
carriers (show no sign of infection), but studies have shown that they will still shed
the bacteria in their saliva and faeces for 7 days after each infectious incident
E. coli ■ This pathogen was found in 60% of raw diets tested – both home-made and
commercially produced
■ Human deaths have been reported from handling raw dog food contaminated with
E. coli
Clostridium spp. ■ Although the pathogenic nature of Clostridium spp. remains unclear, 20% of
commercially produced raw diets were found to carry these bacteria
Campylobacter jejuni ■ This pathogen is present in 50–70% of all chicken sold for human consumption in
the UK
■ Acute polyradiculoneuritis in dogs (a neurological disorder) is thought to be
triggered by pathogenic infection of Campylobacter deriving from contaminated
food fed to pets
Toxoplasma gondii spp. ■ This pathogen is especially dangerous for pregnant women (as it causes fetal
abnormalities) and for immunosuppressed individuals
■ Women are advised to avoid direct contact with their cat’s faeces and litter tray (as
this is where the spread of the pathogen is most likely) during pregnancy
■ As the prevalence of Toxoplasma in cats is greater when fed a raw diet, this should
be given further consideration if living with at-risk individuals
Listeria spp. ■ This pathogen is widely found in meat products sold for human consumption in the
UK. Raw food products have been withdrawn for containing dangerous levels of this
pathogen
Mycobacterium bovis ■ Found in uncooked commercially manufactured raw cat food

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Other pathogens found in raw All pose a health risk to all groups of people having contact with the pet
diets include:
■ Yersinia enterocolitica
■ Tuberculosis
■ Tularaemia
■ Echinococcus multilocularis
Concerns regarding the risks of pathogenic infection from raw diets have been frequently raised. A recent online survey
taking a closer look at pet owners’ perceptions of feeding raw diets and the incidence of infection, has suggested that the
risks appear to be low, although not negligible.
Facts about pathogens

■ Although not common, cases of pets suffering with Salmonella and other pathogens have been reported.
■ Risks to owners arise not only from the handling of uncooked food, but also from handling the pet – namely, contact
with the pet’s saliva, fur, urine and faeces are points of concern. Pathogens are shed by the pet during urination and
defecation. During grooming, the pet may spread pathogens to their coat via their saliva.
■ Pathogens may also be shed asymptomatically into the environment where the pet lives or has contact with, which
might be a further source of spread.
■ 21–48% of home-prepared and commercially produced raw diets tested were found to have pathogenic contamination.
■ Freezing does not eliminate all pathogens that may be harmful. For example, it does decrease Campylobacter colony
counts, but will not eradicate completely Campylobacter or other pathogens. The freezing of pet foods does not
guarantee food safety, as is commonly thought.
■ High hydrostatic pressure processing or high-pressure pasteurization is a process used by some commercial producers
to reduce pathogen risk. However, it does not completely eradicate all pathogens and is thought that it may lead to
pathogenic resistance.
■ Some proponents of raw feeding argue that contamination of pet food with pathogens is more common with
conventional commercial foods (e.g. dry kibble, wet food), which are cooked. While this might be correct when
examining the absolute number of pet food withdrawals, this is because such foods are much more commonly fed.
Relatively speaking, many more withdrawals come from raw-food manufacturers.
■ Based on available evidence, the risk of pathogenic infection should be considered when recommending a raw diet.
Arguably, the potential risk to human health may be more of a concern than the risk to dogs and cats consuming raw
diets. The prevalence of such infections is unknown, as it is not frequently reported, or in some cases the cause may
not be associated with the pet or its food. Therefore, if you who wish to feed a raw diet to your pet, you are strongly
advised to take adequate precautions to reduce this risk.
Potential concerns from specific ingredients
Although known to be rare, there are some potential risks associated with specific types of food.
■ Raw egg – contains avidin, which binds to the B vitamin biotin making it unavailable to be used as a protein source by
the pet. This may result in protein deficiency.
■ Raw fish (e.g. sea bream) or raw shellfish (e.g. scallops) – contains thiaminase, which destroys thiamine (a B vitamin)
causing protein deficiency.
■ Liver – fed in large quantities can cause hypervitaminosis A, due to the large amounts of vitamin A stored in liver tissue.
■ Trachea or gullet – if fed can cause hyperthyroidism, as the thyroid gland is often also consumed.
■ When feeding a raw diet, especially if preparing it at home, it is difficult for you to ensure that what you are feeding is a
complete and balanced diet for your pet.
■ Research looking to determine nutritional adequacy of home-prepared foods, both cooked and uncooked, has found
some concerning results:
● In one study where 95 different raw diets were examined:
− 60% had a significant imbalance

− 40% had a minor imbalance or were balanced
● In two similar studies examining 94 commonly available recipes for home-prepared diets (both cooked and
uncooked) for pets with medical conditions all were found to be inadequate
● In a further study of 200 different recipes for maintenance diets, 95% were deficient in at least one essential nutrient,
and 84% had multiple deficiencies.

● Deficiencies of certain nutrients includes low calcium in the diet:

hyperparathyroidism. This is a very painful condition leading to significant bone loss through demineralization
and multiple pathological bone fractures. ➟
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■ Although there are no published studies on prevalence, the risk of obvious nutrient deficiencies in adult dogs and cats
appears to be rare. However, such deficiencies are more frequently reported in growing animals. As a result, caution
should be exercised when feeding such diets to animals that have not yet reached maturity.
Sticking to the instructions (compliance)
■ As with any diet, compliance with feeding instructions is essential.
■ As it is harder to balance a raw diet, the margin for error may be reduced.
■ Arguably, the greatest concern comes from home-prepared raw diets, as the recipes are often unbalanced to begin with.
Can raw diets provide balanced nutrition?

Yes, provided that the recipe has been designed, overseen or approved by an appropriately qualified person.
What safety measures are recommended to ensure that raw diets are fed
responsibly?
Excellent hygiene
Taking excellent hygiene precautions is essential for the safe feeding of raw diets. They should include the following:
purchased or should be discarded. Damaged products should not be fed to your pet
■ Hand washing should commence:
● After food preparation
● After touching the pet
■ Preparation areas and surfaces should be cleaned with disinfectant immediately after food is prepared
■ Clean food bowls should be used for each meal
■ Bowls, floors and utensils should be disinfected immediately after feeding has finished
■ Bowls or plates for pet use should be kept separate from the ones you use. Washing of bowls and plates alone is not
enough to eliminate bacteria such as Salmonella
■ Correct storage of foods will reduce the cross-contamination risk:
● Any uncooked meats should be refrigerated in a sealed container
● Uncooked meats should be stored away from human food (i.e. at the bottom of the refrigerator or, ideally, in a
separate refrigerator – although this does not appear to be a contributing factor to the incidence of infection
according to a recent study)
■ Care is needed when handling pets and areas that the pet has contact with, especially areas used for toileting:
● Studies have shown that pets infected with pathogenic bacteria can shed them into the environment. Therefore, the
following precautions should be observed:

− Wear gloves or wash hands immediately after any handling or contact with urine or faeces
− Swift disinfection of areas within the home where inappropriate toileting has occurred
− Fastidious clearing or cleaning of toileting areas within the garden
− High general levels of environmental cleanliness and regular washing of bedding are advised, although further
work is needed to ascertain whether washing would be sufficient for pathogen removal
− Consideration should also be given to taking dogs to public areas, which may be difficult or impossible to clean
(i.e. should these dogs be prevented for eliminating in public areas?).
How to defrost frozen uncooked food safely
■ Defrost uncooked foods in sealed containers or in your pet’s bowl, ensuring that it is covered.
■ Defrost uncooked foods on the bottom shelf of the refrigerator (ideally in a refrigerator that is separate from that storing
food for human consumption).
■ Do not refreeze thawed uncooked foods.
■ Thaw juice will contain nutrients and should not be discarded but fed to your pet in the meal.
■ Further storage of defrosted food must be in a sealed container and refrigerated.
Method of feeding
Due to its high moisture content and potential for pathogenic contamination, it is not advisable to feed raw diets on an ad
libitum basis. As with any food, an appropriate daily ration should be fed in meals, with uneaten food being removed after 30
minutes, disposed of and never reoffered to your pet.
Monitoring
It has been suggested that pets fed a raw diet should have regular tests to screen for nutrient deficiency. Adults should be
tested every 6 to 12 months.
Considerations for feeding raw diets in healthy dogs and cats

■ Dietary requirements can vary greatly between the different life stages and, arguably, no one diet will provide optimal
nutrition for all stages.
■ It is strongly advised to seek the advice of an appropriately qualified person before feeding a raw diet to growing animals.
This is likely the life stage where ideal nutrition is most critical. ➟
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Considerations for feeding raw diets in dogs and cats with various
diseases
Many different diseases have specific nutritional requirements, meaning that a raw diet may not be appropriate in such
circumstances. For example:
■ Chronic kidney disease (CKD):
● CKD requires a diet with restricted phosphorus content, while protein restriction should be considered at later stages.
This is extremely difficult to achieve with a raw diet, since protein and phosphorus content can be very high
■ Obesity:
● Behavioural research indicates that dogs rarely regulate their food intake and will commonly overeat, especially when
offered foods they find palatable. The greater fat and protein content of raw diets may mean such diets are
overconsumed if fed ad libitum, leading to unwanted weight gain. While some cats will regulate their own intake,
typically they consume more when fed higher protein diets
● To avoid this, measured amounts of food, weighed carefully daily, should be fed
● Regular monitoring of bodyweight is also essential to prevent obesity. Cats and dogs should be weighed every 2
weeks when transitioning to a new diet, with food intake adjusted until bodyweight is stable. They should then be
weighed regularly thereafter (e.g. at least every 6 months to identify animals at risk of gradual weight gain)
■ Immune compromise:
● Pets that may be immunocompromised include those with neoplasia and hyperadrenocorticism, as well as those
being treated with corticosteroids.
Raw diets in a veterinary hospital

If your pet is hospitalized, it is very important that you notify the veterinary surgeon if you are feeding your pet a raw diet, as
this could have an impact on the hospital. Many large hospitals and referral centres have adopted rules that will not allow you
to take in raw foods for your pet, and it is extremely unlikely that the hospital will feed a raw diet to your pet during their stay.
This is to reduce the risks to other patients and hospital staff from pathogenic infection.
As pets can shed pathogens for 7 days after eating contaminated products, your pet may be housed separately to avoid
pathogen spread to other patients within the hospital, particularly those who are very young or who are immunosuppressed.
Conclusion
The feeding of raw diets has become increasingly popular in recent years. Therefore, it is important that you consider all the
pros and cons when making decisions about what to feed your pet, no matter the diet type. Decisions will be made ‘on
balance’ for your individual pet. Provided assurance of nutritional adequacy is confirmed and sufficiently high levels of hygiene
are met, raw diets can be safely fed. If you are in any doubt, please seek advice from your veterinary practice.
Last updated
August 2023

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Plant-based diets
Plant-based diets, which include vegetarian and vegan diets, are becoming increasingly
popular with owners. Consequently, veterinary professionals need to provide guidance
about the advantages and disadvantages of such foods.
What are plant-based diets?

Plant-based diets comprise cooked and some uncooked ingredients (e.g. cucumber, carrot, nuts and seeds). The type of diet
used, be it vegetarian or vegan, may well correlate with the diet of the owner. Typically, they will contain the following:
Vegetarian diets:
■ Green and/or yellow vegetables
■ Root vegetables
■ Legumes
■ Cereals
■ Nuts
■ Oils
■ Seeds
■ Fruits
■ Dairy products
■ Eggs
■ No meat-based products, including products derived from animals such as gelatine, will be included.
Vegan diets:
■ Root vegetables
■ Legumes
■ Cereals
■ Nuts
■ Oils
■ Seeds
■ Fruits
■ No meat-based products will be included, nor will they include ingredients derived from animals such as dairy products,
eggs, honey or gelatine.
Why do owners choose to feed plant-based diets?

Proponents of plant-based diets may choose this diet type for the following reasons:
Advantage claim Available evidence

To align with their way of ■ When owners follow a vegan diet, the choice of diet for their pet may be an extension of
life their belief system (The Vegan Society, 2022). As a result, products derived from, associated
with, or tested on animals are avoided (e.g. meats, dairy, eggs, honey).
It is a healthier option ■ Some believe obtaining nutrients only from plants have fewer negative effects in terms of
animal welfare and environmental impact. In recent years, the importance of maintaining
human health by eating a diet high in fruits and vegetables has been highlighted (e.g. the
NHS, 5 a Day campaign (NHS England, 2022)). Some studies have suggested that vegan
diets may be a healthy option for pets (Knight et al., 2022); however, the studies undertaken
to date are short-term, observational and have relied on potentially biased owner self-
reporting via surveys. The results, therefore, should be interpreted cautiously, not least ➟
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BSAVA GUIDE TO NUTRITION Plant-based diets

It is a healthier option because the associations identified do not prove causality. Vegan diets differ in nutrient
(continued) formulation from other commercially manufactured options (e.g. dry food); not only will the
ingredient source be different, but additional mineral and amino acid supplements may be
required. Nonetheless, these studies do not suggest that use of a vegetarian or vegan diet
leads to obvious poorer health with short-term feeding. That said, many concerns have
been raised about the nutritional adequacy of vegetarian and vegan diets, particularly for
cats (see ‘What are the disadvantages of feeding a plant-based diet?’ below)
Environmental impact ■ Meat production places a significant toll on the environment. This occurs with the use of
pesticides, fertilisers and pharmaceuticals, as well as loss of natural land through deforestation
to make way for livestock farmland and agricultural crop production. Deforestation, in turn,
causes loss of wildlife due to loss of natural habitats and loss of biodiversity of both plants and
animals in the area (Petrovic et al., 2015). The carbon footprint of meat production (and pet
food production) is thought to be further contributing to global warming (Röös et al., 2013)
Sustainability ■ Due to the environmental impact, meat production, at its current level, may not be
sustainable in the future. There is grave concern that, should meat consumption by both
people and pets continue as it is currently, meat shortages will be experienced within the
next 50 years (Henchion et al., 2017). As pets receive meats that are fit for human
consumption, the competition for meat sources further increases. This has led many to
consider alternative ways of eating and feeding their pets
■ Additionally, meat derivatives (by-products; i.e. the parts of an animal that humans chose
not to eat) are often disposed of despite being nutritious. Therefore, to better sustain human
meat consumption increased meat derivatives use would be a more environmentally
beneficial way to utilize these ingredients
Welfare considerations ■ Producing meat products inevitably means that animals are slaughtered. Many concerns
arise from the conditions animals are kept in prior to slaughter. That said, methods of animal
slaughter in the UK are regulated and overseen by the Foods Standards Agency (FSA, 2022),
who, throughout the process, regularly inspect animals intended for slaughter for meat, to
ensure the welfare of livestock
Religion/culture ■ Though there may be individual variations, Judaism and Islam entirely restrict the consumption
of pork, and vegetarianism is preferred. Buddhists and Hindus are typically vegetarian, and Jains
are strictly vegan. Christians and Baha’i are also advised not to consume meat, including pork
What are the advantages of feeding a plant-based diet?

Achieves a suitable diet ■ The evidence suggests that it may be possible to meet all nutrient requirements, using an
avoiding the need to feed appropriately formulated diet, based solely on plant-based ingredients (Dodd et al., 2018).
animal-based products to Even extremely active sled dogs appear to be sustained well on short-term feeding of
dogs plant-based diets (Brown et al., 2009). However, further work is recommended to confirm
health and safety, including use for long-term feeding
Achieves a suitable diet ■ Cats, as a carnivorous species, have specific requirements for nutrients that can only be found
avoiding the need to feed in meat-based ingredients (see ‘What are the disadvantages of feeding a plant-based diet?’
animal-based products to below). However, recently, non-animal sources for some of these nutrients have been
cats suggested (see below). For example, seaweed is rich in taurine and could be used as an
alternative to taurine from an animal source. Other essential nutrients, such as vitamin A and
arachidonic acid, can be manufactured synthetically. That being said, the bioavailability of
such ingredients to cats has not been demonstrated in feeding trials, meaning that safety of
such diets cannot be assured. Formulation is often problematic meaning that such diets
frequently do not meet either the European Pet Food Industry Federation (FEDIAF) or the
Association of American Feed Control Officials (AAFCO) recommendations for cats, especially
during the growth phase. Therefore, based on the current available evidence, it is not clear
whether plant-based diets are either suitable or safe for cats, and sole feeding of such
foods is not recommended ➟
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Reduced environmental ■ When compared with using meat-based ingredients, producing a pet food only from
impact plant-based ingredients might reduce its environmental impact. However, plant-based
ingredients still have an environmental impact and are not without concern (see, ‘What are
the disadvantages of feeding a plant-based diet?’ below)
More sustainable and ■ Due to the increasing competition and unsustainable nature of meat production, together
environmentally friendly with its increasing environmental impact, greater use of plant-based or other ingredients in
pet foods could be a more sustainable and environmentally friendly option. Many
environmentalists suggest that urgent action is needed
What are the disadvantages of feeding a plant-based diet?

Nutritional inadequacy for ■ Cats are an obligate carnivore species (Bradshaw et al., 1996) and have greater requirements
cats for proteins than dogs and for nutrients that can only be found in animal-based products.
Such nutrients include:
● Arginine
● Taurine
● Methionine
● Cystine
● Arachidonic acid
● Niacin
● Vitamin D
● Preformed retinol – vitamin A (as cats are unable to convert beta-carotene to vitamin A
(Green et al., 2012))

■ ALL these nutrients are naturally available in ingredients from animal sources. However, there
are natural plant-based sources for some of these ingredients. As mentioned above, the
bioavailability of such nutrients is questionable (Michel, 2006). Whilst not perfect,
appropriately conducted feeding trials (e.g. based on AAFCO recommendations) are the only
way of ensuring food safety, but, to the author’s knowledge, none of the available vegetarian
or vegan cat foods have yet been subject to such feeding trials. (Further information on
feeding trials can be found in ‘Commercially manufactured diets’)
Ethics of feeding cats, an ■ Some people have argued that feeding a plant-based diet to cats might be unethical given
obligate carnivore, a that it is at odds with their natural physiology and behaviour (Bennett, 2021). The predatory
plant-based diet instincts of cats have remained throughout their domestication, not least because of their
use for pest control. As a result, cats differ very little genetically from their wild ancestors,
the African Wildcat
■ The impact of feeding a plant-based diet on the behaviour of cats is not known, although
there is some evidence that provision of a diet with a high meat content reduces predation
of wildlife by domestic cats (Cecchetti et al., 2021)
Poor palatability for cats ■ As cats did not evolve to consume plant-based foods, with some exceptions (e.g. pumpkin,
courgette), many plant-based foods may be unpalatable when fed in their natural state.
Therefore, palatability of a diet based on plant-based ingredients might be poor. That said,
when it comes to diets that are commercially manufactured, this can be improved by the
addition of palatants
Nutritional adequacy of ■ Concerns about the nutritional adequacy of plant-based diets are greatest for those diets
plant-based diets formulated at home, where the risk of nutritional deficiency is significant (Larsen et al.,
2012). If such diets are to be considered, it is strongly recommended that guidance be
sought from an individual with a suitable qualification (see ’What safety measures are there
for feeding plant-based diets?’ below). For further information see ‘Home-prepared cooked
diets’
■ Research has shown that many of the plant-based diets produced commercially for both
cats and dogs may also be nutritionally inadequate (Zafalon et al., 2020). However, as more
manufacturers start producing these types of diet, further work to ensure nutritional
adequacy is likely to be undertaken. Some commonly used therapeutic diets for dogs are
already based predominately on plant-based ingredients (e.g. hydrolysed diets based on
soya protein) and these have been used safely for many years. Therefore, nutritional
adequacy (especially for dogs) may well be fully achievable
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Urinary crystal and urolith ■ Since plant-based proteins may produce a more alkaline urine than meat-based proteins,
formation adaptations to the diet formulation might be needed to prevent urolith formation. It would
therefore be prudent to monitor the urinary health of individuals on a plant-based diet,
particularly if they are prone to urolith formation
Environmental impact of ■ Soya bean is already widely used globally as a protein source for both humans and animals
soya bean production and may be considered to be a more environmentally friendly option to proteins derived
from meat production; however, many factors should be considered when determining
how environmentally friendly an ingredient is
■ Most of the soya bean produced (77%) is fed to animals, with lesser amounts being
consumed by people (19%) or used in industry (4%) and only 0.5% being used to feed pets.
Soya bean production requires considerable land and, therefore, can be associated with
deforestation, loss of wildlife, loss of biodiversity of plants and animal species, as well as use
of pesticides and fertilisers which can pollute the environment (Ritchie and Roser, 2021).
Thus, although plant-based ingredients, such as soya bean, may appear to be a more
sustainable choice, they can still pose a significant environmental impact
Can plant-based diets provide balanced nutrition?

As discussed above, it is currently unclear whether plant-based diets can provide all essential nutrients for cats; therefore, for
the time being, we recommend avoiding such diets.
Although it is theoretically possible to produce balanced plant-based diets for dogs, further work is still required to ensure
nutritional adequacy and safety for long-term feeding. Recently, associations have been identified between canine
cardiomyopathy and the feeding of some diets containing plant-based ingredients such as peas and lentils. Currently, the
reason for this association is unclear, including whether there is a causal link with feeding plant-based ingredients; however, for
now, caution is advised.
For further information please see ‘Grain-free diets’.
What safety measures are there for feeding plant-based diets?

Given the concerns detailed above, patients on plant-based diets should be regularly monitored. This may involve regular urine
and blood testing. However, routine biochemistry and haematology are not sufficient to determine nutrient deficiencies;
specific nutrient testing would be required, which may be very costly.
To get help with assessing the safety and suitability of a plant-based diet, or with how to ensure the diet is complete and
balanced, assistance should be sought from an individual with a suitable qualification.
Appropriate qualifications include:
■ PhD in animal nutrition
■ Diplomate of the American College of Veterinary Internal Medicine (Nutrition) (ACVIM)
■ Diplomate of the European College of Veterinary Comparative Nutrition (ECVCN).
Considerations for feeding plant-based diets in healthy dogs and cats

Nutrient inadequacy remains the biggest concern with the use of plant-based diets for both dogs and cats. This is particularly
the case for growing animals where optimal nutrition is critical; deficiencies in essential nutrients such as calcium can have
catastrophic skeletal effects (Zafalon et al., 2020). Therefore, the use of vegetarian or vegan diets is not currently
recommended for this age group.
The current evidence suggests that it may be possible to use vegan and vegetarian diets safely in healthy adults. However,
given that some nutritional deficiencies take a considerable time to develop, monitoring is key. Outwardly, the deficiencies
might not manifest as overt clinical signs for months or even years, by which point the effects may be irreversible.
Considerations for feeding plant-based diets in dogs and cats with

various diseases
In addition to the considerations for healthy pets, any pet with a disease will be significantly impacted by the nutrition they
receive. Healing and recovery are greatly reduced when nutritional deficiency is present. Therefore, it is even more important
that patients with any illness or disease are provided with a safe, suitable, complete and balanced diet. In some circumstances,
plant-based ingredients can be advantageous:
■ Liver disease:
● In the case of liver diseases associated with hepatic encephalopathy in dogs, plant-based (or dairy-based) protein
sources such as soya bean are preferable as they reduce the volume of ammonia produced during digestion, which
must be eliminated by the liver. Plant-based proteins produce less ammonia than meat-based proteins, and so are
often chosen in these instances (Proot et al., 2009).
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● Should an adverse reaction to food be derived from an animal protein source, the use of a plant-based protein
source such as rice or soya bean could be an excellent option to eliminate feeding the ingredient that caused the
clinical signs of the adverse reaction. For further information see ‘Adverse reactions to food’.
■ Obesity:
● Management of obesity requires calorie restriction and nutrient adaptations, alongside many other environmental
changes. As a result, any extra foods given by the pet owner as treats can slow or prevent weight loss. Green watery
vegetables, which are readily accepted by most dogs, can make a good option when used as treats or to add bulk to
the food allocation, helping the dog to feel full and the pet owner to manage food-seeking behaviours. Cats may also
accept vegetables as treats, which can be advantageous during controlled weight reduction. In addition, green
watery vegetables increase water intake which is often desirable
● It should be noted that little nutritional value is derived from using vegetables in this way and all nutrients are
obtained from the therapeutic diet that the pet should be consuming for safe weight loss. The vegetables are used
solely for management of food-seeking behaviours, increasing feelings of satiety with each meal and/or increasing
water intake.
Plant-based diets in a hospital environment – the rules

Plant-based diets do not pose a threat to other patients or veterinary staff working within a hospital environment. However, if
the diet does not deliver complete and balanced nutrition, this could negatively impact health and recovery. Information should
be provided to both cat and dog owners who feed a plant-based diet at home upon admission on the foods their pet will be
fed whilst within the hospital and the reasons for this.
How to talk to owners about plant-based diets

Remember:
■ When talking to owners about plant-based diets, it is important to understand their motivations, correct any
Where nutritional deficiency due to feeding an inappropriate plant-based diet is strongly suspected, and the pet owner is
unwilling to make changes,referral to a suitably qualified individual (as listed above) without delay is essential for the long-term
health of the pet.
Conclusion
Plant-based diets, for dogs at least, appear to offer some possible practical and partial solutions to the problems associated
with the environmental impact of producing pet foods. However, this is not without drawbacks and nutritional challenges,
particularly for cats. Further work is therefore needed before these diets can be widely recommended, although they may
feature more heavily in the way owners feed their pets in the years to come.
References
Bennett LK (2021) The legal, ethical and welfare implications of feeding vegan diets to dogs and cats. The Veterinary Nurse 12,
108–114
Bradshaw JWS, Goodwin D, Legrand-Defrétin V and Nott HMR (1996) Food selection by the domestic cat, an obligate
carnivore. Comparative Biochemistry and Physiology. Part A, Physiology 114, 205–209
Brown WY, Vanselow BA, Redman AJ and Pluske JR (2009) An experimental meat-free diet maintained haematological
characteristics in sprint-racing sled dogs. The British Journal of Nutrition 102, 1318–1323
Cecchetti M, Crowley, S L, Goodwin CED and McDonald RA (2021) Provision of high meat content food and object play reduce
predation of wild animals by domestic cats (Felis catus). Current Biology 31(5) 1107–1111
Dodd SAS, Adolphe JL and Verbrugghe A (2018) Plant-based diets for dogs. Journal of the American Veterinary Medical
Association 253, 1425–1432
Green AS, Tang G, Lango J, Klasing KC and Fascetti AJ (2012) Domestic cats convert [2H8]-β-carotene to [2H4]-retinol
following a single oral dose. Journal of Animal Physiology and Animal Nutrition (Berl) 96, 681–692
Henchion M, Hayes M, Mullen AM, Fenelon M and Tiwari B (2017) Future protein supply and demand: Strategies and factors
influencing a sustainable equilibrium. Foods 6, 1–21
Knight A, Huang E, Rai N and Brown H (2022) Vegan versus meat-based dog food: Guardian-reported indicators of health. PLoS
One 17
Michel KE (2006) Unconventional diets for dogs and cats. Veterinary Clinics of North America: Small Animal Practice 36,
1269–1281
Petrovic Z, Djordjevic V, Milicevic D, Nastasijevic I and Parunovic N (2015) Meat production and consumption. Environmental
consequences. Procedia Food Science 5, 235–238
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Proot S, Biourge V, Teske E and Rothuizen J (2009) Soy protein isolate versus meat-based low-protein diet for dogs with
congenital portosystemic shunts. Journal of Veterinary Internal Medicine 23, 794–800
Röös E, Sundberg C, Tidåker P, Strid I and Hansson PA (2013) Can carbon footprint serve as an indicator of the environmental
impact of meat production? Ecological Indicators 24, 573–581
Zafalon RVA, Risolia LW, Vendramini THA et al. (2020) Nutritional inadequacies in commercial vegan foods for dogs and cats.
PLoS One 15, 1–18
Useful websites
Food Standards Agency: Animal Welfare
https://www.food.gov.uk/board-papers/fsa-22-09-18-annual-animal-welfare-main-report-202122
NHS England: 5 a Day: What counts?
https://www.nhs.uk/live-well/eat-well/5-a-day/5-a-day-what-counts/#:~:text=At%20a%20glance%3A%20what%20
counts,no%20added%20sugar%20or%20salt
Ritchie H and Roser M: Soy
https://ourworldindata.org/soy
The Vegan Society: Definition of Veganism
https://www.vegansociety.com/news/blog/foundations-ethical-veganism#:~:text=The%20Definition,and%20cruelty%20
to%2C%20animals%E2%80%9D
Last updated
August 2023

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OWNER FACTSHEET
Plant-based diets
Introduction
Plant-based diets, which include vegetarian and vegan diets, are becoming increasingly popular and, as a consequence, we as
veterinary professionals would like to provide guidance about the advantages and disadvantages of such foods.
requirements are met, the chosen diet should ideally provide optimal (or ideal) nutrition to promote the good health of your
pet.
What are plant-based diets?

Plant-based diets are typically comprised of cooked, plant-based ingredients and some uncooked ingredients (e.g. cucumber,
carrot, nuts, and seeds). The type of diet used, be it vegetarian or vegan, may well match your chosen diet. Typically, they will
contain the following:
Vegetarian diets:
■ Root vegetables
■ Legumes
■ Cereals
■ Nuts
■ Oils
■ Seeds
Fruits
■
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■ Dairy products
■ Eggs
■ No meat-based products, including products derived from animals such as gelatine, will be included.
Vegan diets:
■ Root vegetables
■ Legumes
■ Cereals
■ Nuts
■ Oils
■ Seeds
■ Fruits
■ No meat-based products will be included, nor will they include ingredients derived from animals such as dairy products,
eggs, honey or gelatine.
Why are pet owners choosing to feed plant-based diets?

Proponents of plant-based diets may choose this diet type for the following reasons:

To align with way of life ■ Particularly when pet owners follow a vegan diet, the rationale for the diet is often a belief
system. As a result, products derived from, associated with, or tested on animals are avoided
(e.g. meats, dairy, eggs, honey)
It is a healthier option ■ Some studies have suggested that vegan diets may be a healthy option for pets, however,
the studies undertaken to date are short-term, observational and have relied on potentially
biased owner self-reporting via surveys. Their results should be interpreted cautiously, not
least because the associations identified do not prove causality
■ Vegan diets differ in nutrient formulation to other commercially manufactured options (e.g.
dry food) and additional mineral supplements and amino acids will be required as well as
the source of raw ingredients being different
■ Studies do not suggest that use of a vegetarian or vegan diet leads to obvious poorer health
with short term feeding
Environmental impact ■ Meat production places a significant toll on the environment. This occurs with use of
pesticides, fertilisers, pharmaceuticals as well as loss of natural land through deforestation
to make way for livestock farmland and agricultural crop production
■ Deforestation, in turn, causes loss of wildlife due to loss of natural habitats and loss of
biodiversity of both plants and animals in the area
■ The carbon footprint of meat production (and pet food production) is thought to be further
contributing to global warming
Sustainability ■ As pets receive meats that are fit for human consumption, the competition for meat sources
further increases. This has led many to consider alternative human and pet diets
■ Additionally, meat derivatives (by-products) – the parts of an animal which humans choose
not to eat – could be utilised more widely. Currently these often-nutritious meat products
are disposed of by either incineration or put into land fill. To better sustain human meat
consumption, increased use of meat derivatives would be a more environmentally beneficial
way to utilise these ingredients
Welfare considerations ■ Producing meat products inevitably means that animals are slaughtered. Many concerns
arise from the conditions animals are kept in prior to slaughter. The Foods Standards Agency
monitor and ensures the welfare of livestock throughout the process and regularly inspect
animals intended for slaughter for meat
Religion/culture ■ Though there may be individual variations, Judaism and Islam entirely restrict the
consumption of pork and vegetarianism is preferred. Buddhists and Hindus are typically
vegetarian and Jains are strictly vegan. Christians and Baha’i are also advised not to
consume meat, including pork
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What are the advantages of feeding a plant-based diet?

Achieves a suitable diet ■ The evidence suggests that it may be possible to meet all nutrient requirements, using an
avoiding the need to feed appropriately formulated diet, based solely on plant-based ingredients
animal-based products to ■ Even extremely active sled dogs appear to be able to be sustained well on short-term
dogs feeding of plant-based diets
■ Further work is recommended to confirm health and safety when using for long-term
feeding
Achieves a suitable diet ■ Cats, as a carnivorous species, have specific requirements for nutrients that can only be
avoiding the need to feed found in meat-based ingredients (see ‘What are the disadvantages of feeding a plant-based
animal-based products to diet?’ below)
cats ■ Non-animal sources for some of these nutrients have been suggested (e.g. seaweed is rich
in taurine and could be used as an alternative to taurine from an animal source)
■ Other essential nutrients, such as vitamin A and arachidonic acid, can be manufactured
synthetically. The bioavailability of such ingredients to cats has not been demonstrated in
feeding trials, meaning that safety of such diets cannot be assured
■ Formulation is often problematic meaning that such diets frequently do not meet either
AAFCO or FEDIAF recommendations for cats, especially during the growth phase
■ Based on the current available evidence, it is not clear whether plant-based diets are either
suitable or safe for cats and sole feeding of such foods is not recommended
Reduced environmental ■ When compared with using meat-based ingredients, producing a pet food only from
impact plant-based ingredients might reduce its environmental impact
■ Plant-based ingredients still have an environmental impact and are not without concern as
detailed in ‘What are the disadvantages of feeding a plant-based diet?’ below
More sustainable and ■ Due to the increasing competition and unsustainable nature of meat production, together
environmentally friendly with its increasing environmental impact, greater use of plant-based or other ingredients in
pet foods could be a more sustainable and environmentally friendly option
What are the disadvantages of feeding a plant-based diet?

Nutritional inadequacy for ■ Cats are an obligate carnivore species (eat mostly meat and cannot properly digest
cats vegetation) and have greater requirements for protein than dogs and for nutrients that can
only be found in animal-based products. Such nutrients include:
● Arginine
● Taurine
● Methionine
● Cystine
● Arachidonic acid
● Niacin
● Vitamin D
● Vitamin A
■ ALL these nutrients are naturally available in ingredients from animal sources
■ There are natural plant-based sources for some of these ingredients
■ Whilst not perfect, appropriately conducted feeding trials (e.g. based on AAFCO
recommendations) are the only way of ensuring food safety and so far (at time of printing)
none of the available vegetarian or vegan cat foods have yet been subject to such feeding
trials. For further information see BSAVA Guide to Nutrition – Commercially manufactured
diets factsheet
Ethics of feeding cats, an ■ It has been argued that feeding a plant-based diet to cats might be unethical given that it is
obligate carnivore, a at odds with their natural physiology and behaviour
plant-based diet ■ The predatory instincts of cats have remained throughout their domestication, not least
because of their use for pest control. As a result, cats differ very little genetically from their
wild ancestors, the African Wildcat
■ The impact of feeding a plant-based diet on the behaviour of cats is not known, although
there is some evidence that provision of a diet with a high meat content reduces predation
of wildlife by domestic cats
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Poor palatability for cats ■ Cats did not evolve to consume plant-based foods. With some exceptions (e.g. pumpkin,
courgette), many plant-based foods may be unpalatable when fed in their natural state
■ Palatability of a diet based on plant-based ingredients might be poor. When it comes to
diets that are commercially manufactured, this can be combated by the addition of
ingredients to improve this
Nutritional adequacy of ■ Nutritional adequacy of plant-based diets is of most concern for those diets formulated at
plant-based diets home, where the risk of nutritional deficiency is significant
■ If such diets are to be considered, it is strongly recommended that guidance be sought
from an individual with a suitable qualification (see ‘What safety measures are there for
feeding a plant-based diet?’ below)
■ Research has shown that many of the plant-based diets produced commercially for both
cats and dogs may also be nutritionally inadequate. Further work to ensure nutritional
adequacy is likely to be undertaken
■ Some commonly used therapeutic diets for dogs are already based predominately on
plant-based ingredients (e.g. hydrolysed diets based on soya protein) and these have been
used safely for many years. Nutritional adequacy (especially for dogs) may well be fully
achievable
Urinary crystal and stone ■ Plant-based proteins may produce a more alkaline urine than meat-based protein.
formation Adaptations to the diet formulation might be needed to prevent urinary stone and crystal
formation
■ Monitoring of the urinary health of pets on a plant-based diet, particularly if they are prone
to stone formation, will be highly important
Environmental impact of ■ Soya bean is already widely used globally as a protein source for both humans and animals
soya bean production and may be considered a more environmentally friendly option to proteins derived from
meat production. There are many factors to be considered when determining how
environmentally friendly an ingredient is:
● 77% of soya bean is used to feed animals, with just 0.5% being used to feed pets
● 19% of soya bean is consumed by people and 4% is used in industry
● Soya bean production requires considerable land and can be associated with
deforestation, loss of wildlife, loss of biodiversity of plants and animal species, as well as
use of pesticides and fertilisers which can pollute the environment and, therefore, still
pose a significant environmental impact
Can plant-based diets provide balanced nutrition?

It is currently unclear whether plant-based diets can provide all essential nutrients for cats. For the time being, we recommend
that such diets are best avoided. Although it is theoretically possible to produce balanced plant-based diets for dogs, further
work is still required to ensure nutritional adequacy and safety for long-term feeding.
Veterinary surgeons (veterinarians) will work with individuals, with suitable qualifications, to gain assistance with assessing
the safety and suitability of a plant-based diet, or to ensure the diet is complete and balanced.
Appropriate qualifications include:
■ Diplomate of the American College of Veterinary Internal Medicine (Nutrition) (ACVIM)
■ Diplomate of the European College of Veterinary Comparative Nutrition (ECVCN).
What safety measures are there for feeding plant-based diets?

Pets on plant-based diets should be regularly monitored by your veterinary surgeon. This may involve regular urine testing and
blood testing. However, routine blood tests are not sufficient to determine nutrient deficiencies, so specific nutrient testing
would be required, which may be very costly. Pet owners should, therefore, seek advice from their veterinary surgeon before
feeding a plant-based diet.
Considerations for feeding plant-based diets in healthy dogs and cats

Nutrient inadequacy remains the biggest concern with the use of plant-based diets for both dogs and cats. This is particularly
the case for growing animals where optimal nutrition is critical; deficiencies in essential nutrients such as calcium can have
catastrophic skeletal effects. Use of vegetarian or vegan diets are not currently recommended for this age group.
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The current evidence suggests that it may be possible to use vegan and vegetarian diets safely in healthy adults. However,
given that some nutritional deficiencies take a considerable time to develop, monitoring is key. Deficiencies might not
manifest for months or even years, by which point the effects may be irreversible.
Considerations for plant-based diets in dogs and cats with various

diseases
In addition to the considerations for healthy pets, any pet with a disease will be significantly impacted by the nutrition they
receive.
Healing and recovery are greatly reduced when nutritional deficiency is present. It is even more important that patients with
any illness or disease are provided with a safe, suitable, compete and balanced diet. In some circumstances, plant-based
ingredients in specific diseases can be advantageous:
■ Liver disease:
● In the case of liver disease in dogs, plant-based (or dairy based) protein sources such as soya bean are preferable as
they reduce the ammonia produced during digestion, which the liver must eliminate. Plant-based proteins produce
less ammonia than meat-based protein sources, and so, in turn, reduce the workload on the liver.
● Should an adverse reaction to food be derived from an animal protein source, the use of a plant-based protein
source such as rice or soya bean could be an excellent option to eliminate feeding the ingredient that caused the
adverse reaction. For further information see BSAVA Guide to Nutrition – Adverse reactions to food factsheet.
■ Obesity:
● Management of obesity requires calorie restriction and nutrient adaptations, alongside many other environmental
changes. As a result, any extra foods given as treats by a pet owner, can slow or prevent weight loss.
Green watery vegetables, which are readily accepted by most dogs, can make a good option when used as treats or to add
bulk to the food allocation, helping the dog to feel full and the pet owner to manage food-seeking behaviours. Cats may also
accept vegetables as treats, which can be advantageous during controlled weight reduction. In addition, green watery
vegetables increase water intake which is often desirable.
Little nutritional value is derived from using vegetables in this way and all nutrients are obtained from the therapeutic diets
that your pet should be consuming for safe weight loss. The vegetables are used solely for management of food-seeking
behaviours, increasing feelings of satiety (being full) with each meal and/or increasing water intake.
Conclusion
Plant-based diets, for dogs at least, appear to offer some possible practical and partial solutions to the problems associated
with the environmental impact of producing pet foods. However, this is not without drawbacks and nutritional challenges,
particularly for cats. Much further work is needed before these diets can be widely recommended, although they may feature
more heavily in the way you feed your pet in the years to come.
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Alternative protein-
based diets
Alternative protein-based diets are becoming increasingly popular with pet owners.
Consequently, veterinary professionals need to provide guidance about the advantages
and disadvantages of such foods.
What are alternative protein-based diets?

Alternative protein-based diets are typically commercially manufactured diets that use an alternative protein source. This is in
contrast to the more commonly used poultry, beef, lamb, pork, salmon and white fish. Alternative proteins may provide the
whole or a partial protein source within the diet.
Alternative protein-based diets may contain plant-based protein sources such as:
■ Soy or soya bean
■ Rice
■ Pea
■ Cereals
■ Algae
■ Fungi
■ Seitan (made from wheat gluten)
■ Fruit by-products.
Insect-based protein sources such as:
■ Black soldier fly larva (BSFL; Hermetia illucens)
■ House crickets (Acheta domesticus)
■ Yellow mealworms (Tenebrio molitor)
■ Mulbury silkworms (Bombyx mori).
Animal-based alternatives:
■ Meat by-products (e.g. feathers)
■ Cultured meats
■ Invasive species (e.g. Asian Carp).
Why do owners choose to feed alternative protein-based diets?

Reduced carbon footprint ■ As more is understood about the impact humans are having on the planet, there is arguably
a need to decrease the impact of pet food. A frequent concern is the significant carbon
footprint created by commercial meat production (Alexander et al., 2020), thus more
environmentally friendly, sustainable options need to be made available. Alternative sources
of protein that can be farmed in vertical structures (e.g. BSFL and crickets), reduce the land
mass required and the need for deforestation, as well as reduce pollution of water sources
given that there is no longer a need for pesticides, fertilizers or antimicrobials
More sustainable ■ As the environmental impact of using alternative protein sources is lower in the long-term,
these sources will become a more sustainable way to feed pets. If changes are not made to
the way pets are fed, it is estimated that within the next 50 years, there will be meat
shortages that will affect both pets and humans
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BSAVA GUIDE TO NUTRITION Alternative protein-based diets

Avoidance of specific ■ Owners increasingly want to know what their pet is consuming and may want their animal’s
ingredients diet to align with their own beliefs; for example, some pet owners wish to avoid feeding a
meat-based product, preferring instead plant-based products (such as soya bean). For
further information see ‘Plant-based diets’
Hypoallergenic ■ There is a perception that foods based on alternative proteins are ‘less likely’ to cause a
hypersensitivity reaction. Many pet owners may choose an alternative protein diet because
they think it might reduce the risk of digestive disturbances or pruritus. However, despite its
widespread use in pet food marketing, there is no legal definition of the term
‘hypoallergenic’ and, to the author’s knowledge, there is no evidence that such proteins are
truly ‘hypoallergenic’. That said, such diets would be a logical choice when managing cats
and dogs with adverse reactions to food because the protein is likely to be novel. For further
information see ‘Adverse reactions to food’ and ‘Grain-free diets’
What are the advantages of feeding an alternative protein-based diet?

Wider selection of protein ■ Some alternative protein sources, such as soya, rice, peas and cereals, have been used in pet
sources, reducing the foods for many years. More recent research has examined the use of some plant-based (e.g.
requirement for currently algae; McCusker et al., 2014) and insect-based protein sources (e.g. BSFL). The Association
used meat-based sources of American Feed Control Officials (AAFCO) and the European Food Safety Authority (EFSA)
have approved the use of BSFL, house crickets and yellow mealworms in pet foods for dogs
and cats. With increasing consumer and environmental pressures, the approval of other
protein sources is bound to follow shortly (Areerat et al., 2021); this will give the pet food
industry a much wider choice of protein sources. In addition, utilizing invasive species (such
as Asian carp) gives a broader choice of protein sources
Novel protein source ■ As some alternative protein sources are new to the market, it is thought unlikely that pets
will have encountered them before. If this is the case, these ingredients could be utilized as
a novel protein source should one be needed (e.g. for management of an adverse reaction
to food), although further studies are required. In addition, further work is needed to
determine the risks of cross-reactive allergies that have been identified (e.g. between
mealworms and dust mites) (Premrov et al., 2021)
Highly digestible ■ Soya (Stein et al., 2008) and insect proteins (McCusker et al., 2014) are highly digestible in
cats and dogs. BSFL is also highly digestible and, although further testing is required, appears
to be safe to feed to cats and dogs (Freel et al., 2021)
Improved animal welfare ■ There are many concerns surrounding the welfare of livestock used in meat production for
pet foods; however, with the use of alternative protein sources (such as insect-based
protein) welfare is considered to be better. In addition, the insect species used typically live
in colonies in tight dark spaces making them good candidates for mass commercial
production
Reduced antimicrobial use ■ Antimicrobial use in commercial meat production is thought to be contributing to and
increasing antimicrobial resistance in both pets and humans (Kasimanickam et al., 2021).
Given that such drugs are not required for the production of most alternative protein
sources, these options are a logical way to reduce the overall level of antimicrobials entering
the human food chain
Can turn low-grade/waste ■ BSFL and other insects can consume vegetable and fruit by-products that would otherwise
food products into be discarded (Spranghers et al., 2017). Turning waste products into high-quality proteins to
high-quality proteins be used in pet foods would be environmentally beneficial and could reduce the quantity of
waste products from the food-producing industry
Fast to produce ■ Raising meat from traditional sources usually takes a number of months, depending on the
species; however, alternative protein sources such as BSFL can be produced very quickly
(i.e. in a number of days) (Meneguz et al., 2018). Thus, proteins from this source could be
made readily available to meet the increasing demands of the pet food industry
Can be organic ■ Insects (e.g. BSFL) used for the production of protein can be fed vegetation and, if this comes
from organic sources, such insect-based proteins could be considered to be organic
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What are the disadvantages of feeding an alternative protein-based

diet?
New concept ■ Since many of the alternative protein sources used in pet foods (e.g. insect-based products)
are relatively new, little is currently known about the long-term impact of these diets.
Further work is needed to confirm whether these diets are safe for pets at all stages of life,
as well as for those with disease (where appropriate). However, other alternative protein
sources (e.g. soya) are well established in canine and feline diets, including use in
therapeutic diets (e.g. management of some types of liver disease (Norton et al., 2016) and
management of adverse reactions to food)
Availability ■ Currently, few diets use alternative protein sources, but this is likely to increase in the future
as innovation and research progresses
Environmental impact ■ Although insect-based proteins offer some meaningful environmental benefits (as described
above), other protein sources such as soya arguably have a negative environmental impact
(Ritchie and Roser, 2021). For further information on the environmental impact of soya bean
production, see ‘Plant-based diets’
Risk of dilated ■ Recent work has highlighted an association between canine DCM and the feeding of diets
cardiomyopathy (DCM) in that contain protein from legumes such as peas and lentils. The mechanism for this remains
dogs with diets high in unknown and, until further information is available, caution should be advised and these
peas and lentils diets might best be avoided. For further information see ‘Grain-free diets’
Acceptance of insect- ■ In some cultures (e.g. Mexican; Ramos-Elorduy, 1997), consuming insects is considered to
based diets be mainstream; however, in much of Europe this is not the case. Pet owners may be
reluctant to feed insect protein to their pet, or to consume insects themselves, no matter
what the nutritional value. Therefore, it might take time before some alternative proteins are
accepted into the mainstream
Can alternative protein-based diets provide balanced nutrition?

Yes, in theory, although confirmation of nutritional adequacy would require properly conducted feeding trials. For further
information, see ‘Commercially manufactured diets’.
What safety measures are there for feeding alternative protein-based

diets?
As for any diet, those containing alternative proteins must fulfil all the nutritional aims described in the ‘Introduction’. As these
diets are most likely to be commercially produced, they must also satisfy all safety regulations that any other commercially
manufactured product is required to meet. For further information see ‘Commercially manufactured diets’.
Considerations for feeding alternative protein-based diets in healthy

dogs and cats
Provided that the diet meets all the nutritional aims, including being complete and balanced for the life stage of the pet and is
safe, there should be no specific considerations for feeding this type of diet to healthy dogs and cats.
Considerations for feeding alternative protein-based diets in dogs and

Protein sources such as soya are already commonly used in therapeutic diets (as described above). Other protein sources such
as insect-based proteins are likely to follow; however, they have only recently started being used in pet food production.
Provided that they demonstrate clinical efficacy, they could offer a viable choice for therapeutic diets in the future.
Alternative protein-based diets in a hospital environment – the rules

There are no specific considerations for a patient fed an alternative protein diet in a hospital setting. Should the owner wish to
bring in the pet’s own complete and balanced alternative protein food, this may be allowed providing it does not pose a risk to
any other patients or staff.
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How to talk to owners about alternative protein-based diets

Remember:
can to ensure the pet receives a complete and balanced diet. However, the use of alternative protein sources is an
emerging trend and as such there is little information available, particularly regarding the long-term effects of feeding
these types of diet (e.g. insect-based diets) to dogs and cats. Pet owners should be made aware of this limitation
■ When talking to owners about plant-based diets, it is important to understand their motivations, correct any
Conclusion
Alternative protein diets might offer a new, potentially more sustainable choice for pet owners concerned about the
environmental impact of using animal proteins in food. These diets could become a common choice in the future.
References
Alexander P, Berri A, Moran D, Reay D and Rounsevell MDA (2020) The global environmental paw print of pet food. Global
Environmental Change 65, 102153
Areerat S, Chundang P, Lekcharoensuk C and Kovitvadhi A (2021) Possibility of using House Cricket (Acheta domesticus) or
Mulberry Silkworm (Bombyx mori) pupae meal to replace poultry meal in canine diets based on health and nutrient
digestibility. Animals 11, 2680
Case LP, Carey DP, Hirakawa DA and Daristotle L (2000) Canine and Feline Nutrition, 2nd edn. Mosby, Missouri
Freel TA, McComb A and Koutsos EA (2021) Digestibility and safety of dry black soldier fly larvae meal and black soldier fly
larvae oil in dogs. Journal of Animal Science 99
Jeffers JG, Shanley KJ and Meyer EK (1991) Diagnostic testing of dogs for food hypersensitivity. Journal of the American
Veterinary Medical Association 198, 245–250
Kasimanickam V, Kasimanickam M and Kasimanickam R (2021) Antibiotics use in food animal production: escalation of
antimicrobial resistance: where are we now in combating AMR? Medical Sciences 9, 14
McCusker S, Buff PR, Yu Z and Fascetti AJ (2014) Amino acid content of selected plant, algae and insect species: a search for
alternative protein sources for use in pet foods. Journal of Nutritional Science 3, e39
Meneguz M, Shiavone A and Gai F (2018) Effect of rearing substrate on growth performance, waste reduction efficiency and
chemical composition of black soldier fly (Hermetia illucens) larvae. Journal of the Science of Food Agriculture 98, 5776–5784
Norton RD, Lenox CE, Manino P and Vulgamott JC (2016) Nutritional considerations for dogs and cats with liver disease.
Journal of the American Animal Hospital Association 52, 1–7
Premrov Bajuk B, Zrimšek P, Kotnik T, Leonardi A, Križaj I and Jakovac Strajn B (2021) Insect protein-based diet as potential risk
of allergy in dogs. Animals 11(7), 1942
Ramos-Elorduy BJ (1997) The importance of edible insects in the nutrition and economy of people of the rural areas of Mexico.
Ecology of Food Nutrition 36, 347–366
Ritchie H and Roser M (2021) Soy. Our World on Data (Available from: https://ourworldindata.org/soy)
Smith CE, Parnell LD, Lai CQ, Rush JE and Freeman LM (2021) Investigation of diets associated with dilated cardiomyopathy in
dogs using foodomics analysis. Scientific Reports 11, 1–12
Spranghers T, Ottobone M, Klootwijk C et al. (2017) Nutritional composition of black soldier fly (Hermetia illucens) prepupae
reared on different organic waste substrates. Journal of the Science of Food Agriculture 97, 2594–2600
Stein HH, Berger LL, Drackley JK, Fahey GC, Hernot DC and Parsons CM (2008) Nutritional properties and feeding values of
soybeans and their coproducts. Soybeans (Available from: https://nutrition.ansci.illinois.edu/nutritional-properties-and-
feeding-values-soybeans-and-their-co-products)
Useful websites
European Food Safety Authority: Novel Food
https://www.efsa.europa.eu/en/topics/topic/novel-food
Global Alliance of Pet Food Associations
www.gapfa.org/files/download/GAPFA_Factsheet_The_Science_of_Pet_Food-Role_of_Protein.pdf
UK Pet food
www.ukpetfood.org/resource/insect-based-ingredients-in-pet-food.html
Last updated
August 2023

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OWNER FACTSHEET
Alternative protein-based diets

Introduction
Alternative protein-based diets are becoming increasingly popular and as a consequence, we as veterinary professionals would
like to provide guidance about the advantages and disadvantages of such foods.
This is so we can help you make decisions about what to feed your pet. As well as ensuring that the minimum nutritional
requirements are met, the chosen diet should ideally provide optimal (or ideal) nutrition to promote the good health of your
pet.
■ Digestible – the nutrients must be bioavailable to your pet consuming the food
■ Achievable – the recommendation must be within your time and financial budget.
What are alternative protein-based diets?

Alternative protein-based diets are typically commercially manufactured diets that use an alternative protein source. This is in
contrast to the more commonly used poultry, beef, lamb, pork, salmon and white fish. Alternative proteins may provide the
whole or a partial protein source within the diet.
Alternative protein-based diets may contain plant-based protein sources such as:
■ Soy or soya bean
■ Rice
■ Pea
■ Cereals
■ Algae
■ Fungi
■ Seitan (made from wheat gluten)
■ Fruit by-products ➟
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Insect-based protein sources such as:

■ Black soldier fly larva (BSFL; Hermetia illucens)
■ House crickets (Acheta domesticus)
■ Yellow mealworms (Tenebrio molitor)
■ Mulbury silkworms (Bombyx mori)
Animal-based alternatives:
■ Meat by-products (e.g. feathers)
■ Cultured meats
■ Invasive species (e.g. Asian Carp)
Why are pet owners choosing to feed alternative protein-based diets?

Reduced carbon footprint ■ As more is understood about the impact humans are having on the planet, there is arguably
a need to decrease the impact of pet food. A frequent concern is the significant carbon
footprint created by commercial meat production meaning that more environmentally
friendly, sustainable options need to be available. Alternative sources of protein (e.g. BSFL
and crickets), which can be farmed in vertical structures, reduce the land mass required and
the need for deforestation, as well as reduce pollution of water sources given that there is
no longer a need for pesticides, fertilizers or antimicrobials
More sustainable ■ As the environmental impact of using alternative protein sources is lower in the long-term,
alternative proteins will become a more sustainable way to feed pets. If changes are not
made to the way pets are fed, it is estimated that in the next 50 years, there will be meat
shortages that will affect both pets and humans
Avoidance of specific ■ You want to know what your pet is consuming and may want your pet’s food to align with
ingredients your own beliefs; for example, you may wish to avoid feeding your pet a meat-based
product, preferring alternative plant-based products (such as soya). For further information
see BSAVA Guide to Nutrition – Plant-based diets factsheet
Hypoallergenic ■ There is a perception that foods based on alternative proteins are ‘less likely’ to cause a
food-related reaction. You may choose an alternative protein diet because you may think it
reduces the risk of stomach upsets or skin conditions. However, despite its widespread use
in pet food marketing, there is no legal definition of the term ‘hypoallergenic’. Such diets are
a logical choice when managing cats and dogs with adverse reactions to food because the
protein is likely to be new to them. For further information see BSAVA Guide to Nutrition –
Adverse reactions to foods and Grain-free diets factsheets
What are the advantages of feeding an alternative protein-based diet?

Wider selection of protein ■ Some alternative protein sources, such as soya, rice, peas and cereals, have been used in pet
sources, reducing the foods for many years. More recent research and interest has examined the use of some
requirement for currently plant-based sources (e.g. algae) and insect-based protein sources (e.g. BSFL). The
used meat-based sources Association of American Feed Control Officials (AAFCO) and the European Food Safety
Authority (EFSA) have approved the use of BSFL, house crickets and yellow mealworms in
pet foods for dogs and cats. With increasing consumer and environmental pressures,
approval of other protein sources such as crickets and mealworms will follow shortly, giving
the pet food industry a much wider choice of protein sources. In addition, using invasive
species (such as Asian carp) gives a broader choice of available protein sources
Novel protein source ■ As some alternative protein sources are new to the market, it is thought unlikely that pets
will have encountered them before. If this is the case, these ingredients could be used as a
novel (new) protein source should one be needed (e.g. for management of an adverse
reaction to food) although further studies are required. In addition, further work is needed to
determine the risks of allergies from alternative protein sources
Highly digestible ■ Soya and insect proteins are highly digestible in cats and dogs. BSFL is also highly digestible
and, although further testing is required, appears to be safe to feed to cats and dogs
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Improved animal welfare ■ There are many concerns surrounding the welfare of livestock used in meat production for
pet foods; however, with the use of alternative protein sources (such as insect-based
protein) welfare is considered to be better. In addition, the insect species used typically live
in colonies in tight dark spaces making them good candidates for mass commercial
production
Reduced antimicrobial use ■ Antimicrobial use in commercial meat production is thought to be contributing to and
increasing antimicrobial resistance in both pets and humans. Given that such drugs are not
required for the production of most alternative protein sources, these options are a logical
way to reduce the overall use of antimicrobials in the human food chain
Can turn low-grade/waste ■ BSFL and other insects can consume vegetable and fruit by-products that would otherwise
food products into be discarded. Turning waste products into high-quality proteins to be used in pet foods
high-quality proteins would be environmentally beneficial and could reduce the quantity of waste products from
the food-producing industry
Fast to produce ■ Raising meat from traditional sources usually takes a number of months, depending on the
species; however, alternative protein sources such as BSFL can be produced very quickly
(i.e. in a number of days). Thus, proteins from this source could be made readily available to
meet the increasing demands of the pet food industry
Can be organic ■ Insects (e.g. BSFL) used for the production of protein can be fed vegetation and, if this
comes from organic sources, such insect-based proteins could be considered to be organic
What are the disadvantages of an alternative protein-based diet?

New concept ■ Since many of the alternative protein sources used in pet foods (e.g. insect-based products)
are relatively new, little is currently known about the long-term impact of these diets.
Further work is needed to confirm whether these diets are safe for pets at all stages of life,
as well as for those with disease (where appropriate). However, other alternative protein
sources (e.g. soya) are well established in canine and feline diets, including use in
therapeutic diets (e.g. management of some types of liver disease and management of
adverse reactions to food)
Availability ■ Currently, few diets use alternative protein sources, but this is likely to increase in the future
as innovation and research progresses
Environmental impact ■ Although insect-based proteins offer some meaningful environmental benefits (as described
above), other protein sources such as soya arguably have a negative environmental impact.
For further information on the environmental impact of soya production, see BSAVA Guide
to Nutrition – Plant-based diets factsheet
Risk of dilated ■ Recent work has highlighted an association between canine DCM and the feeding of diets
cardiomyopathy (DCM) in that contain protein from legumes such as peas and lentils. The mechanism for this remains
dogs with diets high in unknown and, until more is known, caution is advised and these diets might best be avoided.
peas and lentil content For further information, see BSAVA Guide to Nutrition – Grain-free diets factsheet
Acceptance of insect- ■ In some cultures (e.g. Mexican), consuming insects is considered to be mainstream;
based diets however, in much of Europe this is not the case. You may be reluctant to feed insect protein
to your pet, or to consume insects yourself, no matter what the nutritional value. Therefore,
it might take time before some alternative proteins are accepted into the mainstream
Can alternative protein-based diets provide balanced nutrition?

Yes, in theory, although confirmation of nutritional adequacy would require properly conducted feeding trials. For further
information, see BSAVA Guide to Nutrition – Commercially manufactured diets factsheet.
➟
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What safety measures are there for feeding alternative

protein-based diets?
As for any diet, those containing alternative proteins must fulfil all the nutritional aims described above. Since these diets are
most likely to be commercially produced, they must also satisfy all safety regulations that any other commercially
manufactured product would be required to. For further information see BSAVA Guide to Nutrition – Commercially
manufactured diets factsheet.
Considerations for feeding alternative protein-based diets in healthy

dogs and cats
Provided that the diet meets all the nutritional aims, including being complete and balanced for the life stage of your pet and is
safe, there should be no specific considerations for feeding this type of diet to healthy dogs and cats.
Considerations for feeding alternative protein-based diets in dogs and

Protein sources such as soya are already commonly used in therapeutic diets as described above. Other protein sources such
as insect-based proteins are likely to follow; however, they have only recently started being used in pet food production.
Provided that they demonstrate clinical efficacy, they could offer a viable choice for therapeutic diets in the future.
Conclusion
Alternative protein diets might offer a new, potentially more sustainable choice for those concerned about the environmental
impact of using animal proteins in food. These diets could become a common choice in the future.
Last updated
August 2023

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Hospital nutrition
Providing nutrition for hospitalized patients can be challenging; however, it is of the utmost
importance for their health and recovery. Veterinary professionals need to prevent malnutrition
as well as feed patients nutritious diets suited to their requirements.
What is hospital nutrition?

Hospital nutrition is that provided within a veterinary hospital.
The effect of nutrition

Provision of nutrition to patients within the veterinary hospital has the potential to impact prognosis and speed of recovery
directly. To this end, every attempt should be made to avoid malnutrition in hospitalized patients. Sadly, human hospital studies
have shown that 30–50% of patients suffer from malnutrition whilst hospitalized (Konturek et al., 2015); it is thought that a
similar problem exists in veterinary hospitals, with 73% of veterinary patients found to have an energy deficit whilst in the
hospital (Remillard et al., 2001). It is vital, therefore, that adequate calories and nutrients be delivered to all hospitalized patients.
For further information see ‘Critical care nutrition’.
Essential elements
Nutritional assessment upon admittance
All patients need an individualized nutrition plan based on their current health status and the information found during the
nutritional assessment – this should be performed on all patients within the first 24 hours or, ideally, at the time that the patient
is admitted. This assessment should reveal information about the pet’s current diet and preferences together with any other
pertinent information that may affect the hospital nutrition plan, including foods to avoid.
See below under ‘Useful websites’ for an example of a suitable nutritional assessment form that can be used to gather the
required information and also an example of a nutrition plan form to be used within the hospital.
Suitable diets
To provide excellent nutrition whilst patients are in the hospital, a wide range of diets should be available, including therapeutic
and maintenance diets; all available diets should be complete and balanced for the intended species. In addition, a range of
highly palatable foods that can tempt an inappetent patient to eat should be stocked.
Accurate feeding plans
Energy requirements and quantities of food should be calculated accurately for all patients and recorded clearly on the
hospitalization sheets or on a separate hospital nutrition sheet. Spreadsheets can be devised for this purpose so all staff
members can quickly and accurately calculate feeding quantities (see Figure 1). Such spreadsheets can then be added to the
patient file for review or future reference.
Maintenance nutrition plan – canine

Animal’s name: Frank Animal’s weight (kg): 10
Clinician: ......................................................................................................................................... Contact extension: .............................................................................................
BCS:..................................................................................................................................................... MCS: ................................................................................................................................
Current diet:...................................................................................................................................................................................................................................................................................
History: ................................................................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................................................................................
Figure 1 An example of a form for calculating energy requirements and quantities of food. BCS = body condition score;
MCS = muscle condition score. (continues)
(Courtesy of the University of Liverpool, Small Animal Teaching Hospital) ➟
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BSAVA GUIDE TO NUTRITION Hospital nutrition
Maintenance nutrition plan – canine continued

Daily calorific requirement: 534 Kcal Food required: Gastrointestinal
Calorie content in food: 109 Kcal/100 g Total amount of food required: 490 g/day
Day 1 490 g split into 4 meals = 123 g/meal
Weigh the patient daily and record on kennel sheets
Always record how much the patient is actually eating to ensure the patient is not hyporexic or anorexic
(continued) An example of a form for calculating energy requirements and quantities of food. BCS = body condition score;
Figure 1
MCS = muscle condition score.
(Courtesy of the University of Liverpool, Small Animal Teaching Hospital)
The following energy calculations should be used as a starting point in conjunction with suitable diet formulations (National
Research Council, 2006). In addition, it is important to note that ascites can affect apparent bodyweight.
Resting energy requirement (RER)
Used for hospitalized patients who require critical care nutrition (e.g. tube feeding) and all postoperative patients (for further
information see ‘Critical care nutrition’).
■ Patients with a bodyweight of 2–30 kg: (bodyweight x 30) + 70 = RER (calories required per 24 hours)
■ Patients with a bodyweight of <2 kg or >30 kg: 70 x bodyweight0.75 = RER (calories required per 24 hours)
Maintenance energy requirement (MER)

Suitable for stable hospitalized patients who do not require critical care nutrition (e.g. preoperative patients or patients well
enough to go home).
■ Dogs: 95–105 x bodyweight0.75 = MER (calories required per 24 hours)
■ Cats (lean): 100 x bodyweight0.67 = MER (calories required per 24 hours)
■ Cats (obesity prone): 130 x bodyweight0.4 = MER (calories required per 24 hours)
Calculation of food quantity to be fed over 24 hours

Step 1: Determine RER or MER as appropriate, using the above calculations.
Step 2: Decide upon the most appropriate food choice, based on the patient’s condition and the availability of suitable diets.
Step 3: Determine the energy content and calculate the quantity of the food to be fed.
■ The energy content of the chosen food should be found per 100 g on an ‘as fed’ basis. This information can be acquired by
calculating it from the guaranteed analysis on the packaging (see below under ‘Useful websites’ for further information),
by reading any associated literature from the food manufacturer (e.g. product books) or by contacting the manufacturer.
■ Once energy content is known, the following calculation will be necessary to determine feeding quantities:
● (RER or MER / calories in 100 g of food) x 100 = amount of food to feed per 24 hours (g).
Step 4: Determine the quantity of food to be given per meal.

■ Smaller, more frequent meals are preferable; therefore, the total daily food quantity should be divided into four or more
meals.
Weigh in, weigh out
The quantities of food offered and consumed should be recorded. All food, be it wet or dry, should be weighed prior to being
offered and any remaining food weighed when removed. In this way, actual amounts of food (and therefore calories)
consumed can be calculated per day. At the end of each 24-hour period, the quantity of calories consumed should be
reviewed and alterations to the nutrition plan made if this amount does not meet the patient’s needs.
Hyporexic or anorexic patients
Time and care should be taken with patients who are hyporexic or anorexic since poor nutrition within the hospital has been
associated with negative effects. Factors associated with hyporexia or anorexia include:
■ Pain
■ Stress
■ Disease
■ Nausea
■ Injury
■ Recumbency
■ Gastrointestinal obstruction.
Elements to consider for a hyporexic or anorexic patient

To help a patient voluntarily consume the required quantities of food within the hospital, a number of key elements should be
considered:
■ Environment
● Reduce stress. The environment that each patient is housed in should be evaluated with the aim of reducing stress
factors
● Environmental modifications. Modifications should be made (wherever possible) to ensure a quiet, secure place to rest,
recover and eat. For example, moving inappetent patients to quieter areas or providing hiding places for cats (a
good example of a suitable hide can be found on the Cats Protection website – see below under ‘Useful websites’) ➟
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● Separate resources. Cats do not like to eat near their litter tray or their source of water – food bowls should be
placed away from other resources. Larger kennels may be required for cats to facilitate this and ‘double diner’ bowls
should be avoided or used for only food or only water, not a mixture of both
● Change of scenery. Taking dogs to a quiet grassy area (not used for toileting) or to a quiet room can encourage them
to eat. Since cats are a solitary species, taking them into a quiet consulting room away from other patients for feeding
may encourage voluntary food consumption
■ Bowl types
● For some patients, metal bowls appear to be a deterrent due to their shiny, noisy nature, especially when the patient
has to wear an Elizabethan collar which will strike the bowl. Plastic, ceramic or Pyrex® bowls are often tolerated
better. However, some patients may have a contact allergy to plastics, so bowl choice should be considered in each
individual case
● Cats do not like to get food and water on their whiskers so wide shallow bowls or saucers or even a tin lid can be
used, despite the risk of these being more easily overturned

● For large breeds of dog, those with mobility concerns or with spinal or neck pain who may find eating from a bowl on
the floor difficult or even painful, raised bowls may encourage better consumption of food. However, an increased
risk of gastric dilatation and volvulus (GDV) has been associated with feeding from raised bowls (Glickman et al.,
2000), but in the hospital environment the significance of this remains unclear
■ Different foods
● Only one food type should be offered at any one time
● The patient should be given sufficient time (e.g. 20–30 minutes) to consume the food; if it is not consumed, the food
should be removed, except in some circumstances, for example with cats who prefer to eat at night
● A new food can then be offered at the next designated time to feed the patient
■ Highly palatable foods

● If the food being offered is refused, a more palatable diet type can be given (if suitable for the patient’s situation).
Foods with greater moisture, fat and protein content can be more appealing to cats and dogs and might be
consumed more readily. A good understanding of the patient’s condition is necessary, as, for example, high fat diets
may not be desirable in specific instances, such as in cases of lymphangiectasia
● Highly palatable foods include, for example, chicken, ham or tuna, which the hospital may stock; however, since
these foods are not complete and balanced if fed alone, they should only be used to encourage the consumption of
an optimal complete and balanced diet rather than being the sole food fed throughout hospitalization
■ TLC
● Hospitalized patients are usually beloved family pets, so allocating time for non-clinical interactions, grooming and
affection (if the patient enjoys them) can often encourage eating. It is important that more unpleasant interactions, such
as temperature taking and injections, are balanced and timed so as not to interfere with interactions the patient might
enjoy. This may, to a certain extent, offset the stress and fear some patients will experience in a hospital environment
■ Other strategies
● Removing Elizabethan collars (whilst under constant supervision)
● Hand-feeding (without gloves, if possible)
● Matching the patient’s preferences. Often in hospitals, only wet foods are offered. Cats can be unwilling to depart
from their food-type preferences and appear to be neophobic to foods while under stressful conditions (Bradshaw et
al., 2000), so dry food should always be offered if the patient usually eats a dry diet at home
● Warming the food to just below body temperature. This enhances the aroma and palatability. This is especially
important for any patient with an impaired sense of smell. Cats who cannot smell their food are usually unwilling to
consume it, so efforts to maintain their nasal passage, together with warming foods to enhance the smell, can assist
in, for example, cat ‘flu cases
● Providing stronger smelling foods. Foods with a strong aroma, such as oily fish, can encourage consumption
● Getting help from the pet owner. Provided the patient does not become distressed when the owner leaves and the
hospital has a suitable space for this, asking owners to help feed their pets whilst in the hospital can be a good
strategy to encourage eating
● Providing favourite foods. Owners are often willing to bring in the patient’s favourite foods if the hospital does not
stock them. Favourite foods may not be complete and balanced and should only be used to encourage the
consumption of an appropriate diet. All foods brought in by the pet owner should be cooked; uncooked foods
should never be brought into the clinical area of the hospital due to the high pathogen risk these diets present
(Freeman et al., 2013). For further information, see ‘Raw diets’.
If all the above strategies do not result in the patient consuming sufficient quantities of food, assisted feeding will be
required without delay. For further information on assisted feeding, see ‘Critical care nutrition’.
Suitable diet choices

Diet selection will depend on the reason for admission to the hospital. Therefore, a range of diets should always be available,
including:
■ Milk replacement formulas
● For neonates in situations where, for whatever reason, the mother is not available to feed them
■ Growth diets
● Suitable for puppies, kittens or those who may be boarding or brought in as strays ➟
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■ Maintenance adult diets

● Suitable for those adult patients who do not have specific therapeutic nutritional requirements. This may include
uncomplicated postoperative or boarding patients or those brought in as strays

■ Highly digestible diets
● Suitable for patients with no additional medical requirement for a specific therapeutic diet but who are not
consuming food at their usual volume or have gastrointestinal disturbance. This diet type is typically more energy
dense than a maintenance diet, meaning smaller quantities (compared with a maintenance diet) can be consumed to
satisfy energy and nutrient requirements. These diets may also be preferable for hospitalized patients because they
allow for ease of digestion with lower residue, resulting in reduced amounts of faecal output
■ Highly digestible, highly palatable diets suitable for growth
■ Therapeutic diets
● Ideally, a range of diets is required and should include those for animals with:
− Renal impairment, i.e. with lower phosphorus concentrations

− Poor liver function, i.e. with lower copper content and/or an alternative protein source (e.g. soy) to reduce
ammonia accumulations
− Suspected adverse reactions to food, i.e. hydrolysed or single-protein diets
− Any condition requiring a low-fat diet
■ Diets suitable for tube feeding
● Further information can be found in ‘Critical care nutrition’
■ Single-protein sources
● For example, cooked chicken, ham or tuna; however, as aforementioned, these are to be used to encourage food
consumption only and are not to be fed alone.
Other management factors

Learned behaviours and key words
It is useful to ask the pet owner if there are any learned behaviours that have been encouraged at the time of feeding using key
words. This may include signals or release words the patient may require before they will eat. This is not only applicable for
highly trained service or working dogs, since many pet dogs and cats are asked to wait before being released to eat their food.
Failing to gather this information for a patient may delay eating whilst in the hospital.
Misconceptions about hospital nutrition

Misconception Comments
Chicken alone is suitable to be fed within ■ If chicken is fed to a cat or dog as the sole source of food, it will provide
the hospital only 54% or 62%, respectively, of the essential nutrients required (quantities
calculated with the use of an online nutritional formulation tool (BalanceIT))
■ For adult patients, this poses only a small risk, provided the duration of
feeding just chicken is limited to only 2–3 days. For patients hospitalized
for more than 3 consecutive days, this could pose a significant risk of
malnutrition
■ Therefore, single-protein sources should only be used to encourage
eating a complete and balanced diet and, wherever possible, not used as
the sole food source whilst the patient is under the hospital’s care
It is best to start a long-term therapeutic ■ In most cases, transitions to a diet required in the long term are best
diet within the hospital performed at home unless a significant diet alteration is required
immediately, e.g. in cases where a low-fat diet is needed
■ Especially where the diet is pivotal in the management of the patient’s
condition, transitions to the new diet should be carefully controlled and
performed over a sufficient amount of time to give the best chance of
acceptance by the patient
■ In addition, introducing the new diet within the hospital may lead to an
association with the negative experience of having an illness and being
hospitalized, known as an acquired aversion to food (Johnson and
Freeman, 2017), even when the patient returns home. For this reason,
most food transitions can be started upon the patient returning home
■ To maximize success, all food transitions should be performed over
several days. For patients with a good appetite, 3–4 days should be
sufficient; for those who may be less keen to make changes, 7–10 days
would be recommended; for those who prove resistant to any diet
alteration, transition at a frequency of only one kibble or teaspoon
difference per day over a period of 1–2 months may be required
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How to talk to owners

For a pet owner relinquishing their pet to the veterinary team, no matter their level of knowledge or understanding or how
much they trust the team, it will a be stressful experience. Time is necessary to discuss all aspects of the pet’s stay in the
hospital thoroughly and this should include information about what the pet will be offered to consume each day. The
nutritional assessment upon admission is key to reassuring the pet owner that all aspects of care have been considered and
that their preferences and those of the pet will be taken into account.
When performing nutritional assessments, veterinary professionals should all be aware that the owner will be in a state of
heightened stress and, as such, this may affect their ability to recall important information. The pet owner should know who to
contact if they remember something important later.
So that treatment can commence swiftly, the nutritional assessment could be performed by a member of the team other
than the veterinary surgeon, in some cases. Veterinary nurses are perfectly placed to do this, and members of the reception
team can also play a vital role in gathering basic information about what the pet would usually eat at home and their food and
feeding management preferences.
Pet owners may also benefit from a description, either verbal or written, of what they can expect their pet to eat while they
are in the hospital. Some brief information could easily be prepared to be delivered with all other paperwork given upon
admittance. This also affords an opportunity to divulge the practice’s policy on the feeding of non-standard diets within the
hospital and describe the alternatives that will be used.
Conclusion
Feeding patients within the hospital can be challenging. With many different conditions and preferences to manage, finding
foods the patients want to consume whilst delivering excellent nutrition and preventing malnutrition can prove difficult. With a
thorough nutritional assessment, a wide range of diets and foods and careful thought about each individual patient’s
requirements, an excellent standard of nutrition can be provided for all hospitalized patients.
References
BalanceIT. Available from: https://secure.balanceit.com/index.php
Bradshaw JWS, Healey LM, Thorne CJ, MacDonald DW and Arden-Clark C (2000) Differences in food preferences between
individuals and populations of domestic cats Felis silvestris catus. Applied Animal Behaviour Science 68, 257–268
Freeman LM, Chandler ML, Hamper BA and Weeth LP (2013) Current knowledge about the risks and benefits of raw meat-
based diets for dogs and cats. Journal of the American Veterinary Medical Association 243, 1549–1558
Glickman LT, Glickman NW, Schellenberg DB, Raghavan M and Lee T (2000) Non-dietary risk factors for gastric dilatation-
volvulus in large and giant breed dogs. Journal of the American Veterinary Medical Association 217, 1492–1499
Johnson LN and Freeman LM (2017) Recognizing, describing, and managing reduced food intake in dogs and cats. Journal of
the American Veterinary Medical Association 251, 1260–1266
Konturek PC, Herrmann HJ, Schink K, Neurath MF and Zopf Y (2015) Malnutrition in hospitals: It was, is now, and must not
remain a problem! Medical Science Monitor 21, 2969–2975
National Research Council (2006) Nutrient Requirements of Dogs and Cats. National Academies Press, Washington DC
Remillard RL, Darden DE, Michel KE et al. (2001) An investigation of the relationship between caloric intake and outcome in
hospitalized dogs. Veterinary Therapeutics 2, 301–310
Useful websites
Cats Protection
https://www.cats.org.uk/
Pet Food Manufacturers Association (PFMA) calorie calculator for cats
https://www.pfma.org.uk/cat-calorie-calculator-nrc-method
Pet Food Manufacturers Association (PFMA) calorie calculator for dogs
https://www.pfma.org.uk/dog-calorie-calculator-nrc-method
World Small Animal Veterinary Association (WSAVA) feeding instructions for hospitalized patients
https://wsava.org/wp-content/uploads/2020/01/Feeding-Instructions-and-Monitoring-Chart-for-Hospitalized-Patients.pdf
World Small Animal Veterinary Association (WSAVA) Nutritional Assessment Checklist
https://wsava.org/wp-content/uploads/2020/01/Nutritional-Assessment-Checklist.pdf
Last updated
August 2023

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OWNER FACTSHEET
Hospital nutrition
Introduction
Nutrition is the cornerstone of good health and wellbeing for our pets. Through decades of innovation, research and
development, there are now many excellent diets to feed pets, which are safe and which will deliver everything pets need in
optimal quantities. For healthy pets, the aim of these diets is to maintain good health and quality of life for as long as possible.
However, we recognize that nutritional requirements undoubtedly change in times of illness or disease. In recent years, the
development of disease-specific therapeutic diets has significantly increased. These therapeutic diets not only deliver essential
nutritional requirements but can also, through their nutritional adaptations, help to reduce signs of disease and promote
recovery from illness or injury.
What is hospital nutrition?

Hospital nutrition is that provided to your pet while they are within a veterinary hospital.

Providing your pet with sufficient nutrition within the veterinary hospital has the potential to impact the speed of their recovery
directly. To this end, every attempt will be made to provide all the nutrition your pet needs whilst they are hospitalized.
Essential elements
Nutritional assessment upon admittance
To be able to set an appropriate nutrition plan for your pet, a nutritional assessment will be required within the first 24 hours –
ideally, at the time your pet is admitted to the hospital.
Information gathered will include details of your pet’s current diet and preferences as well as any other important
information that may affect the hospital nutrition plan, including foods to avoid.
Suitable diets
The veterinary hospital will have a wide range of diets available, including therapeutic diets for specific conditions and
maintenance diets, all of which will be complete and balanced for your pet. In addition, a range of highly palatable foods will be
stocked that can help tempt your pet to eat if required.
Daily review
Once the nutrition plan has been put in place, quantities of all foods offered and eaten will be recorded each day. At the end of
each 24-hour period, an evaluation of the quantity of food that your pet has eaten will be made and changes put in place if the
amount is not meeting your pet’s needs.
Elements we will consider if your pet is not eating any or enough food
To help your pet eat the required amounts of food within the hospital, a number of key elements will be considered:
■ Environment
● Reduce stress. The environment that your pet is housed in will be evaluated with the aim of reducing stress
factors if present
➟
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● Environmental modifications. Modifications will be made (wherever possible) to ensure a quiet, secure place to rest,
recover and eat (e.g. providing hiding places for cats)
● Change of scenery. Taking dogs to a quiet grassy area (not used for toileting) or to a quiet room can help encourage
them to eat. Since cats are a solitary species, taking them into a quiet room away from other patients for feeding may
help encourage them to eat on their own
■ Bowl types
● For some, metal bowls appear to be a deterrent due to their shiny, noisy nature, especially if your pet has to wear an
Elizabethan collar which will strike the bowl. Plastic, ceramic or Pyrex® bowls are often tolerated better. However,
some pets may have a contact allergy to plastics, so bowl choice is considered in each individual case. Warning:
When your pet is admitted to the hospital, you must inform the veterinary team if your pet has a contact allergy to
plastics.
● For large breeds of dog or those with mobility problems who may find eating from a bowl on the floor difficult or
even painful, raised bowls may be used to encourage eating

■ TLC
● We know that hospitalized patients are much-loved family pets, so time is allocated for non-clinical interactions such
as grooming and affection. If your pet enjoys them, this can often encourage eating
■ Highly palatable foods
● If the food being offered is refused, a more palatable diet type can be offered (if suitable for your pet’s situation).
Foods with greater moisture, fat and protein content can be more appealing to cats and dogs
● Highly palatable foods include chicken, ham or tuna, which the hospital may stock; however, since these foods are
not complete and balanced if fed alone, they will only be used to encourage eating a complete and balanced diet
rather than being the sole food fed throughout hospitalization
■ Other strategies for encouraging eating within the hospital
● Removing Elizabethan collars (whilst under constant supervision)
● Hand-feeding
● Matching your pet’s preferences (as far as possible)
● Warming the food to just below body temperature. This enhances aroma and palatability
● Providing stronger smelling foods. Foods such as oily fish can be a good option due to the enhanced aroma, which
encourages eating
● Asking you to help us feed your pet. Provided the hospital has a suitable empty room and staff to accommodate it, in
certain circumstances it may be possible for you to spend time with your pet to encourage them to eat whilst they
are in the hospital. However, this would not be possible if your pet became distressed after you left the hospital, as
this would be detrimental to their recovery. Decisions will be made on a case-by-case basis. Some hospitals will not
be able to facilitate such visits
● Providing favourite foods. If the hospital does not stock your pet’s favourite food, it may be appropriate to bring
some into the hospital for your pet to encourage them to eat. Favourite foods may not be complete and balanced
and, if so, will only be used to encourage eating an appropriate diet. All foods you wish to bring in must be cooked;
uncooked foods should never be brought into the hospital due to the high pathogen risk they present.
If all of the above does not result in your pet eating enough food, assisted feeding will be required without delay.

Diet selection will depend on the reason your pet has been admitted to the hospital. A range of diets should always be
available, including:
■ Milk replacement formulas
● For newborn kittens and puppies in situations where, for whatever reason, the mother is not available to feed them
■ Growth diets
● Suitable for puppies, kittens or those who may be boarding
■ Maintenance adult diets

● Suitable for adult pets who do not have specific nutritional requirements
■ Highly digestible diets

● Suitable for pets with no additional medical requirement for a specific diet but who are not consuming food at their
usual volume or have gastrointestinal disturbance

■ Highly digestible, highly palatable diets suitable for growth
■ Therapeutic diets
● To manage specific conditions
■ Diets suitable for tube feeding

■ Single-protein sources
● For example, cooked chicken, ham or tuna; however, as aforementioned, these will only be used to encourage your
pet to eat.
➟
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Learned behaviours and key words
Upon your pet’s admission to the hospital, it is useful for the veterinary team to know if there are any specific learned
behaviours that have been encouraged at the time of feeding. This may include signals or release words your pet may require
before they will eat.
Misconceptions about hospital nutrition

It is best to start a long-term therapeutic diet within the ■ In most cases, transitions to a diet required in the long
hospital term are best performed at home, unless a significant diet
alteration is required immediately, e.g. in cases where a
low-fat diet is needed
■ Especially where the diet is essential in the management
of your pet’s condition, transitions to the new diet should
be carefully controlled and performed over enough time
to give the best chance of acceptance by your pet
■ In addition, introducing the new diet within the hospital
may be associated with the negative experience of having
an illness and being hospitalized, known as an acquired
aversion to food, even when your pet returns home. For
this reason, most food transitions can be started once
your pet has returned home
■ To maximize success, all food transitions should be
performed over several days. Timings for transitioning
your pet to a new diet are as follows:
● Pets who will readily eat anything offered: 2–3 days
should be sufficient to transition food without digestive

disturbance
● Good eaters: 4–7 days will help make transition easy
by promoting good acceptance and preventing

digestive disturbance
● Picky eaters: 10–14 days should be taken for the
transition
● Fussy eaters: 2–3 weeks or more should be taken. If
necessary, pets can be transitioned by only one kibble

or teaspoonful per day, taking 1–2 months in some
cases
Considerations when your pet is hospitalized

We understand that it may be stressful for you to leave your pet in the hospital under the care of the veterinary team. Therefore,
time is necessary to discuss all aspects of your pet’s stay in the hospital thoroughly and this should include all the relevant
information about what your pet will be offered to eat each day. The nutritional assessment is key so we can consider all of
your and your pet’s preferences and give your pet the best chance of eating well while they are hospitalized. If you forget to
tell the veterinary team any important information about what your pet eats, you should contact the hospital so it can be
passed on to the team caring for your pet.
Conclusion
Ensuring your pet eats well whilst in the veterinary hospital can, at times, be challenging but it is essential to give us the best
chance of returning them home to you as quickly as possible. The nutritional assessment will allow us to have a good
understanding of your pet’s needs and preferences so we can provide them with a diet they are likely to want to eat whilst away
from home.
Last updated
August 2023

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Critical care
nutrition
Feeding critically ill patients within the veterinary hospital is a vital part of their care. Veterinary
professionals need to provide excellent nutrition for patients, even when they cannot or will
not consume food voluntarily.
What is critical care nutrition?

Critical care nutrition is provided to those patients within veterinary hospitals who require close monitoring and nursing care or
those who are unwilling or unable to consume sufficient food voluntarily due to illness or injury.

Provision of nutrition to patients within the veterinary hospital has the potential to impact the outcome of treatment
significantly. To promote a timely return to the pet owner’s care, malnutrition within the veterinary hospital should be avoided.
Sadly, studies have shown that 30–50% of human patients suffer from malnutrition whilst hospitalized (Konturek et al., 2015),
and it is thought a similar problem exists in veterinary hospitals, with 73% of veterinary patients found to have an energy deficit
whilst in the hospital (Remillard et al., 2001).
Nutrient and energy deficits directly decrease the patient’s ability to recover. Poor nutrition leads to prolonged healing
times, impaired immunity, altered metabolism of drugs and extended hospitalization, all of which are of particular concern for
the most vulnerable critical patients (Saker and Remillard, 2010). Deficiencies and the associated concerns are not limited to
long-term critical patients alone – even in the short term, malnutrition should be avoided because metabolic alterations can be
observed after just 3 days of hyporexia or anorexia due to insufficient energy and nutrients (Chan, 2004). This includes the time
the patient may not have been eating prior to hospital admission in addition to any period of hyporexia or anorexia within the
hospital. When determining the need to intervene, it is essential to have a clear understanding of when the patient last ate, what
was eaten and how much.
Provided that the patient is haemodynamically stable and properly hydrated, a timely nutrition plan should be instigated for all
patients, including those that are critical, with nutrition delivered by a means appropriate for the individual. The nutrition plan should
be accurately formulated and instructions clearly communicated to all veterinary hospital staff caring for the patient. The nutrition
plan should be followed alongside all other medical management and hospitalization instructions. For provision of more complex
nutrition plans, as will be necessary for critical patients, separate detailed nutrition forms should be used and careful evaluation and
reviews performed daily to ensure minimum requirements are being met. See ‘Useful websites’ below for further information.
Essential elements
For information on all basic feeding requirements within the hospital, see ‘Hospital nutrition’. Nutritional support is required for
critical patients who are not voluntarily consuming sufficient food or cannot do so due to a physical restriction. Such nutritional
support can take several different forms, as discussed below.
Food reintroduction
Following a period of hyporexia or anorexia, food should be gradually reintroduced to prevent refeeding syndrome, which is
rare but can cause serious complications as a result of electrolyte disturbances such as hypophosphataemia. Therefore, a
staged approach to food reintroduction (over 3–4 days) is recommended. For energy requirements and an example of a 3-day
reintroduction of food, see the section on ‘Calculation of feeding requirements’.
The timeframe in which food is introduced can vary and more gradual increases can sometimes be needed. Therefore,
on each day, the patient’s response should be assessed to ensure that they are tolerating the feeding before the next
increment is made.
Assisted feeding
When a patient will not eat voluntarily despite efforts to tempt them to eat, assisted feeding should be introduced without
delay. See ‘Hospital nutrition’ for all key elements for tempting patients to consume food voluntarily.
Methods of assisted feeding include:
■ Medication
● Appetite stimulants should be used alongside all efforts to tempt the patient to voluntarily consume foods
they are likely to find appetizing ➟

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BSAVA GUIDE TO NUTRITION Critical care nutrition
● Mirtazapine can be given to both cats and dogs and can encourage voluntary food consumption in some instances.
Dosages can be found in the BSAVA Small Animal Formulary
● Antiemetics may be helpful, e.g. maropitant
● Capromorelin (Entyce ), a ghrelin receptor agonist, has recently become licensed in North America and has been
®
shown to be an effective appetite stimulant in dogs (Rhodes et al., 2018). Availability in other countries is more
limited; for example, an import licence is required in the UK
■ Syringe feeding
● Force-feeding a patient with a syringe should be avoided. It is very unpleasant and stressful for the patient and may
cause resentment of being handled. In contrast, gently introducing food into the cheek pouch or on to the tongue of a
patient with a syringe may encourage eating, especially in cats. However, it is unlikely that this method of feeding will
meet energy requirements, so other methods of assisted feeding should be utilized in most circumstances
● For neonates, gentle syringe feeding may be appropriate though care not to flood the airway with food must be
taken to prevent aspiration pneumonia

■ Feeding tubes
● Feeding tubes are used to deliver sufficient nutrition to a patient in the absence of voluntary food consumption and are
often the most appropriate means of providing nutritional support. Frequently thought of as a last resort, it is preferable
to consider tube feeding sooner rather than later. Examples of cases where tube feeding is necessary include upper
gastrointestinal tract disorders (e.g. oesophageal disease), disorders affecting deglutition (e.g. fractured jaw), alimentary
organ diseases (e.g. pancreatic disease, liver disease) and systemic diseases associated with hyporexia or anorexia (e.g.
renal disease). Wherever possible, the gastrointestinal tract should be utilized for nutrient and energy absorption
● Feeding tube selection will depend on the disease status of the patient, the duration assisted feeding is likely to be
required for and the availability of equipment and surgical or other expertise to place each tube type
● For neonates, feeding tubes can be an easier and safer option than syringe feeding as it reduces the risks of aspiration
pneumonia
● Commonly used feeding tubes:
− Naso-oesophageal or nasogastric tubes

• Placed via the nares
• Duration of use: 3–10 days
• Tube diameter: 5–8 Fr
Naso-oesophageal or nasogastric tubes

Advantages ■ Can be placed without a general anaesthetic
■ Low risk of infection as naso-oesophageal and nasogastric tubes do not have an
associated stoma at the point of entry into the patient’s body
■ Minimal equipment required
■ Can be placed rapidly
Disadvantages ■ Short-term use only
■ Must be secured with glue or sutures to the head or face, which may become dislodged
■ Once placed and secured, the tube can be dislodged by sneezing or patient interference
■ Tube displacement may cause subsequent aspiration of food
■ Elizabethan collars must be worn to prevent patient interference. Collars are not always
well tolerated and may hinder the patient’s attempts to consume food voluntarily should
their appetite improve
■ Only very small-diameter tubes can be used, restricted by the diameter of the patient’s nares.
Suitable diets for the patient’s condition may not be available in an appropriate consistency
to pass down such narrow tubes. Large amounts of water may have to be added to make
suitable diets liquid enough to pass down these tubes. Large volumes may not be desirable
− Oesophagostomy tubes
• Surgically placed into the oesophagus via the lateral neck
• Duration of use: weeks to months
• Steps required for safe use of oesophagostomy tubes can be found under ‘Other management factors’
Oesophagostomy tubes
Advantages ■ Mid-term use
■ Wider bore than naso-oesophageal or nasogastric tubes, allowing suitable foods to be
given more easily, though dilution of canned diets may still be required
■ Tolerated well in most cases with low levels of patient interference
■ An Elizabethan collar is not required in most cases
■ Food can be offered for voluntary consumption, provided no functional restriction is
present that would prevent it
■ Suitable for at-home use by a pet owner after a demonstration has been given. This allows
for a shorter duration of hospitalization
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Oesophagostomy tubes
Disadvantages ■ Requires a short general anaesthetic to place. The patient must be haemodynamically
stable and well enough to withstand an anaesthetic
■ Risk of stoma site infection. The stoma should be cleaned using an aseptic technique and
fresh dressings applied daily
■ Can be dislodged by vomiting
■ Can become blocked if proper flushing is not undertaken prior to feeding
■ Risk of tube displacement and subsequent aspiration of food
− Gastrostomy tubes
• Placed percutaneously, endoscopically or surgically
• Duration: >6 months
Gastrostomy tubes
Advantages ■ For long-term assisted feeding
■ Wide-bore tubes which allow suitable diets to be given with minimal preparation
■ Tolerated well in most cases
■ Likelihood of patient interference is low
■ No need for an Elizabethan collar in most cases
■ Food can be offered for voluntary consumption
■ Intended for use at home by the pet owner long-term
Disadvantages ■ Requires a general anaesthetic to place

■ Specialist equipment, e.g. an endoscope, and skilled staff are required
■ Risk of stoma site infection until a sealed stoma has formed
− Enterostomy (jejunostomy) tubes

• Placed surgically
• Requires 24-hour nursing care and food delivery by constant-rate infusion.
Parenteral nutrition
Parenteral nutrition is that which is administered elsewhere in the body other than the mouth and alimentary canal. This
approach is required in rare cases, for example when the entire gastrointestinal tract is not available and/or cannot absorb
enough nutrients. However, this approach is less commonly used in veterinary practice.
Total nutritional support can be delivered via a central vein (jugular vein or threaded into the vena cava via the saphenous
vein). Peripheral parenteral nutrition (PPN) can only provide partial nutritional support as the osmolality of the solution needs to
be lower. PPN can be a good adjunct therapy to partial enteral feeding when a patient cannot cope with 100% of the resting
energy requirement (RER) enterally.
Calculation of feeding requirements
Step 1: Calculate total energy requirements.
■ The most appropriate calculation for use in critical patients is RER.
■ RER can be calculated as follows:
● Patients with a bodyweight of 2–30 kg: (bodyweight x 30) + 70 = RER (calories per 24 hours)
● Patients with a bodyweight of <2 kg or >30 kg: 70 x bodyweight = RER (calories per 24 hours).
0.75
Step 2: Decide on the most appropriate food.

■ Food choice will be based on the individual patient’s requirements and the availability of suitable liquid diets or food
blenders which can bring diets to a suitable consistency for feeding tubes.
Step 3: Determine calorie content and calculate the necessary quantity of food.
■ The caloric content of the chosen diet should be found per 100 g of food. This information can be acquired by
calculating it from the guaranteed analysis on the packaging (see below under ‘Useful websites’ for further information),
by reading any associated literature from the food manufacturer (e.g. product books) or by contacting the manufacturer.
■ Once the caloric content is known, the following calculation will be necessary to determine feeding quantities:
● (RER / calories in 100 g of food) x 100 = amount of food to feed per 24 hours (g).
Step 4: Determine the quantity of food to be given per day, if different from the full RER. This is now known as the daily energy
requirement (DER).
■ Should a staged introduction of food be desired, the calorie quantity should be reintroduced slowly over 3–4 days,
depending on the duration of hyporexia or anorexia.
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■ Example of a 3-day reintroduction of food:

● DER day 1 = 1/3 of RER
● DER day 2 = 2/3 of RER
● DER day 3 = full RER.
Step 5: Determine the quantity of food to be given per meal.

■ When using feeding tubes, smaller, more frequent meals are desired in order to reduce the risk of vomiting; therefore,
the total daily food quantity should be divided into four or more meals.
Note:
■ Given that feeding calculations can be complex and time-consuming, designing spreadsheets to calculate feeding
amounts rapidly and accurately minimizes the chance of errors (Figure 1). Such documents can be saved to the patient’s
file to provide a record of the feeding plan as well as how quantities were determined
■ A list of the calorie content of commonly stocked foods is very helpful to use alongside this spreadsheet or to have on
file, thus reducing the need to recalculate for each new patient that requires a tube-feeding plan.
ICU/feeding tubes nutrition plan – canine

Animal’s name: .......................................................................................................................... Animal’s weight (kg): 10
Clinician: ......................................................................................................................................... Contact extension: .............................................................................................
BCS:.................................................................................................................................................................. MCS: ..........................................................................................................................................
Current diet: ...........................................................................................................................................................................................................................................................................................................
History: ................................................................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................................................................................
Daily calorific requirement: 370 Kcal Food required:.......................................................................................................................................

Calorie content in food: 391 Kcal/100 g Total amount of food required: 95 g/day
If using PEG or oesophagostomy tubes, see separate sheets for instructions on how to feed. Please split the meals as
below, the total requirement should be gradually increased over 3 days to reach total amount on day 3 (48 hours after
starting to feed).
Day 1 (1/3 total amount) 32 g split into 5 meals = 6 g/meal
Day 2 (2/3 total amount) 63 g split into 5 meals = 13 g/meal
Day 3 (full amount) 95 g split into 5 meals = 19 g/meal
If no assisted feeding is required, start on full amount on day 1
Day 1 95 g split into 5 meals = 19 g/meal
Weigh the patient daily and record on kennel sheets
Always record how much the patient is actually eating to ensure not hyporexic or anorexic
An example of a form for calculating energy requirements and quantities of food. BCS = body condition score;
Figure 1
MCS = muscle condition score; PEG = percutaneous endoscopic gastrostomy.
(Courtesy of the University of Liverpool, Small Animal Teaching Hospital)
EXAMPLE
Example of a feeding quantity calculation for a critical patient who has a feeding tube and requires a staged reintroduction
of food:
■ Case details:
● Domestic Shorthaired cat
● Male
● Neutered
● 8 years old
● Bodyweight: 4.5 kg
● Body condition score (BCS): 5/9
● Muscle condition score (MCS): normal
● Current diet: commercially produced wet and dry diet
● Fractured jaw following a road traffic accident
− Anorexic for 3–4 days

● Energy requirement: RER = (4.5 x 30) + 70 = 205 Kcal/day
● Chosen food: high-energy nutrient-dense wet-food preparation (many food options are available in this category)
● Calorie content of food: 120 Kcal/100 g
● Feeding amount for full RER: (205/120) x 100 = 171 g per day
● Staged reintroduction of food required:
− Food amount on day 1 (1/3 of RER): 171/3 = 57 g

− Food amount on day 2 (2/3 of RER): (171/3) x 2 = 114 g
− Food amount on day 3 and thereafter (full RER): 171 g.
➟
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Pre-prepared liquid formulations specifically designed for use with feeding tubes are readily available for different medical
conditions. However, especially for large breeds of dog, this can become an expensive method of feeding.
Alternatively, therapeutic or other diets can be blended with water in a food processor to become a slurry thin enough to
be delivered via a feeding tube. The added water must be accounted for in all feeding quantity calculations. Disadvantages of
blending therapeutic diets include the difficulty of obtaining an optimal consistency for very narrow-bore tubes without a
large amount of water, which would then greatly increase the volume of food delivered to the patient and decrease the caloric
density. This may be contraindicated in the presence of delayed gastric emptying or may cause the patient to vomit. Very large
feed volumes can be delivered via constant-rate infusions, provided the necessary equipment and monitoring are available.
For excitable patients, this may not be a suitable option.

Care and safe nutrition delivery for patients with oesophageal feeding tubes
Insertion site inspection
■ This should be undertaken on a daily basis.
■ Personal protective equipment, such as gloves, is required to minimize the risk of introducing infection to the stoma site.
■ Method:
● Remove bandages and dressings from around the tube
● Inspect stoma site for infection
● Clean gently around the tube at the insertion site
● Dry the area
● Reapply a fresh dressing and bandage.
Feeding by bolus
■ Prepare the food and equipment.
● During preparation, always offer highly palatable food for voluntary consumption if oral intake is appropriate for the
patient. Should the patient voluntarily consume food that would equal >80% of the required amount, tube feeding
may not be needed on this occasion. However, should the patient not consume food in a similar way at the next
meal, tube feeding will still be necessary.
● Prepare all equipment needed. For example:
− 1 x empty 5 ml syringe
− 1 x 5 ml syringe for sterile water
− 1 x 5 ml syringe for tap water
− Appropriately sized syringes for the selected food; 60 ml syringes are a good option for large feeding volumes.
● Ensure food and liquids are at the necessary temperatures.
− Sterile water and tap water should be at room temperature, warmed if necessary.
− The food should be at body temperature.
− Avoid delivering hot or cold fluids.
− Never microwave the syringes as this creates hotspots or melts them.
− Allow food to warm up in warm-water baths until the desired temperature is reached, first capping the end of the
syringes to prevent leakage of the food contents.
● Check whether medications are to be given with the food; prepare if required. This may involve crushing some
medications to be delivered via the tube along with the food.

■ Confirm correct tube position.
● Clean the delivery port.
● Uncap the tube, but keep the tubing pinched and occluded until a syringe is attached.
● First, attach the empty syringe and draw back. Negative pressure should be observed on drawback.
− Should air enter the syringe freely, the tube may have become dislodged and could now be in the airway.
− Should stomach contents appear in the syringe, insufficient time has elapsed since the last feed, the stomach may
not be emptying correctly or vomiting has occurred.
− In both cases, the veterinary team should review the situation and decide how to proceed.
● Pinch and occlude the tube whilst changing the empty syringe for the one containing sterile water.
● Flush the tube with 2–5 ml of sterile water and monitor for a cough. Stop introducing water immediately if a cough is
observed; however, the absence of a cough does not guarantee that the tube has not been displaced to the airway.
■ Deliver the full food quantity.
● Once correct tube position has been confirmed, delivery of the food can commence.
● Whilst again pinching and occluding the tube, the syringe that contained sterile water can be replaced by the syringe
containing the food.

● The delivery of the food volume should be slow, taking 5–20 minutes (depending on the size of the patient, its
response and the volume to be given). If salivation or gulping is observed, slow the rate of infusion by 50% and
observe further throughout a slower delivery. Too rapid an introduction of food can cause vomiting and, in this case,
delivery of food should be slowed to 1 ml/minute if no other cause is suspected.
● Whilst feeding, there is a good opportunity to give the patient some TLC. This may also make tube feeding a pleasant
experience and so reduce the risk of the patient resenting the process.

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■ Complete the final steps.

● Pinch and occlude the tube whilst changing the now empty food syringe for the 5 ml syringe containing tap water.
Sterile water is not necessary for this process as correct tube position has already been confirmed.
● Once the feed has been completed, flush the tube to clear it of any remaining food or medications.
● Ensure all dressings remain clean and dry – replace them if needed.
● Cap the feeding tube and tuck it out of the way to prevent it catching and becoming dislodged or annoying the
patient. The use of stockinet dressings over the neck dressing can be very useful for this purpose. Specific
oesophagostomy-tube neck collars are also available.
● Make sure the patient is clean and dry before leaving; cats especially are fastidious cleaners of their coat.
As voluntary consumption resumes, provided the patient is consuming enough food to maintain their bodyweight, the
feeding tube can be removed.
Misconceptions about critical care nutrition

Carbonated cola drinks can be used freely to ■ Carbonated drinks may assist with unblocking feeding tubes if they have
unblock feeding tubes become occluded. However, the use of high-sugar drinks, which may
significantly increase the blood glucose of the patient if given in large
quantities, is rarely desirable and caution should be exercised. Carbonated
drinks may also contain phosphoric acid, which is also undesirable for
some patients
■ Water alone, moreover, has been found to be more effective than any
carbonated drink or cranberry juice for unblocking feeding tubes
■ Further, the best solution to dissolve such occlusions was found to be
325 mg of sodium bicarbonate and a quarter of a teaspoon of pancreatic
enzyme mixed together in 5 ml of water (Parker and Freeman, 2013)
■ Diligent prevention of blockages by sufficiently flushing the feeding tube
after all feeds is strongly recommended
Weight loss is inevitable in critical patients ■ Provided sufficient energy is delivered, bodyweight can be maintained via
with feeding tubes all types of feeding tubes in many patients
■ However, in a patient in a catabolic state, weight loss is inevitable despite
the use of a feeding tube
■ In addition, determining exact energy requirements for each individual is
not possible, so monitoring is key and patients should be weighed daily to
ensure their weight remains stable
■ In the initial few days when food reintroduction is taking place, slight
weight loss may be observed, though this should not continue once the
full daily energy requirement is delivered

For any pet owner, whether they have medical knowledge or not, the prospect of their pet requiring hospitalization can be
daunting. Such times are stressful and, as a result, good communication is essential about all aspects of treatment and care,
including nutrition.
Conclusion
Critically ill patients require significant veterinary treatment and care, and the provision of nutrition is vital for a good recovery
and a timely return home to the pet owner. Even if voluntary intake is absent, there are many suitable options to continue to
provide nutrition and every critical patient should have an individualized, detailed nutrition plan created and initiated as soon as
it is feasible to do so.
References
Chan DL (2004) Nutritional requirements of the critically ill patient. Clinical Techniques in Small Animal Practice 19, 1–5
Konturek PC, Herrmann HJ, Schink K, Neurath MF and Zopf Y (2015) Malnutrition in hospitals: It was, is now, and must not
remain a problem! Medical Science Monitor 21, 2969–2975
Parker VJ and Freeman LM (2013) Comparison of various solutions to dissolve critical care diet clots. Journal of Veterinary
Emergency and Critical Care 23, 344–347
Remillard RL, Darden DE, Michel KE et al. (2001) An investigation of the relationship between caloric intake and outcome in
hospitalized dogs. Veterinary Therapeutics 2, 301–310
Rhodes L, Zollers B, Wofford JA and Heinen E (2018) Capromorelin: a ghrelin receptor agonist and novel therapy for stimulation
of appetite in dogs. Veterinary Medicine and Science 4, 3–16
Saker KE and Remillard RL (2010) Critical Care Nutrition and Enteral-Assisted Feeding. In: Small Animal Clinical Nutrition, 5th
edn, ed. MS Hand, CD Thatcher, RL Remillard, P Roudebush and BJ Novotny, pp. 439–476. Mark Morris Institute, Topeka
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Useful websites
Pet Food Manufacturers Association (PFMA) calorie calculators for dogs
https://www.pfma.org.uk/dog-calorie-calculator-nrc-method
Pet Food Manufacturers Association (PFMA) calorie calculators for cats
https://www.pfma.org.uk/cat-calorie-calculator-nrc-method
World Small Animal Veterinary Association (WSAVA) hospital nutrition chart
https://wsava.org/wp-content/uploads/2020/01/Feeding-Instructions-and-Monitoring-Chart-for-Hospitalized-Patients.pdf
Last updated
August 2023

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OWNER FACTSHEET
Critical care nutrition
Introduction
What is critical care nutrition?

Critical care nutrition is provided to your pet within the veterinary hospital when your pet is unwilling or unable to eat enough
food on their own due to illness or injury.

Nutrition is vital to help your pet recover from illness or injury and will give them the best chance of returning home to you as
quickly as possible.
As soon as your pet’s condition is stable enough, a feeding plan will be put in place and will be reviewed daily.
Essential elements
Food reintroduction
Following a period when your pet has not been eating, food will be gradually reintroduced to prevent an electrolyte
disturbance. Typically, it is recommended that reintroduction takes place over 3–4 days.
Assisted feeding
If your pet will not eat on their own, despite efforts to tempt them to eat, assisted feeding may be introduced.
Methods of assisted feeding include:
■ Medication
● It may be appropriate to use an appetite stimulant alongside all efforts to tempt your pet to eat foods they are likely
to find appetizing
● Anti-sickness drugs may also be used to reduce any nausea
■ Syringe feeding
● In the first instance, syringe feeding may be attempted. This involves gently introducing food into your pet’s cheek
pouch or on to their tongue with a syringe, which may encourage eating, especially in cats
■ Feeding tubes
● Feeding tubes allow us to feed your pet when they are not eating for themselves
● There are many different types of feeding tube. The type of tube your pet may receive will be chosen according to
their condition, their individual needs and how long the tube is likely to be needed for
■ Parenteral nutrition
● In very rare cases, introducing food into the digestive system is not possible due to ongoing illness. In these circum-
stances nutrients can be delivered in specialist formulas via a vein to continually support your pet’s recovery. ➟
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Pre-prepared liquid diets specifically designed for use with feeding tubes are readily available for different medical conditions.
Alternatively, therapeutic or other diets can be blended with water in a food processor to become a slurry thin enough to be
given via a feeding tube.

In some cases, your pet may be well enough to come home with their feeding tube still in place for you to continue their care,
assisting with their long-term recovery.
Guidelines for using an oesophageal feeding tube at home
A demonstration of all aspects must be given by the veterinary team before you attempt to feed your pet on your own. Usually,
your first attempt will be at the veterinary hospital so the team can support you through the entire process. You must fully
understand all instructions before feeding your pet in this way at home and you should not hesitate to contact the veterinary
team at any time should you have any questions or concerns.
Care and safe food delivery for your pet with an oesophageal feeding tube
Check the insertion site
This is where the feeding tube enters your pet’s neck.
■ The insertion site should be checked on a daily basis.
■ Ideally, gloves should be worn to minimize introducing any infection to the stoma site.
■ Method:
● Carefully, so as not to pull on the tube, remove any bandages and dressings from around the tube
● Inspect the stoma site for infection. If the tube or skin is discoloured, sticky or smelly, contact the veterinary team for
advice
● Clean gently around the tube at the insertion site
● Dry the area
● Reapply a fresh dressing and bandage.
Feeding
■ Prepare the food and equipment.
● Prepare all equipment needed. For example:
− 1 x empty 5 ml syringe
− 1 x 5 ml syringe for sterile water
− 1 x 5 ml syringe for tap water
− Food to be fed, drawn into appropriately sized syringes.
● Ensure food and liquids are at the necessary temperature.
− Sterile water and tap water should be at room temperature, warmed if necessary.
− Warm the food to body temperature.
− Avoid delivering hot or cold fluids.
− Never microwave the syringes as this creates hotspots or may melt them.
− Allow food to warm up in warm-water baths until the desired temperature is reached, first capping the end of the
syringes to prevent leakage of the food contents.
● If medications are to be given with the food, prepare them. This may require crushing some medications to be
delivered via the tube along with the food.

■ Confirm correct tube position.
● Clean the delivery port.
● Uncap the tube, but keep the tubing pinched and occluded until a syringe is attached.
● First, attach the empty syringe and draw back. Negative pressure (resistance) should be observed on drawback.
− Should air enter the syringe freely, the tube may have become dislodged and could now be in the airway. Do not
continue with the feed if you are in any doubt.
• Contact your veterinary team before continuing.
− Should liquids (stomach contents) appear in the syringe, not enough time has passed since the last feed, the
stomach may not be emptying correctly or vomiting has occurred.
• In both cases, contact your veterinary team for advice.
● Pinch and occlude the tube whilst changing the empty syringe for the one containing sterile water.
● Flush the tube with 2–5 ml of sterile water and observe for a cough. Stop giving water immediately if a cough is seen
and contact your veterinary team for advice. A cough indicates displacement of the feeding tube into the airways.
■ Deliver the full food quantity.
● Once correct tube position has been confirmed, you can start to deliver the food to your pet through the tube.
● Whilst again pinching and occluding the tube, the syringe that contained sterile water can be replaced by the syringe
containing the food.

● The delivery of the food volume should be slow, taking as much time as you have been advised. This will usually be
5–20 minutes but it will depend on the size of your pet.

● If salivation (drooling) or gulping is observed during the feed, pause the feed and contact your veterinary team
for advice. ➟
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■ Complete the final steps.

● Pinch and occlude the tube whilst changing the now empty food syringe for the 5 ml syringe containing tap water.
Sterile water is not necessary for this process as correct tube position has already been confirmed.
● Once the feed has been completed, flush the tube to clear it of any remaining food or medications.
● Ensure all dressings remain clean and dry – replace them if needed.
● Cap the feeding tube and tuck it out of the way to prevent it catching and becoming dislodged. The veterinary team
will be able to provide further information about available dressings or collars that can help with this.
● Make sure your pet is clean and dry before leaving; cats especially are fastidious cleaners of their coat.
Conclusion
Providing nutrition to your pet when they are critically ill is vital for a good recovery and a timely return home. Even if your pet
is not eating on their own, there are many suitable options for continuing to provide nutrition to them, some of which you may
also be able to do at home.
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Adverse reactions
to food
When animals suffer an adverse reaction to food, correct identification of the cause or causes
of the reaction are key to providing an effective nutritional management strategy. Veterinary
professionals need to provide guidance about identification of the source of the reaction as
well as about diets that are suitable for the patient’s requirements.
What is an adverse reaction to food?

An adverse reaction to food may be due to one of the following:
■ Dietary indiscretion
■ Food intolerance
■ Food poisoning
■ Food allergy (hypersensitivity).
Adverse reactions to food may be immune-mediated, as in cases of food allergy, or the result of mechanisms that do not
involve the immune system. Therefore, it is incorrect to label all reactions to foods as ‘allergies’. Clinically, reactions most often
manifest with gastrointestinal and/or dermatological signs. Foods commonly associated with a cutaneous adverse reaction are
(Roudebush et al., 2010):
■ In dogs:
● Beef
● Dairy products
● Soya
● Wheat
■ In cats:
● Beef
● Dairy products
● Fish.
These associations largely reflect ingredients which are commonly included in diets and, as a result, they are likely to vary
between countries and pet populations.

Given that certain ingredients are responsible for the adverse reaction, altering the diet is the best way both of determining the
cause and of preventing further reactions long-term. The gold-standard method for determining an adverse reaction to food is
to conduct a food elimination trial, as detailed below under ‘Essential elements’ (Case et al., 2000). Although serology and
saliva testing are available, they have been shown to be unreliable and, therefore, should not be used (Jeffers et al., 1991).
Essential elements
How to conduct a food elimination trial
Step 1: Conduct a nutritional review.
Thoroughly review the pet’s dietary history and use this to create a list of all ingredients in their main diet as well as all treats,
food scraps, supplements, foods used to administer medications and the medications themselves (especially in ‘chewable’
preparations or any that are given in capsules, which are typically made from bovine or porcine gelatine) that the pet has
encountered for at least the previous year.
Step 2: Select an appropriate diet.
This would typically be one of the following:
■ Novel – a diet consisting of a carbohydrate and protein source that the pet has not consumed in the past
■ Hydrolysed – a diet containing a protein source whose molecular size has been reduced, typically to a level below
10,000 daltons (Roudebush et al., 2010). At this size, the protein molecules are less likely to cause a reaction. ➟
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BSAVA GUIDE TO NUTRITION Adverse reactions to food
Step 3: Exclusively feed the chosen diet.

The necessity for complete compliance with feeding the selected diet should be stressed to the owner. Feeding additional
foods may render the results of the trial inconclusive. Given that some medications, especially ‘chewable’ preparations, might
also contain food-based ingredients, these should also, ideally, be avoided during the trial.
Step 4: Decide upon a feeding duration.
For those with gastrointestinal reactions, a 2-week trial is usually sufficient, given that most signs will resolve in 7–10 days. For
patients with dermatological signs, the trial period should last for 6–10 weeks (Rosser, 1993). A positive response occurs when
clinical signs have diminished by the end of the trial period.
Should clinical signs remain, this could indicate another cause (e.g. a disease that is not of dietary origin), a possible reaction
to one of the ingredients chosen for the trial or insufficient time on the trial diet. Some patients may require over 12 weeks
whereas others will respond in just 3 weeks.
Step 5: Re-challenge for the first time.
Once the pet has completed the full trial for the specified duration, they should be re-challenged with their original diet and
observed closely for returning clinical signs. A return of signs within 2 weeks would be indicative of a reaction to one or more
of the ingredients within the original food (Jeffers et al., 1991). Identification of specific ingredients is now required.
NB: Many pet owners will be unwilling to re-challenge their pet (or undertake secondary re-challenge) for fear of the
clinical signs returning. In such cases, feeding the trial diet long-term can be considered; this can be undertaken, provided that
the trial diet selected was complete and balanced.
Step 6: Return to the trial diet.
The pet should now be returned to the trial diet, and it should be fed until the clinical signs subside once again.
Step 7: Re-challenge for the second time.
The pet should now be reintroduced to one food ingredient at a time and carefully monitored for any reactions. If no reaction
is observed, another ingredient may be introduced. The return of clinical signs would indicate a reaction to the ingredient of
concern. This ingredient should be withdrawn and the process of rechallenge continued systematically until all common
ingredients have been tested.

A suitable diet for an adverse reaction to food is one that does not contain ingredients that the pet is known to react to (ideally
identified during food elimination trials). This may be a novel maintenance diet, a therapeutic diet or, where no commercially
produced diet is suitable, a home-prepared cooked diet. In this case, it is recommended that the recipe be designed, overseen
or approved by an individual with appropriate qualifications. These include:
■ Diploma from the American College of Veterinary Internal Medicine (Nutrition) (ACVIM)
■ Diploma from the European College of Veterinary Comparative Nutrition (ECVCN).
For further information see ‘Home-prepared cooked diets’.
Misconceptions about adverse reactions to food
Owners can still give treats during ■ Pet owners are highly likely to give treats as part of their normal interactions with
the diet trial their pets, so they should be advised to use part of the daily allocation of the
elimination diet as treats throughout the trial period
■ Any foods other than the trial diet must not be fed or they will invalidate the trial
and the results will not identify which food ingredients are causing a reaction
■ Some pet owners may wish to create treats from the trial diet by adding water,
rolling out, cutting into pieces and baking to form biscuit shapes. Should an
owner wish to do this, they must understand that the nutritional value of the food
used may be significantly reduced. However, if making homemade treats
increases overall compliance, this would improve the chances of achieving an
informative result from the trial
Feeding a grain-free diet will prevent ■ A strict grain-free diet is only applicable to those pets who have a proven reaction
‘food allergies’ to grains, e.g. in cases of gluten-sensitive dyskinesia (Lowrie et al., 2015)
■ There is no evidence that feeding diets containing grains causes adverse reactions
to food and, therefore, feeding a grain-free diet is unlikely to prevent them
■ Recent research has highlighted significant concerns with the feeding of some
grain-free diets and the development of cardiomyopathy in dogs, although exact
mechanisms are unclear. Therefore, with the exception of dogs and cats proven
to react to grains, it may be wise to avoid recommending grain-free diets until
further research has been conducted
■ For further information see ‘Grain-free diets’
➟
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Homemade diets are the best choice ■ If the home-prepared cooked diet was formulated and overseen by an individual
for a pet with ‘allergies’ with a suitable qualification (see section on ‘Suitable diet choices’), who ensured
that the diet was complete and balanced, it is certainly a suitable option
■ However, there are many potential pitfalls with feeding home-prepared cooked
diets, not least due to the fact that the majority have been found to be
nutritionally inadequate (Heinze et al., 2012; Larsen et al., 2012; Stockman et al.,
2013), especially when recipes from the internet, books or magazines are used or
when expert guidance has not been sought
■ Further, even if the recipe has been correctly formulated, it still relies upon the pet
owner following the recipe precisely
■ For more information see ‘Home-prepared cooked diets’

A diagnosis of an adverse reaction to food may be easily accepted by some pet owners, e.g. when there is only one pet within
the household, when the source of a single ingredient can easily be eliminated or when a simple environmental alteration can be
used to prevent access. However, when multiple ingredients are responsible for the adverse reaction, strict compliance can be
more difficult for an owner to maintain. A holistic view should be taken, which includes the pet, owner and home environment,
and owners need to be made aware of the wider implications of the recommendation. Challenges with implementing any
recommendations should be discussed, and ongoing owner support may be required. If food sharing is a frequent occurrence,
owners will need to develop strategies to minimize this or eliminate it altogether, although, provided that the new food is
complete and balanced, it should not present any problems for the other, unaffected pet(s). In a multi-pet household, a
successful plan might require the diet of all pets to be changed in order to avoid any risk of exposure for the affected animal.
Another solution for cats and small dogs on dry diets is to use a microchip-activated food bowl, meaning only the designated
pet can consume the food within it. It may be necessary to segregate larger dogs during feeding.
How to prevent a recurrence of an adverse reaction to food

Depending on the underlying cause, further reactions are prevented by good compliance with the dietary recommendation or
by prevention of further dietary indiscretions through environmental changes, e.g. securing the lid of the waste bin so it can no
longer be accessed.
Conclusion
Adverse reactions to food can occur for several reasons; effective management relies upon identification of the source of the
reaction and subsequent elimination of the ingredients of concern. Provided good compliance is maintained, provision of
optimal nutrition is central to successful management and maintenance of good health in these cases.
References
Case LP, Carey DP, Hirakawa DA and Daristotle L (2000) Canine and Feline Nutrition. Mosby, Maryland Heights
Heinze CR, Gomez FC and Freeman LM (2012) Assessment of commercial diets and recipes for home-prepared diets
Jeffers JG, Shanley KJ and Meyer EK (1991) Diagnostic testing of dogs for food hypersensitivity. Journal of the American
Veterinary Medical Association 198, 245–250
Lowrie M, Garden OA, Hadjivassiliou M et al. (2015) The clinical and serological effect of a gluten-free diet in Border Terriers
with epileptoid cramping syndrome. Journal of Veterinary Internal Medicine 29, 1564–1568
Rosser EJ (1993) Diagnosis of food allergy in dogs. Journal of the American Veterinary Medical Association 203, 259–262
Roudebush P, Guilford WG and Jackson HA (2010) Adverse reactions to food. In: Small Animal Clinical Nutrition, 5th edn, ed.
MS Hand, CD Thatcher, RL Remillard, P Roudebush and BJ Novotny, pp. 609–634. Mark Morris Institute, Topeka
Stockman J, Fascetti AJ, Kass PH and Larsen JA (2013) Evaluation of recipes of home-prepared maintenance diets for dogs.
Journal of the American Veterinary Medical Association 242, 1500–1505
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OWNER FACTSHEET
Adverse reactions to food
Introduction
What is an adverse reaction to food?

An adverse reaction to food may be due to one of the following:
■ Dietary indiscretion
■ Food intolerance
■ Food poisoning
■ Food allergy (hypersensitivity).
Adverse reactions to food may be caused by the immune system, as in cases of food allergy, or be the result of mechanisms
that do not involve the immune system. Therefore, it is incorrect to label all reactions to foods as ‘allergies’. Clinically, an
adverse reaction to food most often manifests with digestive disturbances and/or skin signs. Foods commonly associated with
a skin reaction are:
■ In dogs:
● Beef
● Dairy products
● Soya
● Wheat
■ In cats:
● Beef
● Dairy products
● Fish.
These associations largely reflect ingredients that are commonly included in diets and, as a result, they are likely to vary
between countries and pet populations.

Given that certain ingredients are responsible for the adverse reaction, altering the diet is the best way both of finding the cause
and of preventing further reactions long-term.
The best method for determining an adverse reaction to food is to conduct a food elimination trial, as shown below under
‘Essential elements’.
Although serology (blood) and saliva testing are available, they have been shown to be unreliable and, therefore, should
not be used. ➟
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Essential elements
How a food elimination trial is conducted
Step 1: Carry out a nutritional review.
Your veterinary practice will, firstly, perform a thorough review of your pet’s dietary history. This will be used to create a list of all
ingredients in your pet’s main diet and also any that have come from treats, food scraps, supplements, foods used to administer
medications and the medications themselves (especially those that come in a chewable form or that are given in capsules, which
are typically made from bovine or porcine gelatine) that your pet has encountered for at least the previous year.
Step 2: Select an appropriate diet.
This would typically be one of the following:
■ Novel – a diet comprising a carbohydrate and protein source that your pet has not consumed in the past
■ Hydrolysed – a diet containing a protein source whose molecular size has been reduced and so is less likely to cause a
reaction.
Step 3: Exclusively feed the chosen diet.
It will be necessary to comply strictly with all the instructions for feeding the selected diet, including which medications can
and cannot be given during the trial. The feeding of any additional foods will render the results of the trial inconclusive.
Step 4: Decide how long to feed the chosen diet.
For those with digestive disturbances, a 2-week trial is usually needed, given that most signs will resolve in 7–10 days. For
patients with skin signs, the trial period will typically last for 6–10 weeks.
A positive response to the trial is seen when clinical signs have diminished by the end of the trial period.
Should clinical signs remain, this could indicate another cause of the reaction. For example:
■ The presence of a disease that is not of dietary origin
■ The possibility of a reaction to one of the ingredients in the chosen trial diet
■ Insufficient time on the trial diet. Some patients may require over 12 weeks whereas others will respond in just 3 weeks.
Step 5: Re-challenge for the first time.
Once your pet has completed the full trial for the specified duration, they should be re-challenged with their original diet and
observed closely for returning clinical signs. A return of signs within 2 weeks would be an indication of a reaction to one or
more of the ingredients within the original food. Identification of specific ingredients is now required.
Step 6: Return to the trial diet.
Your pet will now be returned to the trial diet, which should be fed until the clinical signs subside once again.
Step 7: Re-challenge for the second time.
Your pet should now be reintroduced to one food ingredient at a time and carefully monitored for any reactions. If no reaction
is observed, another ingredient may be introduced. The return of any clinical signs would indicate a reaction to the ingredient
of concern. This ingredient should be withdrawn and the process of re-challenge continued systematically until all common
ingredients have been tested.

A suitable diet for an adverse reaction to food is one that does not contain ingredients that your pet is known to react to (ideally
identified during a food elimination trial). This may be a novel maintenance diet, a therapeutic diet or, where no commercially
produced diet is suitable, a home-prepared cooked diet. In this case, it is recommended that the recipe be designed, overseen
or approved by an individual with appropriate qualifications. These include:
■ Diploma from the American College of Veterinary Internal Medicine (Nutrition) (ACVIM)
■ Diploma from the European College of Veterinary Comparative Nutrition (ECVCN).

Considerations when your pet has an adverse reaction to food
For some, a diagnosis of an adverse reaction to food may be easy to accommodate, e.g. when there is only one pet within your
household, when the source of a single ingredient can easily be eliminated or when a simple environmental alteration can be
used to prevent access to foods that cause a reaction. However, when multiple ingredients are responsible for the adverse
reaction and your pet lives in a house with other animals, it can be challenging to follow strictly all necessary advice.
For example, if food sharing is a frequent occurrence between your pets, you will need to develop strategies to minimize
this or eliminate it altogether. For cats and small dogs on dry diets, a successful plan might be to use a microchip-activated
food bowl, meaning only the designated pet can consume the food within it. For larger dogs, it may be necessary to separate
them during feeding. Finally, if these interventions are not possible, it may be necessary to change the diets of all your pets in
order to avoid any risk of exposure for the affected pet.
➟
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How to prevent a recurrence of an adverse reaction to food

Depending on the underlying cause, further reactions are prevented by good compliance with the dietary recommendation or
by prevention of further dietary indiscretions through environmental changes, e.g. securing the lid of the waste bin so it can no
longer be accessed.
Misconceptions about adverse reactions to food

Pets can still have treats during the diet trial ■ Although giving treats is likely to be part of the normal way you interact
with your pet, any additional foods will invalidate the trial
■ It may be possible to create treats from the trial diet by adding water,
rolling out, cutting into pieces and baking to form biscuit shapes.
Caution: The nutritional value of any food made into treats in this way
will be significantly reduced, so quantities should be kept to a
minimum in order not to unbalance your pet’s diet
Feeding a grain-free diet will prevent ‘food ■ A strict grain-free diet is only required for those pets who have a proven
allergies’ reaction to grains, e.g. in cases of gluten-sensitive dyskinesia
■ There is no evidence that feeding diets containing grains causes adverse
reactions to food and, therefore, feeding a grain-free diet is unlikely to
prevent them from occurring
■ Recent research has highlighted significant concerns with the feeding of
some grain-free diets and the development of cardiomyopathy in dogs,
although exact mechanisms are unclear. Therefore, with the exception of
dogs and cats proven to react to grains, it may be wise to avoid feeding a
grain-free diet until further research has been conducted
Homemade diets are the best choice for a pet ■ If the home-prepared cooked diet was formulated and overseen by an
with ‘allergies’ individual with a suitable qualification (see section on ‘Suitable diet
choices’ for further information), who ensured that the diet was
complete and balanced, it is certainly a suitable option
■ However, there are many potential pitfalls with feeding home-prepared
cooked diets, not least due to the fact that the majority have been found
to be nutritionally inadequate, especially when recipes from the internet,
books and magazines are used or when expert guidance has not been
sought
■ Further, even if the recipe has been correctly formulated, its suitability
still relies upon the recipe being followed precisely
Conclusion
Adverse reactions to food can occur for several reasons. Management of your pet’s condition relies upon firstly the
identification of the source of the reaction and then elimination of the ingredients of concern. Provided strict compliance with
the diet plan is maintained, this can eliminate the signs of reaction and maintain good health for your pet.
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Obesity care
Nutrition is the cornerstone of good health and wellbeing for pets. Through decades of
innovation, research and development there are now many excellent diets to feed animals that
we can rely upon to be safe, and which will deliver everything the pet needs in optimal quantities.
For healthy pets, the aim is to maintain good health and deliver a long life of excellent
quality. However, during times of illness or disease we recognize that nutritional requirements
change, and in more recent years the development of disease-specific therapeutic diets has
significantly increased. Therapeutic diets not only deliver all basic nutritional requirements but,
through adaptations, can improve or eradicate clinical signs of disease, promote recovery from
illness or injury and, in certain cases, can prolong life expectancy.
To deliver optimal nutrition for each disease state an understanding of aetiology and
pathology is required. This, in conjunction with selection of an appropriate diet and methods
for medical management, is vital for achieving a desirable outcome. The impact of optimal
nutrition in the face of illness or injury should not be underestimated and, as veterinary
professionals, we have an obligation to provide a suitable nutritional recommendation as a
central part of providing excellent veterinary care to our patients.
What is pet obesity?

Obesity is defined as ‘a disease in which adipose (fat) tissue has been accumulated, to the point that health can be adversely
affected’ (Kopelman et al., 2000). Pet obesity is formally recognized as a chronic and incurable disease, which is prevalent in
the UK. In recent surveys, 65% of dogs (German et al., 2018) and 39% of cats (Courcier et al., 2010) were estimated to be either
overweight or to have obesity. In dogs, 37% were found to be above their ideal weight during the first 2 years of life (German et
al., 2018). This trend is likely to increase further in the coming years unless steps are taken to manage obesity effectively and
prevent it from occurring wherever possible.
Obesity is an insidious disease, and no specific group is protected from the risks. Obesity develops when there is a
prolonged imbalance between energy consumed and energy used. However, the causes of such imbalances are multiple,
complex and interconnecting, making obesity a particularly challenging disease to manage.
When a pet consumes more energy than they require, via the calories obtained from the foods they eat, a positive energy
state develops, with most of the excess energy being stored in white adipose tissue. Initially, the process can be considered as
‘physiological’ (i.e. storing excess energy for future use) but continued expansion initiates pathological processes, such as
adipose tissue hypoxia, provoking abnormal release of chemical mediators (so-called ‘adipokines’). Fat can also be deposited in
other organs, triggering dysregulation of metabolic, hormonal and inflammatory processes. This dysregulation is one of the
mechanisms by which the adverse health consequences of obesity can arise (see below).
Once obesity has developed, the only way for the process to be reversed is with caloric energy restriction, often coupled
with increasing physical activity (German et al., 2007). Successful weight loss can take a prolonged period of time and may be
challenging for the owner. Furthermore, even if the desired amount of weight is lost (a significant achievement), many of the
effects of obesity remain lifelong. Maintaining weight loss can be a further challenge as maintenance energy requirements,
after weight loss, are less than they were before (German et al., 2012a). Therefore, whilst obesity can often be managed it can,
arguably, never be cured, with some form of control likely being required for the rest of the pet’s life to prevent weight regain
(see below).
Health consequences may arise through two means: mechanical and chemical. Mechanical impacts are either the result of
local deposition of adipose tissue (e.g. respiratory compromise) or having an increased body mass (e.g. increased joint loading).
Chemical mechanisms result from the production of adipokines and other chemical substances that are responsible for
increased inflammation, insulin resistance and impaired immune function (German et al., 2010). As a result, many adverse
health effects may arise including:
■ Orthopaedic disease (e.g. osteoarthritis)
■ Metabolic disorders (e.g. diabetes mellitus) ➟
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BSAVA GUIDE TO NUTRITION Obesity care
■ Respiratory diseases (e.g. asthma in cats, brachycephalic airway syndrome and tracheal collapse in dogs)
■ Urinary tract disease
■ Increased risk of:
● Cancer
● Surgical complications
● Anaesthetic complications.
■ Poor skin and coat condition.

In dogs, obesity is associated with a shorter median lifespan, varying from 6 months to >2 years, depending on the breed
(Salt et al., 2018). Furthermore, both dogs and cats with obesity have a poorer quality of life, which can be alleviated with
successful weight loss (German et al., 2012b; Flanagan et al., 2017; 2018).
Diagnosis
Obesity is diagnosed by weighing and body condition scoring (BCS). Weighing alone is not enough; scales do not adequately
indicate body composition, nor does comparing weight against a breed standard, as individual variation can be vast and there
are no standards for mixed breed dogs. Therefore, it is necessary to also conduct a BCS assessment. This can be easily
incorporated into a routine physical examination and provides a semi-quantitative measure of adiposity. Although many
systems exist, the World Small Animal Veterinary Association (WSAVA) recommends use of the 9-point BCS system (Freeman et
al., 2011). One limitation of this system is that some animals can have marked obesity (>40% above ideal weight) and this
exceeds the body shape indicated by the maximum score (9/9). It can be difficult to determine the ideal weight in such patients
and other methods are needed (e.g. using historical weight recordings in the animal’s medical notes).

Appropriate nutritional management is essential for SAFE weight reduction, with the key components of a therapeutic diet being:
■ Complete and balanced: The diet must deliver all essential nutrients to the pet in the correct quantities throughout the
weight loss period and beyond. Therapeutic diets that have been formulated for weight management have greater
amounts of essential nutrients relative to their energy content, ensuring that all needs are met even in the face of caloric
restriction. It is inadvisable to use a diet that has not been formulated for use during controlled weight reduction
■ Energy restriction: Energy restriction is required to facilitate weight loss by creating a negative energy balance. Different
strategies should be considered depending on the degree of obesity:
● Should the pet have a BCS of <6/9 representing <10% above its optimal weight, short-term weight loss can be
attempted using a low-energy (e.g. light) maintenance diet (Keller et al., 2020). However, food intake can only safely
be restricted to ~80% of maintenance requirements. If no weight loss is observed when using such a food, a
specifically formulated therapeutic weight reduction diet is needed
● Should the pet have a BCS of >7/9 (i.e. ≥20% above ideal weight), therapeutic diets formulated for weight loss are
recommended. These diets have an increased essential nutrient content relative to energy, enabling weight loss
without the risk of malnutrition.
■ Generating satiety: Satiety can be achieved by feeding diets with an increased protein and fibre content (Weber et al.,
2007; Bissot et al., 2010) and, if using a dry food, altering the shape of the kibble (Sagols et al., 2019):
● Increased fibre: Increased levels of fibre in the diet increases gastric volume and delay gastric emptying. Both
improve feelings of fullness and help to reduce food-seeking behaviours

● Increased protein: In dogs, increased dietary protein improves satiety, decreasing voluntary food intake with no loss
of palatability. However, in cats, increased dietary protein actually increases food intake
● Kibble shape: Changing the shape of a kibble can affect the amount of chewing that is required and improve satiety;
the effect is a decrease in voluntary food intake.

■ Method of feeding: The use of slow feeder bowls or interactive feeding toys both increase meal duration improving
satiety
■ Treat management:
● Cessation of all other high calorie carrying food products including:
− Treats – pre-packaged or homemade

− Rewards (e.g. training treats)
− Human foods and drinks (e.g. milk, tea, scraps, leftovers)
− Dental chews or anything given for teeth cleaning. Brushing with an appropriate toothbrush and pet-friendly
toothpaste should be encouraged instead
− Rawhide chews
− Cooked or uncooked animal bones.
● Suitable replacements: Given how important offering treats as a form of affection is, most owners will not accept the
complete cessation of such behaviour. Alternatives should, therefore, be proposed. Examples of a good treat option
include:
− Reserving part of the daily allowance of dry food
− Courgette (can be offered to cats and dogs)
− Broccoli
− Cauliflower
− Green beans ➟
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−Sprouts
−Watermelon
− Cucumber.
■ Wet and dry food options: To allow a pet’s preferences and routines to be met
■ Palatable: Pets must want to consume the food offered. Palatability is vital for overall success
■ Easy to obtain: Not all pet owners can travel to the veterinary practice every few weeks to obtain food, especially if large
bags are desired or the owner does not have their own means of transport. Nor can all pet owners order food online.
The dietary recommendation must be easily obtainable for the pet owner in the long-term.
NB. The term ‘begging’ has negative associations and refers to the actions of humans; ‘food seeking behaviours’ is the
preferred term for behaviours displayed by dogs and cats.
Essential elements
In addition to the dietary alterations described above, other aspects are required to maximize the chances of success of the
obesity care plan.
Routine monitoring and recording of weight and body condition score for all patients
Weighing and performing a BCS assessment (every pet at every point of contact) and recording the results in healthcare
records is a critical strategy for obesity prevention. In this way, changes to bodyweight and BCS can be identified early, enabling
corrective measures to be implemented.
System of referral for patients with obesity

Through regular weighing and BCS, many patients with obesity will be diagnosed (not least given the current prevalence). The
practice will need to have a system in place to deal efficiently with such cases. Ideally, one or two staff members (often
veterinary nurses) should take responsibility for providing obesity care. Therefore, when a patient with obesity is identified, the
practice should have a system for internally referring them to those responsible.
Diet choices
Suitable diets
■ Commercially-produced therapeutic diets specifically formulated for weight management (see above).
■ Home-prepared cooked diets for weight loss might be suitable, but only if the recipe is designed and overseen by a
suitably qualified individual and the appropriate supplements used. For further information see ‘Home-prepared cooked
diets’.
Unsuitable diets
■ Any diet that has not been formulated to be complete and balanced when fed for a prolonged period of time for
controlled weight reduction (e.g. a diet formulated to meet maintenance requirements only).
■ Any diet containing uncooked ingredients that has not been formulated and overseen by an individual qualified to do so.
For further information see ‘Raw diets’.
Align to the pet’s preferences and owner routines

It is best never to change more than is necessary to make progress in a particular case. For this reason, it is best to choose a
diet type (wet, dry or a combination) that suits the preferences of the pet.

Obesity care for senior pets or those with concurrent disease
Obesity care plans should still be considered in pets that are older and/or those with comorbidities. The goals set in these cases
should be tailored to the likely benefits to health; for example, a more modest weight loss target might be chosen, not least
since measurable improvements in mobility and quality of life can be seen after only a small amount of weight loss (Marshall et
al., 2010; Flanagan et al., 2017; 2018).
Examples of tailoring for specific conditions and age

The majority (~83%) of the body tissue that is lost during the weight reduction process is fat, although some lean tissue is also
lost, with the amount increasing as percentage weight loss increases (German, 2016). Excessive lean tissue loss is undesirable,
not least in senior patients and those with comorbidities since outcomes can be adversely affected. More modest weight loss
targets therefore should be set in these cases, and patients should be monitored closely throughout the process.
Chronic kidney disease
The severity of chronic kidney disease (CKD) can be categorized with the International Renal Interest Society (IRIS) staging
system. Weight loss is safe in cats and dogs with IRIS stage 1 or 2 CKD (provided that serum phosphate is <1.5 mmol/l), although
a maximum of 10–15% loss is usually recommended, since greater amounts of weight loss might lead to excessive lean tissue
loss. A therapeutic weight loss diet can be safely used for weight reduction in such cases, but a different diet (e.g. senior diet or
therapeutic low phosphorus diet) should be considered for maintenance. For further information see ‘Chronic kidney disease’.

➟
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Senior age
For dogs and cats with obesity who are in the senior life stage, a weight reduction of 10–15% should be sufficient for quality of
life and mobility improvements, without negative consequences (e.g. excessive lean tissue loss).
Orthopaedic disease
In these cases, improved mobility is always desirable. Measurable improvements may be demonstrated after just 6–9% weight
loss (Marshall et al., 2010).
Avoiding regain after successful weight reduction

After the animal has reached its target weight, the following approach can be used for transitioning to the maintenance phase:
1. Initially increase food intake by a small amount (e.g. ~5%) and reweigh the animal after 2 weeks.
2. If there is further weight loss at the first follow-up visit, increase food intake by ~5% and reweigh after a further 2 weeks.
3. If weight has been regained at the first follow-up visit, decrease food intake by half the amount it was increased by
originally (~2.5%), and reweigh after a further 2 weeks.
4. Repeat the process of adjustments (e.g. further small increases or decreases) and fortnightly weight checks until weight
is stable.
5. Continue to reweigh regularly but gradually increase the interval between the checks (e.g. 4-weekly, 8-weekly and then
3-monthly) provided that weight continues to remain stable.
6. Thereafter, continue to weigh the animal regularly at least every 6 months, but more regularly if possible.
Studies have suggested that approximately half of dogs and cats with obesity that successfully lose weight will subsequently
regain some of this weight (German et al., 2012a; Deagle et al., 2014). The odds of such weight regain is associated with the
type of food chosen for the weight maintenance phase. Compared with switching to a different food (e.g. a standard or even
‘light’ maintenance diet), weight regain is less likely to occur if the therapeutic food chosen for weight reduction is continued,
albeit fed to meet maintenance energy requirements (German et al., 2012a). The only circumstances when switching diets is
recommended for following weight loss is when a different therapeutic diet is required; for example, if the dog or cat has CKD
a low phosphorous diet would be indicated.
Myths and truths

Myth Truth
Pet obesity is all the owner’s fault ■ Obesity is a complex disease and, although owners have some control over what their
pet eats and how much they exercise, there are many other factors outside of their
control (e.g. genetic and environmental influences). Given the multitude of (often
overlapping) factors, it is both wrong and unhelpful to blame the owner for the
development of obesity in their pet
Pets with obesity can be healthy ■ Although pets with obesity may appear to be fit and healthy, particularly from an
owner’s point of view, they will still be at greater risk of many of the associated
diseases and complications. Since the health consequences can take time to develop,
the absence of concurrent problems can be used as an incentive to act and maintain
health
Obesity can be managed through ■ Increasing physical activity alone is ineffective as a weight loss strategy (Chapman et
exercise alone al., 2019), and owners who attempt to achieve weight loss in their pet simply by
increasing exercise are rarely successful. Therefore, dietary management should
always be used, and this can be successful even in patients with limited mobility.
Nonetheless, whenever feasible, adding physical activity to the plan is recommended
because this can help to preserve lean tissue (Vitger et al., 2016)

Many veterinary professionals struggle communicating with owners about obesity due to concerns about causing offence.
However, it is important to have such conversations because of the potential for obesity care to improve the pet’s quality of life.
Strategies that can facilitate obesity conversations include:
■ Weighing and BCS EVERY patient at EVERY visit and RECORD the findings
● By routinely performing these measurements, owners will understand the reason for use and the importance of their
pet maintaining a healthy weight, without having to use terms such as ‘obesity’. Introducing regular weighing and
BCS assessments when the pet is in ideal weight, makes it easier to discuss weight subsequently.
■ Use BCS as a method of initiating a conversation about weight
● Pet owners can easily be shown how to conduct a BCS assessment on their pet and, with some guidance, may
recognize that their pet is overweight. By recognizing this for themselves they may be more likely to accept this
information.
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■ Discuss the risks of being above an ideal weight and relate them wherever possible to any other clinical concerns
● Pet owners may struggle to associate the signs they observe in their pet (e.g. mobility issues, snoring and other
respiratory signs) with obesity; convincing owners of such a link might improve the likelihood that they will accept a
weight reduction plan. Making owners aware of other possible disease risks can sometimes also be persuasive.
Any conversations about obesity should be constructive and supportive, whilst avoiding blame as this can be
counterproductive. Care should also be taken not to devalue the importance or the impact of this disease with the use of
humorous or derogatory terms with negative connotations, which might cause offence. Rarely is attempting to shock the
owner into action very well received. Finally, although the terms ‘overweight’ and ‘obese’ are the formal terminology, owners
may have negative associations with these words; therefore, the phrase ‘above ideal weight’ is preferable.
Conclusion
Pet obesity is a complex and challenging disease to manage, and lifelong care is often required for affected individuals. Tailored
obesity care plans should be used with the main priority of improving quality of life.
References
Bissot T, Servet E, Vidal S et al. (2010) Novel dietary strategies can improve the outcome of weight loss programmes in obese
client-owned cats. Journal of Feline Medicine and Surgery 12, 104–112
Chapman M, Woods GRT, Ladha C, Westgarth C and German AJ (2019) An open-label randomised clinical trial to compare the
efficacy of dietary caloric restriction and physical activity for weight loss in overweight pet dogs. Veterinary Journal 243,
65–73
Courcier EA, O’Higgins R, Mellor DJ and Yam PS (2010) Prevalence and risk factors for feline obesity in a first opinion practice in
Glasgow, Scotland. Journal of Feline Medicine and Surgery 12, 746–753
Daley A, Jolly K, Madigan C et al. (2019) A brief behavioural intervention to promote regular self-weighing to prevent weight
regain after weight loss: a RCT. Public Health Research 7, 1–66
Deagle G, Holden SL, Biourge V, Morris PJ and German A (2014) Long-term follow-up after weight management in obese cats.
Journal of Nutritional Science 3, e25; DOI: 10.1017/jns.2014.36.
Deagle G, Holden S, Biourge V, Serisier S and German A (2015) The kinetics of weight loss in obese client-owned dogs:
ESVCN-O-1. Journal of Veterinary Internal Medicine 29, 443–444
Deagle G, Holden SL, Biourge V, Queau Y and German AJ (2015) The kinetics of weight loss in obese client-owned cats. In:
BSAVA Congress Proceedings 2015 491
Donataccio MP, Vanzo A and Bosello O (2021) Obesity paradox and heart failure. Eating and Weight Disorders 26, 1697–1707
Flanagan J, Bissot T, Hours MA, Moreno B, Feugier A, German AJ (2017) Success of a weight loss plan for overweight dogs: The
results of an international weight loss study. PLoS One 12(9)
Flanagan J, Bissot T, Hours MA, Moreno B and German AJ (2018) An international multi-centre cohort study of weight loss in
overweight cats: Differences in outcome in different geographical locations. PLoS One 13(7)
Foster GD, Wadden TA, Makris AP et al. (2003) Primary care physicians’ attitudes about obesity and its treatment. Obesity
Research 11, 1168–1177
Freeman L, Becvarova I, Cave N et al. (2011) WSAVA nutritional assessment guidelines. Compendium. Continuing Education for
the Veterinarian 33, 1–12
German AJ (2006) The growing problem of obesity in dogs and cats. Journal of Nutrition 136(7), 1940S–1946S
German AJ (2016) Weight management in obese pets: The tailoring concept and how it can improve results. Acta Veterinaria
Scandinavica 58, 3–9
German AJ, Holden SL, Bissot T, Hackett RM and Biourge V (2007) Dietary energy restriction and successful weight loss in
obese client-owned dogs. Journal of Veterinary Internal Medicine 21, 1174–1180
German AJ, Ryan VH, German AC, Wood IS and Trayhurn P (2010) Obesity, its associated disorders and the role of inflammatory
adipokines in companion animals. Veterinary Journal 185, 4–9
German AJ, Holden SL, Mason SL et al. (2011) Imprecision when using measuring cups to weigh out extruded dry kibbled food.
Journal of Animal Physiology and Animal Nutrition (Berlin) 95, 368–373
German AJ, Holden SL, Morris PJ and Biourge V (2012a) Long-term follow-up after weight management in obese dogs: The
role of diet in preventing regain. Veterinary Journal 192, 65–70
German AJ, Holden SL, Wiseman-Orr ML et al. (2012b) Quality of life is reduced in obese dogs but improves after successful
weight loss. Veterinary Journal 192, 428–434
German AJ, Woods GRT, Holden SL, Brennan L and Burke C (2018) Dangerous trends in pet obesity. Veterinary Record 182,
25–25
Gravina G, Ferrari F and Nebbiai G (2021) The obesity paradox and diabetes. Eating and Weight Disorders 26, 1057–1068
Keller E, Sagols E, Flanagan J, Biourge V and German AJ (2020) Use of reduced-energy content maintenance diets for modest
weight reduction in overweight cats and dogs. Research in Veterinary Science 131, 194–205
Kopelman PG (2000) Obesity as a medical problem. Nature 404, 635–643
Marshall WG, Hazewinkel HAW, Mullen D et al. (2010) The effect of weight loss on lameness in obese dogs with osteoarthritis.
Veterinary Research Communications 34, 241–253
Martinez-Tapia C, Diot T, Oubaya N et al. (2021) The obesity paradox for mid- and long-term mortality in older cancer patients:
a prospective multicenter cohort study. American Journal of Clinical Nutrition 113, 129–141
Pearl RL, Wadden TA, Bach C, Leonard SM and Michel KE (2020) Who’s a good boy? Effects of dog and owner body weight on
veterinarian perceptions and treatment recommendations. International Journal of Obesity 44, 2455–2464
Sagols E, Hours MA, Daniel I et al. (2019) Comparison of the effects of different kibble shape on voluntary food intake and
palatability of weight loss diets in pet dogs. Research in Veterinary Science 124, 375–382
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Salt C, Morris PJ, Wilson D, Lund EM and German AJ (2018) Association between lifespan and canine body condition: an
epidemiological study in neutered client-owned dogs. Journal of Veterinary Internal Medicine 33, 89-99
Slupe JL, Freeman LM and Rush JE (2008) Association of body weight and body condition with survival in dogs with heart
failure. Journal of Veterinary Internal Medicine 22, 561–565
Thorne CJ (1982) Feeding behaviour in the cat – recent advances. Journal of Small Animal Practice 23, 555–562
Vitger AD, Stallknecht BM, Nielsen DH and Bjornvad CR (2016) Integration of a physical training program in a weight loss plan
for overweight pet dogs. Journal of the American Veterinary Medical Association 248, 174–182
Weber M, Bissot T, Servet E et al. (2007) A high-protein, high-fiber diet designed for weight loss improves satiety in dogs.
Journal of Veterinary Internal Medicine 21, 1203–1208
Useful websites
International Renal Interest Society (IRIS)
IRIS staging (www.iris-kidney.com)
WSAVA body condition scoring resource
https://wsava.org/wp-content/uploads/2020/08/Body-Condition-Score-cat-updated-August-2020.pdf
https://wsava.org/wp-content/uploads/2020/01/Body-Condition-Score-Dog.pdf
Last updated
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OWNER FACTSHEET
Obesity care
Introduction
Nutrition is the cornerstone of good health and wellbeing for pets. Through decades of innovation, research and development
there are now many excellent diets to feed animals that we can rely upon to be safe, and which will deliver everything the pet
needs in ideal quantities.
For healthy pets, the aim is to maintain good health and deliver a long life of excellent quality. However, during times of
illness or disease we recognize that nutritional requirements change, and in more recent years the development of disease-
specific therapeutic diets (a diet that has been formulated to support a specific disease) has significantly increased. Therapeutic
diets not only deliver all basic nutritional requirements but, through adaptations, can improve or eradicate clinical signs of
disease, promote recovery from illness or injury and, in certain cases, can prolong life expectancy.
What is pet obesity?

Obesity is defined as ‘a disease in which adipose (fat) tissue has been accumulated, to the point that health can be adversely
affected’. Pet obesity is formally recognized as a chronic and incurable disease, which is prevalent in the UK. In recent surveys,
65% of dogs and 39% of cats were estimated to be either overweight or to have obesity.
Obesity is an insidious disease, and no specific group is protected from the risks. Obesity develops when there is a prolonged
imbalance between the energy your pet consumes and the amount of energy they use each day. However, the causes of such
imbalances are multiple, complex and interconnecting, making obesity a particularly challenging disease to manage.
When your pet consumes more energy than they require, via the calories obtained from the foods they eat, a positive
energy state develops, with most of the excess energy being stored in the fat tissue. Initially, the process can be considered
‘physiological’ (i.e. storing excess energy for future use) but continued expansion initiates pathological processes, which
ultimately lead to the adverse health consequences associated with obesity (see below).
Once obesity has developed, the only way for the process to be reversed is with calorie restriction, often coupled with
increasing physical activity. Successful weight loss can take a prolonged period of time and may be immensely challenging.
Maintaining weight loss can be a further challenge as day-to-day energy requirements are less after weight loss than they were
before. Therefore, whilst obesity can often be managed it can, arguably, never be cured, with some form of control likely being
required for the rest of your pet’s life to prevent weight regain (see below).
Health consequences may arise through two mechanisms: mechanical and chemical. Mechanical impacts are either the
result of local deposition of fat tissue (e.g. respiratory compromise) or of having an increased body mass, which adds weight and
bulk to skeletal structures that have not been created to support it. Fat tissue is not an inert substance but an active endocrine
tissue, releasing hormones known as adipokines, which are detrimental to your pet. The chemical impacts that adipokines are
responsible for include increased inflammation, insulin resistance and impaired immune function. As a result, many adverse
health effects may arise including:
■ Orthopaedic disease (e.g. osteoarthritis)
■ Metabolic disorders (e.g. diabetes mellitus in cats)
■ Respiratory disease (e.g. asthma in cats, brachycephalic airway syndrome and tracheal collapse in dogs)
■ Urinary tract disease
■ Increased risk of:
● Cancer
● Surgical complications
● Anaesthetic complications.
■ Poor skin and coat

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In dogs, obesity is associated with a shorter median lifespan, varying from 6 months to >2 years, depending on the breed.
Furthermore, both dogs and cats with obesity have a poorer quality of life, which can be alleviated with successful weight loss.
Obesity assessment
Obesity is assessed by weighing and body condition scoring (BCS). Weighing alone is not enough; scales do not adequately
indicate body composition, nor does comparing weight against a breed standard, as individual variation can be vast and there
are no standards for mixed breed dogs. Therefore, it is necessary to also conduct a BCS assessment. The assessment uses a
9-point BCS system. A score of between 1 and 3 = under ideal weight; between 4 and 5 = ideal weight; and between 7 and 9 =
over ideal weight.

Appropriate nutritional management is essential for SAFE weight reduction, with the key components of a therapeutic diet being:
■ Complete and balanced: The diet must deliver all essential nutrients to your pet in the correct quantities throughout the
weight loss period and beyond. Therapeutic diets that have been formulated for weight management have greater
amounts of essential nutrients relative to their energy content, ensuring that all needs are met even in the face of caloric
restriction. It is inadvisable to use a diet that has not been formulated for use during controlled weight reduction
■ Energy restriction: Energy restriction is required to facilitate weight loss by creating a negative energy balance. Different
strategies should be considered depending on the degree of obesity:
● Should your pet have a BCS of <6/9 representing <10% above its ideal weight, short-term weight loss can be
attempted using a low-energy (e.g. light) maintenance diet. However, food intake can only safely be restricted to
~80% of maintenance requirements. If no weight loss is observed when using such a food, a specifically formulated
therapeutic weight reduction diet is needed
● Should your pet have a BCS of >7/9 (i.e. ≥20% above ideal weight), therapeutic diets formulated for weight loss are
recommended. These diets have an increased essential nutrient content relative to energy, enabling weight loss
without the risk of malnutrition.
■ Generating satiety: Satiety can be achieved by feeding diets with an increased protein and fibre content and, if using a
dry food, altering the shape of the kibble:
● Increased fibre: Increased levels of fibre in the diet increases gastric volume and delays gastric emptying. Both
improve feelings of fullness and help to reduce food-seeking behaviours

● Increased protein: In dogs, increased dietary protein improves satiety, decreasing voluntary food intake with no loss
of palatability. However, in cats, increased dietary protein actually increases food intake
● Kibble shape: Changing the shape of a kibble can affect the amount of chewing that is required and improve satiety;
the effect is a decrease in voluntary food intake.

■ Method of feeding: The use of slow feeder bowls or interactive feeding toys both increase meal duration improving satiety
■ Treat management:
● Cessation of all other high calorie food products including:
− Treats – pre-packaged or homemade

− Rewards (e.g. training treats)
− Human foods and drinks (e.g. milk, tea, scraps, leftovers)
− Dental chews or anything given for teeth cleaning. Brushing with an appropriate toothbrush and pet-friendly
toothpaste should be undertaken instead
− Rawhide chews
− Cooked or uncooked animal bones.
● Suitable replacements: Examples of good treat options include:
− Reserving part of the daily allowance of dry food

− Courgette (can be offered to cats and dogs)
− Broccoli
− Cauliflower
− Green beans
− Sprouts
− Watermelon
− Cucumber.
■ Wet and dry food options: To allow your pet’s preferences and routines to be met
■ Palatable: Your pet must want to consume the food offered. Palatability is vital for overall success.
Essential elements
In addition to the dietary alterations described above, other aspects are required to maximize the chances of success of the
obesity care plan.
Routine monitoring and recording of weight and body condition score for all patients
At every point of contact, your pet will be weighed and a BCS assessment performed. The results will then be recorded on their
healthcare records. In this way, changes to bodyweight and BCS can be identified early, enabling corrective measures to be
implemented.
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Diet choices
Suitable diets
■ Commercially-produced therapeutic diets specifically formulated for weight management (see above).
■ Home-prepared cooked diets for weight loss might be suitable, but only if the recipe is designed and overseen by a
suitably qualified individual and the appropriate supplements used. For further information see BSAVA Guide to Nutrition
– Home-prepared cooked diets factsheet.
Unsuitable diets
■ Any diet that has not been formulated to be complete and balanced when fed for a prolonged period of time for
controlled weight reduction (e.g. a diet formulated to meet maintenance requirements only).
■ Any diet containing uncooked ingredients that has not been formulated and overseen by an individual qualified to do so.
For further information see BSAVA Guide to Nutrition – Raw diets factsheet.
Myths and truths

Myth Truth
Pet obesity is all the owner’s fault ■ Obesity is a complex disease with many contributory factors. Although we
acknowledge that as owners you may have some, but rarely, complete control over
what your pet eats, this is not the only factor that must be considered. As there are
many complex, interconnecting causes that may be contributing to obesity of your
pet, it cannot be the fault of one element or person and nor is it helpful to apportion
blame
Pets with obesity can be healthy ■ Although pets with obesity may appear to be fit and healthy, they will still be at
greater risk of many of the associated diseases and complications. Since the health
consequences can take time to develop, medical problems can arise even if you, as
the owner, are not aware of them
Obesity can be managed through ■ Increasing physical activity alone is ineffective as a weight loss strategy, and some
exercise alone form of nutritional management is usually required for success. Nutritional
management can be successful even in patients with limited mobility. Nonetheless,
whenever feasible, adding physical activity to the plan is recommended to help
preserve muscle mass. For further information see BSAVA Guide to Nutrition –
Restricted activity factsheet
Conclusion
Pet obesity is a complex and challenging disease to manage, and lifelong care if often required for affected individuals. Tailored
obesity care plans should be used with the main priority of improving quality of life.
Last updated
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Restricted activity
Nutrition is the cornerstone of good health and wellbeing for pets. Through decades of
innovation, research and development there are now many excellent diets to feed animals that
we can rely upon to be safe, and which will deliver everything the pet needs in optimal quantities.
For healthy pets, the aim is to maintain good health and deliver a long life of excellent
quality. However, during times of illness or disease we recognize that nutritional requirements
change and, in more recent years, the development of disease-specific therapeutic diets has
significantly increased. Therapeutic diets not only deliver all basic nutritional requirements but,
through adaptations, can improve or eradicate clinical signs of disease, promote recovery from
illness or injury and, in certain cases, can prolong life expectancy.
To deliver optimal nutrition for each disease state, an understanding of aetiology and
pathology is required. This, in conjunction with selection of an appropriate diet and methods
for medical management, is vital for achieving a desirable outcome. The impact of optimal
nutrition in the face of illness or injury should not be underestimated and, as veterinary
professionals, we have an obligation to provide a suitable nutritional recommendation as a
central part of providing excellent veterinary care to our patients.
What is restricted activity?

Restricted activity may be pet-led (e.g. due to ageing), or prescribed by a veterinary professional to allow for recovery from
injury or surgery, or management of a long-term disease. Restricted activity can be instigated for a short period of time (i.e. just
a few days or weeks) or be much longer in duration (e.g. for ongoing orthopaedic concerns). No matter what the motivation
for restriction or the duration of restriction, nutritional adjustments should be considered.
The maintenance energy requirement (MER) is the amount of energy the pet requires each day to perform all their usual
daily activities whilst keeping their weight stable. In the presence of disease or injury, additional energy is often required for
healing and recovery. However, during these times the activity level of pets is often restricted meaning that the energy
expended on daily activities is reduced. These factors do not cancel each other out as the additional energy required for
healing and recovery is, in most cases, minor. The reduction in normal activity affects the energy requirement, reducing it more
profoundly.
Due to the changes in energy requirement during activity restriction, if no dietary alterations are made, there may be
disruption to the energy balance (energy intake versus expenditure). When a pet consumes more energy than they require, they
enter a positive energy state. This positive energy state results in the pet storing surplus energy in adipose (fat) tissue. This
should be prevented at every opportunity as subsequent obesity can often be observed. Obesity is a complex, multifactorial
disease and no individual element can be singled out as it manifests where a combination of factors occurs concurrently.
Restricted exercise is one such factor and means that a pet whose activity is restricted is at greater risk of developing obesity, or
exacerbating it if already present. Obesity is known to reduce quality of life and together with other concurrent diseases can
lead to a wide range of negative effects. Focus, therefore, during periods of restricted activity should be to reduce these risks by
preventing weight gain.
Restricted activity and obesity are closely linked. For further information, see ‘Obesity care’.

Nutrition plays a key role in promoting health and preventing weight gain during times of restricted activity. Optimal nutrition
should be provided throughout the period of restricted activity, with delivery of all nutrients in the correct quantities. The
nutritional recommendation will depend of the species, age, level of restriction, expected duration of restriction and concurrent
medical problems.
The patient should be monitored carefully throughout the period of restricted activity. Completing a thorough nutritional
assessment as early as possible will highlight points of concern. Owners should also be asked to complete a food diary for their
pet during this time. These measures, together with regular weight checks, should allow good control of nutritional intake
and prevention of weight gain. ➟
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BSAVA GUIDE TO NUTRITION Restricted activity
Essential elements
Diet alterations and considerations when instigating restrictions include:
■ Short term activity restriction: 7–10 days (e.g. postoperative period following neutering)
● Care should be taken to reduce or eliminate all treats, snacks and food extras during this time
● Good quality complete and balanced diets should be fed
● The pet should be weighed following the period of restricted activity to ensure weight gain has not occurred; if it has
occurred, alterations to the diet may be needed

● All food allocations should be calculated for the pet owner to ensure the correct amounts are being fed
● All food allocations should be weighed out carefully on digital scales each day to prevent over- or underfeeding.
■ Mid-term activity restriction: 4–6 weeks (e.g. following fracture repair)

● The pet should be weighed regularly throughout this time (e.g. every 2 weeks and action quickly taken if weight
changes are observed to restabilize the weight)

● Care should be taken to eliminate all treats, snacks and food extras during this time
● Part of the daily food allowance could be used as rewards
● All food allocations should be calculated for the pet owner to ensure the correct amounts are being fed
● All food allocations should be weighed out carefully on digital scales each day to prevent over- or underfeeding
● A lower calorie diet may be used (e.g. a ‘light’ diet could be recommended to provide a small overall calorie
reduction). It is important to note that ‘light’ diets are not suitable for weight loss in most cases. For a pet up to 10%
above their optimal weight, a ‘light’ diet may be used in the short-term, but for no more than 8 weeks, as the risks of
nutritional deficiencies increase after this period (Keller et al., 2020)
● Obesity care should be initiated if required. Recovery will not be compromised provided suitable weight loss diets are
used. All specifically formulated weight loss diets should deliver complete and balanced nutrition with the only
restriction being the calorie content. For further information, see ‘Obesity care’
● Weight management diets could be selected during this time whether obesity is present or not. If the pet is prone to
obesity or if food-seeking levels are high, components within weight management diets such as expanded kibble and
high fibre promoting satiety are desirable
● Fight boredom. Often very active pets struggle when their activity is restricted and can display negative behaviours.
■ Long term activity restriction: Over 6 weeks (e.g. cases of osteoarthritis)

● Pets in this category are at high risk of developing obesity if alterations to the diet are not made
● All steps listed above for mid-term activity restriction should be followed but for a longer duration of time
● Activity within the pet’s limits should be encouraged. Additional activity can be allowed in the form of puzzle toys or
slow feeder food bowls, which increase general activity without risking injury.
Hydrotherapy as a form of non-weight bearing activity can be instigated if appropriate. Reputable providers of hydrotherapy
should be sought. Ideally, patients should be referred to a centre where the hydrotherapist is a member of the Association of
Chartered Physiotherapists in Animal Therapy (ACPAT) or centres that are members of the Canine Hydrotherapy Association
(CHA) or Institute of Canine Hydrotherapists (ICH).

Suitable diets will include:
■ Adult maintenance diets
■ ‘Light diets’ (modest caloric reduction only)
■ Weight management diets (calorie restricted)
■ Alternative diet types (e.g. home-prepared cooked diets and raw diets). For further information, see ‘Raw diets’ and
‘Home prepared-cooked diets’.

Alleviating boredom and managing food seeking behaviours
Many pets find periods of restricted activity difficult and frustrating, especially if they are used to a reliable routine of exercise.
They do not understand that activity restriction is in their long-term best interests. In addition, the use of analgesic drugs can
increase frustration further because the pet is no longer in pain and may attempt to resume normal daily activities. This
frustration can lead to undesirable behaviours (e.g. destruction and attention- or food-seeking). Owners should be advised that
there are a number of ways to help their pet during these times and alternative activities can be recommended.
Getting pets to work for their food is a great way to challenge their mental abilities, increase their general activities and help
manage some of the boredom or frustration-related behaviours.
Ways to help increase general activity

■ Split the daily food allocation into more than the usual two meals per day:
● Feeding 4–6 smaller meals per day, each in a different way, can be more satisfying for the pet
● Cats, in particular, prefer to consume food many times per day; up to 16 times per day has been reported
(Thorne, 1982).
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■ Hide the food around the home.

■ Scatter feeding in the garden, on a patio or on an easily cleanable floor (e.g. the kitchen floor).
■ Use homemade toys such as ice cube trays or toilet roll tube towers (see Figure 1).
■ Use puzzle toys and interactive feeding bowls, of which many types are commercially available (see Figure 2 and 3).
■ This is also a great opportunity for the owner to do some training with their cat or to teach their dog a new command,
reinforcing the pet–owner bond and giving the pet an outlet for any excess energy.
■ Grooming can be an enjoyable past time for a pet with restricted activity, without the need for additional foods, as can
gentle play with a favourite toy – provided this play can remain quiet and calm.
Homemade puzzle Interactive puzzle feeder. Puzzle feeder bowl.

Figure 1: Figure 2: Figure 3:
feeder. (© Georgia Woods-Lee) (© Royal Canin Weight
(© Georgia Woods-Lee) Management Clinic, University of
Liverpool, UK)

Pet owners are likely to be occupied initially with concerns regarding the reasons why their pet required a period of restricted
activity. It is important, therefore, to inform them of the consequences if dietary control is not practiced during this time. There
are many ways in which owners can help their pet and, given the right direction, are often happy to do whatever they can to
speed their pet’s recovery, promote a good outcome and return them to normal activity levels (although not in all cases), whilst
preventing weight gain and obesity.
In addition, at a time when an owner may perceive their pet to be suffering to some degree, they may be tempted to
increase treats and rewards to somehow make the pet feel better. Owners may also experience feelings of guilt associated with
reduced activity and so again provide food as a substitute. Warning that there may be temptation to do this will hopefully bring
it to the owner’s attention and prevent them overfeeding. This must be coupled with strategies for what owners can do to help
their pet throughout the restriction period (see above).
Should obesity already be present, this could be a good opportunity to discuss initiation of obesity care and weight
reduction. Especially in cases of long-term restricted activity, weight loss is shown to have a huge impact on mobility. The
improvements in mobility can be observed after just 6–9% weight loss (Marshall et al., 2010). Many pet owners may feel that
weight loss is not possible due to the low activity level. However, since weight loss relies on creating a negative energy balance
(by food restriction and/or increasing activity), although weight loss may be slower during periods of restriction, it is still
possible. For further information, see ‘Obesity care’.
Conclusion
Periods of time in a pet’s life where restricted activity is required can be challenging for the pet and owner. It is important the
pet emerges from this period of restriction without having gained additional weight or developed undesirable behaviours. Some
pets may always have some degree of activity restriction, so long-term solutions should be sought to ensure weight is
controlled. By carefully considering which foods are fed and the methods of feeding, owners can help prevent weight gain,
optimize the outcome, and support their pet throughout.
References
Keller E, Sagols E, Flanagan J, Biourge V and German AJ (2020) Use of reduced-energy content maintenance diets for modest
weight reduction in overweight cats and dogs. Research in Veterinary Science 131, 194–205
Marshall WG, Hazewinkel, Mullen D et al. (2010) The effect of weight loss on lameness in obese dogs with osteoarthritis.
Veterinary Research Communications 34, 241–253
Thorne CJ (1982) Feeding behaviour in the cat – recent advances. Journal of Small Animal Practice 23, 555–562
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Useful websites
World Small Animal Veterinary Association (WSAVA) diet history form
https://wsava.org/wp-content/uploads/2020/01/Diet-History-Form.pdf
World Small Animal Veterinary Association (WSAVA) nutrition assessment checklist
https://wsava.org/wp-content/uploads/2020/01/Nutritional-Assessment-Checklist.pdf
World Small Animal Veterinary Association (WSAVA) nutrition assessment guide
https://wsava.org/wp-content/uploads/2020/01/Implementing-the-WSAVA-Nutrition-Guidelines.pdf
Last updated
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OWNER FACTSHEET
Restricted activity
Introduction
Nutrition is the cornerstone of good health and wellbeing for pets. Through decades of innovation, research and development
there are now many excellent diets to feed animals that we can rely upon to be safe, and which will deliver everything your pet
needs in optimal quantities.
For healthy pets, the aim is to maintain good health and deliver a long life of excellent quality. However, during times of
illness or disease we recognize that nutritional requirements change and, in more recent years, the development of disease-
specific therapeutic diets has significantly increased. Therapeutic diets not only deliver all basic nutritional requirements but,
through adaptations, can improve or eradicate clinical signs of disease, promote recovery from illness or injury and, in certain
cases, can prolong life expectancy.
What is restricted activity?

Restricted activity may be pet-led (e.g. due to ageing), or prescribed by a veterinary professional to allow for recovery from
injury or surgery, or management of a long-term disease. Restricted activity can be instigated for a short period of time (i.e. just
a few days or weeks) or be much longer in duration (e.g. for ongoing orthopaedic concerns). No matter what the motivation
for restriction or the duration of restriction, nutritional adjustments should be considered.
The maintenance energy requirement (MER) is the amount of energy your pet requires each day to perform all their usual daily
activities whilst keeping their weight stable. In the presence of disease or injury, additional energy is often required for healing
and recovery. However, during these times the activity level of pets is often restricted meaning the energy expended on daily
activities is reduced. These factors do not cancel each other out as the additional energy required for healing and recovery is, in
most cases, minor. The reduction in normal activity affects the energy requirement, reducing it more profoundly.
Due to the changes in energy requirement during activity restriction, if no dietary alterations are made, there may be disruption
to the energy balance (energy intake versus expenditure). When a pet consumes more energy than they require they are placed
into a positive energy state. This positive energy state results in your pet storing surplus energy in adipose (fat) tissue. This
should be prevented at every opportunity as subsequent obesity can often be observed. Obesity is a complex, multifactorial
disease and no individual element can be singled out as it manifests where a combination of factors occurs concurrently.
Restricted exercise is one such factor and means that pets whose activity is restricted is at greater risk of developing obesity, or
exacerbating it if already present. Obesity is known to reduce the quality of life and together with other concurrent diseases
can lead to a wide range of negative effects. Focus, therefore, during periods of restricted activity should be to reduce these
risks by preventing weight gain.
For further information see BSAVA Guide to Nutrition – Obesity care factsheet.

Nutrition plays a key role in promoting health and preventing weight gain during times of restricted activity. Optimal nutrition
should be provided throughout the period of activity restriction, with delivery of all essential nutrients in the correct quantities.
The nutritional recommendation will depend on the species, age, level of restriction, expected duration of restriction and
concurrent medical problems.
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Essential elements
Diet alterations and considerations when instigating restrictions include:
■ Short term activity restriction: 7–10 days (e.g. postoperative period following neutering)
● Care should be taken to reduce or eliminate all treats, snacks and food extras during this time
● Your pet should be weighed following the period of restricted activity to ensure weight gain has not occurred; if it has
occurred, alterations to the diet may be needed

● All food allocations should be calculated to ensure the correct amounts are being fed
● All food allocations should be weighed out carefully on digital scales each day to prevent over- or under-feeding.
■ Mid-term activity restriction: 4–6 weeks (e.g. following fracture repair)

● Your pet should be weighed regularly throughout this time (e.g. every 2 weeks and action quickly taken if weight
changes are observed to restabilize the weight)

● Care should be taken to eliminate all treats, snacks and food extras during this time
● Part of the daily allowance could be used as rewards
● All food allocations should be calculated to ensure the correct amounts are being fed
● All food allocations should be weighed out carefully on digital scales each day to prevent over- or underfeeding
● A lower calorie diet may be used (e.g. a ‘light’ diet could be recommended to provide a small overall calorie
reduction). It is important to note that ‘light’ diets are not suitable for weight loss in most cases. For a pet up to 10%
above their optimal weight, a ‘light’ diet may be used in the short-term, but for no more than 8 weeks, as the risks of
nutritional deficiencies increase after this period
● Weight management diets could be selected during this time whether obesity is present or not. If your pet is prone to
obesity or if food-seeking levels are high, components within weight management diets such as expanded kibble and
high fibre promoting satiety (feeling of being full) are desirable
● Fight boredom. Often very active pets struggle when their activity is restricted and can display negative behaviours.
■ Long term activity restriction: Over 6 weeks (e.g. cases of osteoarthritis)

● Pets in this category are at high risk of developing obesity if alterations to the diet are not made
● All steps listed above for mid-term activity restriction should be followed but for a longer duration of time
● Activity within your pet’s limits should be encouraged. Additional activity can be allowed in the form of puzzle toys or
slow feeder food bowls, which increase general activity without risking injury.
Hydrotherapy as a form of non-weight bearing activity can be instigated if appropriate. Referrals to a centre where the
hydrotherapist is a member of the Association of Chartered Physiotherapists in Animal Therapy (ACPAT) or centres that are
members of the Canine Hydrotherapy Association (CHA) or Institute of Canine Hydrotherapists (ICH) can be requested from
your veterinary surgeon (veterinarian).

Suitable diets include:
■ Adult maintenance diets
■ ‘Light diets’ (modest caloric reduction only)
■ Weight management diets (calorie restricted)
■ Alternative diet types (e.g. home-prepared cooked diets and raw diets). For further information see BSAVA Guide to
Nutrition – Raw diets and Home-prepared cooked diets factsheets.

Alleviating boredom and managing food seeking behaviours
Many pets find periods of restricted activity difficult and frustrating, especially if they are used to a reliable routine of exercise.
They do not understand that activity restriction is in their long-term best interests. This frustration can lead to undesirable
behaviours (e.g. destruction and attention- or food-seeking). There are a number of ways to help your pet during these times
and alternative activities can be recommended.
Getting your pet to work for their food is a great way to challenge their mental abilities, increase their general activities and
help manage some of the boredom or frustration-related behaviours.
Ways to help increase general activity

■ Split the daily food allocation into more than the usual two meals per day:
● Feeding 4–6 smaller meals per day, each in a different way, can be more satisfying for your pet
● Cats, in particular, prefer to consume food many times per day; up to 16 times per day has been reported.
■ Hide the food around the home.

■ Scatter feeding in the garden, on a patio or on an easily cleanable floor (e.g. the kitchen floor).
■ Use homemade toys such as ice cube trays or toilet roll tube towers (see Figure 1)
■ Use puzzle toys and interactive feeding bowls, of which many types are commercially available (see Figure 2 and 3)
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■ This is also a great opportunity for training to be done with your cat or to teach your dog a new command, reenforcing
your pet-owner bonds and giving them an outlet for any excess energy.
■ Grooming can be an enjoyable past time for a pet with restricted activity, without the need for additional foods, as can
gentle play with a favourite toy – provided this play can remain quiet and calm.
Homemade puzzle Interactive puzzle feeder. Puzzle feeder bowl.

Figure 1: Figure 2: Figure 3:
feeder. (© Georgia Woods-Lee) (© Royal Canin Weight
(© Georgia Woods-Lee) Management Clinic, University of
Liverpool, UK
Conclusion
Periods of time in a pet’s life where restricted activity is required can be challenging for you and your pet. It is important your
pet emerges from this period of restriction without having gained additional weight or developed undesirable behaviours. Some
pets may always have some degree of activity restriction, so long-term solutions should be sought to ensure weight is always
controlled.
Last updated
August 2023

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Chronic kidney
disease
Chronic kidney disease is common and incurable, but nutrition can play a key role in prolonging
patients’ lives. Veterinary professionals should provide dietary guidance depending on the
severity of the disease.
What is chronic kidney disease?

Chronic kidney disease (CKD) is a common progressive disease of both dogs and cats. In both species CKD is a primary cause of
both mortality and decreased quality of life. The kidney has many vital functions, including excretion of waste products (e.g.
nitrogenous waste), homeostasis, osmoregulation, regulation of blood pressure, hormone production and acid–base balance.
Normal renal function relies upon having functional renal nephrons to filter waste products from the blood and to excrete them
via the urine. In the presence of CKD, due to loss of nephron function, the efficiency of waste excretion is increasingly reduced,
resulting in a build-up of toxic waste products and eventually leading to a uraemic syndrome that affects multiple organs (Nigam
and Bush, 2019).
The kidneys have a large functional reserve, meaning that clinical signs are evident only in the later stages of the disease
when a 75–80% loss of functional nephrons has already occurred. This highlights the need for regular screening of at-risk
patients, e.g. those in senior years, or prior to administering drugs which may affect kidney function.

There is no cure for CKD; however, through correct nutritional adaptation, life expectancy can be significantly lengthened
(Elliott et al., 2000). Therefore, nutrition is important for successful management, alongside pharmaceutical interventions and
proactive monitoring. Since the primary goal of dietary management is to reduce phosphorus intake (see section on ‘Essential
elements’), nutritional adaptation is indicated when serum phosphorus concentrations are >1.5 mmol/l (4.6 mg/dl), as
recommended by the International Renal Interest Society (IRIS) (see section on ‘Useful websites’), and when the urine
protein:creatinine ratio is increased. Other aims include decreasing nitrogenous waste products, preserving remaining nephron
function and reducing the rate of further nephron damage.
Essential elements
Phosphorus restriction
Under normal circumstances, phosphorus is excreted by the kidneys; this function is significantly impaired in the presence of CKD,
resulting in an increased serum phosphorus concentration, which is associated with many negative consequences. Given that
phosphorus and calcium homeostasis are linked, increases in serum phosphorus cause a fall in serum calcium; combined, these
effects can stimulate the parathyroid gland to produce parathyroid hormone, which initiates demineralization of bone in an
attempt to increase the serum calcium concentration. This demineralization, known as secondary renal hyperparathyroidism, can
result in brittle bones and an increased risk of fractures. The ionized calcium concentration should be monitored in these patients
as hypercalcaemia has also been observed in some cases. Moreover, persistently high serum phosphorus concentrations can lead
to further renal damage and greater impairment. For this reason, dietary phosphorus should be restricted in pets with CKD, with
the aim of maintaining the serum phosphorus concentration >0.9 mmol/l but <1.5 mmol/l. While information is not yet present on
pet food labels, less soluble forms of dietary phosphorus are preferred to more soluble forms for renal health. Where dietary
phosphorus restriction alone is not sufficient, concurrent use of phosphorus binders is recommended.
Protein restriction
Proteins consumed by the pet are broken down during utilization, producing nitrogenous waste which is subsequently
excreted by the kidneys. In the impaired kidney, this excretion is not efficient and nitrogenous waste accumulates and becomes
toxic, especially in the later stages of CKD when it exacerbates the consequences of the uraemic syndrome. Protein restriction
can limit the accumulation of nitrogenous waste but, since amino acids are essential nutrients, care must be taken to ensure
that requirements are met. This can be achieved by feeding proteins of high quality and high digestibility so all amino acid
requirements can be met from a smaller quantity of protein. Cats are a carnivore species and have a greater requirement for
protein in their diet than dogs, who are more omnivorous; the requirement is usually met by including proteins of animal origin
(Ross et al., 2006), so formulating these diets can be more challenging. Further, animal-based protein products are the
main source of phosphorus in the diets of both cats and dogs. ➟
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BSAVA GUIDE TO NUTRITION Chronic kidney disease
Increased water intake

For all pets with CKD, increasing water intake will help to maintain hydration and, therefore, should be encouraged. Ways to
increase water intake are:
■ Switch to a wet food (e.g. cans, pouches or foil trays). Wet food typically contains around 80% water, so facilitates a
greater intake than dry food, which usually contains only 8–10% water
■ Add water to food. Water can be added to either wet or dry food to increase intake
■ Ensure there are multiple water sources. Bowls should be placed on all floors of the house that the pet has access to,
so water is readily available. This is especially necessary for senior pets with CKD as they may be less willing to go up or
down stairs for water
■ Alter water delivery. Providing a running water source, e.g. a water fountain (Pachel and Neilson, 2010), and different
dish types may promote water intake, especially in some cats (Bartges, 2012). Many cats also appear to prefer to drink
from shallow ceramic or Pyrex® bowls rather than plastic bowls (as they retain a specific scent cats find unpleasant) or
deep metal bowls
■ Use hydration products. Nutritional products have recently been developed that can be added to a feeding regime to
encourage additional water intake e.g. PRO PLAN® HC HydraCare Wet Cat Food Pouch.
Monitoring water intake in these cases is frequently required as increases can be indicative of disease progression. Intake
can be monitored with the use of recent technology such as Felaqua bowls by Sure Petcare®, which are application-linked
bowls that measure the volume and frequency of water intake. The application collates the information so the pet owner can
quickly and easily observe how much their pet has drunk each day. Measuring jugs and routine recording of amounts drunk per
day can also be used to track trends over time and flag significant increases early. Where increased water intake and urine
output is noted, further testing is advised as adjustments to the ongoing therapy may be required.

At IRIS stage 1 (see Figures 1 and 2), current guidance suggests that the use of diets formulated to have a lower phosphorus
content than adult maintenance diets (e.g. therapeutic diets specifically formulated for early renal care or some senior diets
where phosphorus is mildly restricted) might have some benefit if introduced at this stage. Moreover, a recent study has
suggested moderate phosphorus restriction might provide additional benefits for the long-term management of these cases
(Hall et al., 2019). Further work in this area is ongoing.
At IRIS stage 2 and above (see Figures 1 and 2), therapeutic diets specifically formulated for CKD with restricted phosphorus
concentrations and moderate amounts of protein should be used.
For other diet types, see section on ‘Misconceptions about chronic kidney disease’.
IRIS stage 1 Blood creatinine (μmol/l) <125

Blood creatinine (mg/dl) <1.4
SDMA (μg/dl) <18
IRIS stage 2 Blood creatinine (μmol/l) 125–250

Blood creatinine (mg/dl) 1.4–2.8
SDMA (μg/dl) 18–35

Blood creatinine (mg/dl) 2.9–5
IRIS stage 4 Blood creatinine (μmol/l) >440

Blood creatinine (mg/dl) >5
>54 IRIS staging for dogs.
SDMA (μg/dl) Figure 1:
SDMA = symmetric dimethylarginine.
IRIS stage 1 Blood creatinine (μmol/l) <140

Blood creatinine (mg/dl) <1.6
SDMA (μg/dl) <18

Blood creatinine (mg/dl) 1.6–2.8

Blood creatinine (mg/dl) 2.9–5
IRIS stage 4 Blood creatinine (μmol/l) >440

Blood creatinine (mg/dl) >5
IRIS staging for cats.
SDMA (μg/dl) >38 Figure 2:
SDMA = symmetric dimethylarginine. ➟
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Potassium replacement
As pets with CKD frequently have an increased water turnover, too much potassium can be lost in the urine and, therefore, it is
advisable to replace the ongoing losses (Bartges, 2012). Hypokalaemia can result in muscle weakness, lethargy, ventral flexion
of the neck (in cats) and appetite loss. Most therapeutic diets formulated for CKD contain higher concentrations of potassium
for this purpose.
In contrast, some patients may become hyperkalaemic on renal diets and require a homemade diet formulation. This
highlights the importance of close monitoring of potassium concentrations in these cases.
Sodium moderation
Since increased dietary sodium intake may be damaging to the kidneys, excessive amounts should be avoided (Bartges et al., 1996).
Treat management
Education should be provided to pet owners that many pet foods and treats contain high levels of protein and phosphorus
because these elements increase palatability. Owners are unlikely to comply with recommendations to eradicate treats
completely because giving treats is often an important behaviour for them. After a discussion with a pet owner to assess the
needs and routines of their pet, alternative treat options should be discussed, for example green watery vegetables (such as
courgette, broccoli or cauliflower for dogs and courgette for cats – cats typically prefer courgette to be peeled and cooked
whereas dogs will eat vegetables either cooked or uncooked, depending on the individual). Additionally, consuming green
watery vegetables can increase water intake, which is desired.
Food transition
Since feeding the correct diet can increase life expectancy and quality of life for pets with CKD, helping the pet to accept the
optimal diet is essential. It is always worth taking sufficient time for a successful transition to the correct diet. The speed of the
process depends on the individual and it should never be rushed. In some cases, small amounts of a highly palatable food (e.g.
chicken) may be used to assist with a successful food transition, provided the quantity is small so as to not unbalance the diet
and that it is gradually withdrawn following completion of the transition. Examples of options for transition are as follows:
■ Pets who will readily eat anything offered: 2–3 days should be sufficient to transition food without digestive
disturbance
■ Good eaters: 4–7 days will help make transition easy by promoting good acceptance and preventing digestive
disturbance
■ Picky eaters: 10–14 days should be taken for the transition
■ Fussy eaters: 2–3 weeks or more should be taken. If necessary, pets can be transitioned by only one kibble or
teaspoonful per day, taking 1–2 months in some cases (Ross et al., 2006).
Phosphorus binders
In cases where the pet does not accept the therapeutic diet, the owner is unwilling, the transition has failed despite all efforts or
serum phosphorus concentrations remain elevated despite the use of a renal diet, phosphorus binders may be used (Bartges,
2012). These are added to the pet’s preferred food and trap the phosphorus upon ingestion. However, their overall effect is less
reliable than feeding a therapeutic diet that has been specifically formulated to be low in phosphorus.
Supplements
There is some evidence that the addition of eicosapentaenoic acids (EPAs; omega-3 fatty acids) can prolong survival times for
both dogs and cats with CKD (Brown et al., 2000; Plantinga et al., 2005). Derived from fish oils, EPAs are thought to reduce
inflammation.
Antioxidants
Oxidative stress occurs with the loss of nephrons due to CKD; therefore, there are suggestions that the addition of antioxidants
can combat free-radical production and slow the progression of the disease (Brown, 2008). However, it remains unclear which
products are most beneficial and further work, including clinical trials, is required to determine the most beneficial products,
how they function and when the best time to introduce them would be.
Misconceptions about chronic kidney disease
Adult maintenance diets can be fed if a ■ For IRIS stage 1 CKD (see Figures 1 and 2), this may be possible in the short
pet has CKD term but is not necessarily the best option; diet changes may be required
(Hall et al., 2019)
■ For IRIS stage 2 and above (see Figures 1 and 2), a diet with the above-
described alterations is recommended to avoid increasing the workload
of the kidneys and accelerating disease progression, resulting in death
more rapidly ➟

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Any diet type can be used for ■ Not all diet types are appropriate for the management of CKD. The use of, for
management of CKD example, home-prepared cooked diets and raw meat-based diets should be
considered carefully as they have been very frequently shown to be
unbalanced, with multiple nutritional deficiencies present (Larsen et al., 2012)##
■ Home-prepared cooked diets: these can be formulated with the necessary
restrictions; however, this should only ever be attempted or overseen by a
person with a suitable qualification to avoid nutritional inadequacies. Such
qualifications include:
● Diploma from the American College of Veterinary Internal Medicine
(Nutrition) (ACVIM)
● Diploma from the European College of Veterinary Comparative
Nutrition (ECVCN)
● For further information, see ‘Home-prepared cooked diets’
■ Raw meat-based diets: CKD typically requires a diet with restricted

phosphorus content, which is difficult to achieve with a raw diet
● For further information, see ‘Raw diets’
Commercially manufactured foods, ■ There is no evidence to substantiate this and the majority of cats and dogs
especially in kibble form, containing fed a manufactured diet do not acquire CKD
preservatives, can cause CKD ■ Further, cats and dogs fed on alternative diets, e.g. raw meat-based diets or
home-prepared cooked diets, still suffer from CKD. Therefore, food is
unlikely to be a causal factor for the disease
■ However, there are concerns that inorganic phosphorus salts added to
processed pet foods may be associated with increased disturbances of
calcium and phosphorus. Further work is required to determine the
significance of these findings (Dobenecker et al., 2021)#
Feeding dry foods to cats causes ■ A review of three available studies found that there was no association
dehydration, leading to renal damage between diet and CKD (Hughes et al., 2002; Lefebvre, 2013; Greene et al.,
2014; McLeonard, 2017)
■ There is no evidence yet supporting this statement and further work is
required; however, one study showed dry diets may decrease the risk of CKD
in cats (Piyarungsri and Pusoonthornthum, 2017)#
■ As in all cases of CKD, steps should be taken to ensure water intake at all times

Following a diagnosis of CKD, the pet owner is likely to be distressed and anxious about how much time they will have left with
their beloved pet. It is important that owners fully understand that, sadly, this is not a disease that can be cured but progression
can be slowed. One of the most important ways to do so is management of the diet the pet is fed. Owners have a huge role to
play and their compliance with the dietary recommendations can extend the time they will have with their pet. In most cases,
with suitable close support, pet owners are able to make the necessary changes.
Conclusion
Although CKD is a progressive incurable disease, much can be done to help prolong life. Through optimal dietary adaptations
and excellent owner compliance, this can be achieved and there are many ideal therapeutic diets available for this purpose.
References
Bartges JW (2012) Chronic kidney disease in dogs and cats. Veterinary Clinics of North America: Small Animal Practice 42,
669–692
Bartges JW, Willis AM and Polzin DJ (1996) Hypertension and renal disease. Veterinary Clinics of North America: Small Animal
Practice 26, 1331–1345
Brown SA (2008) Oxidative stress and chronic kidney disease. Veterinary Clinics of North America: Small Animal Practice 38,
157–166
Brown SA, Brown CA, Crowell WA et al. (2000) Effects of dietary polyunsaturated fatty acid supplementation in early renal
insufficiency in dogs. Journal of Laboratory and Clinical Medicine 135, 275–286
Dobenecker B, Reese S and Herbst S (2021) Effects of dietary phosphates from organic and inorganic sources on parameters of
phosphorus homeostasis in healthy adult dogs. PLoS One 16, e0246950
Elliott J, Rawlings JM, Markwell PJ and Barber PJ (2000) Survival of cats with naturally occurring chronic renal failure: Effect of
dietary management. Journal of Small Animal Practice 41, 235–242
Greene JP, Lefebvre SL, Wang M et al. (2014) Risk factors associated with the development of chronic kidney disease in cats
evaluated at primary care veterinary hospitals. Journal of the American Veterinary Medical Association 244, 320–327
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Hall JA, Fritsch DA, Jewell DE, Burris PA and Gross KL (2019) Cats with IRIS stage 1 and 2 chronic kidney disease maintain body
weight and lean muscle mass when fed food having increased caloric density, and enhanced concentrations of carnitine
and essential amino acids. Veterinary Record 184, 190
Hughes K, Slater M, Geller S, Burkholder W and Fitzgerald C (2002) Diet and lifestyle variables as risk factors for chronic renal
failure in pet cats. Preventive Veterinary Medicine 55, 1–15
Lefebvre S (2013) Clinical findings in cats and dogs with chronic kidney disease. Veterinary Focus 23, 26–27
McLeonard CA (2017) Are adult cats fed on wet maintenance diets less at risk of developing chronic kidney disease compared
to adult cats fed on dry maintenance diets? Veterinary Evidence 2. DOI: 10.18849/VE.V2I4.130
Nigam SK and Bush KT (2019) Uraemic syndrome of chronic kidney disease: altered remote sensing and signalling. Nature
Reviews Nephrology 15, 301–316
Pachel C and Neilson J (2010) Comparison of feline water consumption between still and flowing water sources: A pilot study.
Journal of Veterinary Behaviour 5, 130–133
Piyarungsri K and Pusoonthornthum R (2017) Risk and protective factors for cats with naturally occurring chronic kidney
disease. Journal of Feline Medicine and Surgery 19, 358–363
Plantinga EA, Everts H, Kastelein AMC and Beynen AC (2005) Retrospective study of the survival of cats with acquired chronic
renal insufficiency offered different commercial diets. Veterinary Record 157, 185–187
Ross SJ, Osborne CA, Kirk CA et al. (2006) Clinical evaluation of dietary modification for treatment of spontaneous chronic
kidney disease in cats. Journal of the American Veterinary Medical Association 229, 949–957
Useful websites
International Renal Interest Society (IRIS)
www.iris-kidney.com
Last updated
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OWNER FACTSHEET
Chronic kidney disease
Introduction
What is chronic kidney disease?

Chronic kidney disease (CKD) is a common progressive disease of both dogs and cats. Sadly, CKD significantly reduces quality
of life and is a primary cause of death. The kidney has many vital functions, including removal of waste products, regulation of
blood pressure and hormone production. Functional kidneys are necessary to filter waste products from the blood and to
excrete them via the urine. In the presence of CKD, due to loss of kidney function, the efficiency of waste excretion is
increasingly reduced, resulting in a build-up of toxic waste products.
The kidneys have a large functional reserve, meaning signs that your pet is unwell may not be seen until the later stages of
the disease, when a 75–80% loss of function has already occurred.

There is, unfortunately, no cure for CKD; however, through correct diet changes, life expectancy can be significantly
lengthened. Therefore, feeding the correct diet is vital, alongside all prescribed medications and ongoing monitoring.
The main goals of dietary management are to:
■ Reduce phosphorus intake
■ Reduce amounts of waste products
■ Preserve current kidney function
■ Reduce further kidney damage.
Essential elements
Phosphorus restriction
Under normal circumstances, phosphorus is removed by the kidneys; this function is significantly reduced in pets with CKD,
resulting in increased amounts of phosphorus in the blood, which is associated with many negative consequences. Phosphorus
and calcium balance are linked and an increase in phosphorus within the blood causes a fall in calcium. A fall in calcium and an
increase in phosphorus stimulates the parathyroid gland to produce parathyroid hormone, which starts to demineralize (break
down) bone in an attempt to increase the amount of calcium in the blood to a normal level. This demineralization is known as
secondary renal hyperparathyroidism and can result in brittle bones, increasing the risk of fractures. For this reason,
phosphorus within the diet should be restricted in pets with CKD. ➟
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Protein restriction
Proteins, when consumed by pets, are broken down, producing nitrogenous waste which must then be removed from the
body by the kidneys. In poorly functioning kidneys, this excretion is not efficient; the nitrogenous waste builds up and becomes
toxic, especially in the later stages of CKD.
Protein restriction can limit the accumulation of nitrogenous waste but, since proteins are essential nutrients for cats and
dogs, care must be taken to ensure that their requirements are still met. This can be achieved by feeding foods containing proteins
of high quality and high digestibility. Cats are a carnivore species and have a greater requirement for protein in their diet than dogs,
who are more omnivorous; the requirement is usually met by including proteins of animal origin, so formulating these diets can
be more challenging. Further, animal-based proteins are the main source of phosphorus in the diet of both cats and dogs.
Increased water intake
For all pets with CKD, increasing water intake will help maintain hydration and, therefore, should be encouraged. Ways to
increase water intake are:
■ Switch to a wet food (e.g. cans, pouches or foil trays). Wet food typically contains around 80% water, so facilitates a
greater intake of water than dry food, which usually contains only 8–10% water
■ Add water to food. Water can be added to either wet or dry food to increase intake
■ Ensure there are multiple water sources. Bowls should be placed on all floors of the house your pet has access to, so
water is readily available. This is especially necessary for senior pets with CKD, as they may be less willing to go up or
down stairs for water
■ Altered water delivery. Providing a running water source, e.g. a water fountain, and different dish types may encourage
water intake, especially in some cats. Many cats also appear to prefer to drink from shallow ceramic or Pyrex® bowls
rather than from plastic bowls (as they retain a specific scent cats find unpleasant) or deep metal bowls
■ Use hydration products. Nutritional products have recently been developed that can be added to a feeding regime to
encourage additional water intake, e.g. PRO PLAN® HC HydraCare Wet Cat Food Pouch.
Monitoring water intake is frequently required as increases can highlight disease progression. Intake can be monitored with
the use of recent technology such as Felaqua bowls by Sure Petcare®, which are application-linked bowls that measure the
volume and frequency of water intake. The application calculates the amount of water drunk each day so water intake can be
quickly and easily monitored. Measuring jugs and routine recording of amounts drunk per day can also be used and reviewed at
regular intervals to track trends over time and to flag significant water increases early. Where increased water intake and urine
output is noted, further testing is advised as adjustments to the ongoing therapy may be required.

The IRIS staging system is widely used to categorize the degree of kidney disease your pet may have, based on their blood
results.
For each pet with CKD, suitable diets depend on the stage of the disease and include:
■ At IRIS stage 1, current guidance suggests the use of diets formulated to have a lower phosphorus content than adult
maintenance diets. These may be:
● Therapeutic diets specifically formulated for early renal care
● Some senior diets that are mildly restricted in phosphorus
■ At IRIS stage 2 and above, therapeutic diets specifically formulated for CKD with restricted phosphorus concentrations
and moderate amounts of protein are recommended.
For other diet types, see section on ‘Misconceptions about chronic kidney disease’.

Potassium replacement
As pets with CKD frequently have an increased water turnover, too much potassium can sometimes be lost in the urine and,
therefore, it is advisable to replace the ongoing losses. Hypokalaemia (low potassium) can result in muscle weakness, lethargy,
ventral flexion of the neck (in cats) and appetite loss. Most therapeutic diets formulated for CKD contain higher concentrations
of potassium for this purpose. Potassium levels should, however, be monitored since hyperkalaemia (high potassium) can occur.
Sodium moderation
Since increased dietary sodium intake may be damaging to the kidneys, excessive amounts should be avoided.
Treat management
Giving your pet treats is probably an essential part of your relationship. Unfortunately, many pet foods and treats will contain
high levels of protein and phosphorus because these elements may increase how tasty your pet finds them. Eliminating treats
altogether is likely to be very difficult for both you and your pet, so alternatives should be found. Examples of treats that would
be suitable include:
■ Green watery vegetables:
● Courgette, broccoli or cauliflower for dogs
● Courgette for cats
Cats typically prefer courgette to be peeled and cooked whereas dogs will eat vegetables either cooked or uncooked,
depending on the individual. Additionally, consuming green watery vegetables can increase water intake, which is desired. ➟
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Food transition
Since feeding the correct diet can increase life expectancy and quality of life for pets with CKD, helping your pet to accept
the ideal diet is essential. It is always worth taking as much time as you need for a successful transition to the correct diet, the
speed of which depends on your pet, and the process should never be rushed. In some cases, small amounts of a highly
palatable food (e.g. chicken) may be used to assist with a successful food transition, provided the quantity is small so as to not
unbalance the diet and that it is gradually withdrawn following completion of the transition.
Examples of options for diet transition are as follows:
■ Pets who will readily eat anything offered: 2–3 days should be sufficient to transition food without digestive
disturbance
■ Good eaters: 4–7 days will help make transition easy by promoting good acceptance and preventing digestive
disturbance
■ Picky eaters: 10–14 days should be taken for the transition
■ Fussy eaters: 2–3 weeks or more should be taken. If necessary, pets can be transitioned by only one kibble or
teaspoonful per day, taking 1–2 months in some cases.
Phosphorus binders
In cases where your pet does not accept the therapeutic diet, the transition has failed despite all efforts or blood phosphorus
concentrations remain high despite being fed a suitable kidney diet, phosphorus binders may be used. These are added to your
pet’s preferred food and trap the phosphorus once eaten. However, their overall effect is less reliable than feeding a CKD
therapeutic diet that has been specifically formulated to be low in phosphorus.
Supplements
There is some evidence that the addition of omega-3 fatty acids can prolong survival times for both dogs and cats with CKD.
Derived from fish oils, they are thought to reduce inflammation.
Antioxidants
Oxidative stress occurs with CKD. There is some suggestion that the addition of antioxidants can combat this and, therefore, slow
the progression of the disease. However, it remains unclear which products are most beneficial and further work is required.
Misconceptions about chronic kidney disease

Adult maintenance diets can be fed if a pet ■ For IRIS stage 1 CKD, this may be possible in the short term but is not
has CKD necessarily the best option; diet changes may be required
■ For IRIS stage 2 and above, a diet with the above-described alterations is
recommended to avoid increasing the workload of the kidneys and
accelerating disease progression, resulting in death more rapidly
Any diet type can be used for management ■ Not all diet types are appropriate for the management of CKD. The use of,
of CKD for example, home-prepared cooked diets and raw meat-based diets
should be considered carefully as they have been very frequently shown to
be unbalanced, with multiple nutritional deficiencies present
■ Home-prepared cooked diets: Home-prepared cooked diets can be
formulated with the necessary restrictions; however, this should only ever
be attempted or overseen by a person with a suitable qualification to avoid
nutritional inadequacies. Such qualifications include:
● Diploma from the American College of Veterinary Internal
Medicine (Nutrition) (ACVIM)

● Diploma from the European College of Veterinary Comparative
Nutrition (ECVCN)
■ Raw meat-based diets: CKD typically requires a diet with restricted
phosphorus content, which is difficult to achieve with a raw diet
Commercially manufactured foods, ■ There is no evidence to substantiate this, and the majority of cats and dogs
especially in kibble form, containing fed a manufactured diet do not acquire CKD
preservatives, can cause CKD ■ Further, cats and dogs fed on alternative diets, e.g. raw meat-based diets or
home-prepared cooked diets, still suffer from CKD. Therefore, food is
unlikely to be a causal factor for CKD
Feeding dry foods to cats causes ■ There is no evidence yet supporting this statement and further work is
dehydration, leading to kidney damage required; however, there is evidence that suggests dry diets may possibly
decrease the risk of CKD in cats
■ As in all cases of CKD, steps should be taken to ensure water intake at all times
➟
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Considerations when your pet has chronic kidney disease

Following a diagnosis of CKD, you will understandably be anxious about what will happen to your beloved pet. Sadly, this is not
a disease that can be cured, but progression can be slowed. One of the most important factors for doing so is the management
of your pet’s diet. You will play a hugely important role by following the dietary recommendations which can significantly
extend the time you will have with your pet.
Conclusion
Although CKD is a progressive incurable disease, much can be done to help prolong life. Through feeding the ideal diet, this
can be achieved and there are many ideal therapeutic diets available for this purpose.
Last updated
August 2023

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Appendix
Glossary of terms
Term Definition
Ad libitum (fed) Food is left out so that the pet can eat freely whenever it chooses
Adverse reactions to food This term is used for when dogs or cats develop clinical signs (usually related to the skin or
intestine) as a result of something that they eat. It encompasses true food allergies (where
the body mounts an abnormal immune response to a food component (usually protein))
and food intolerances (see below). This term is preferred because, in practice, it is very
difficult to prove a true food allergy and, in fact, most are probably intolerances
Alternative protein-based Commercially manufactured diets that use an alternative protein source
diets
Asymptomatic Shows no signs of any problem
Bioavailable Refers to how, when a food enters a pet, it can be digested, absorbed and utilized
Body Condition Score (BCS) A practical means of assessing the coverage of fat on the body
Carnivore Animals that must obtain at least some of their nutrition from eating meat-based foods
Compliance Carrying out instructions as they have been given. The level of compliance depends on how
completely the instructions are followed
Digestibility (of a food) How easily the body can break down the food into its constituents to be absorbed and
utilized
Dilated cardiomyopathy A serious heart condition where the heart enlarges, its muscle becomes very weak, and the
(DCM) heart no longer pumps effectively
Genomic Relating to the pet’s genes
Hydrolysed diets Diets that have undergone hydrolysis. The process of hydrolysis breaks down the proteins
into smaller units, so that the risk of the body mounting an immune response to them is
decreased. Often used to treat adverse reactions to food
Food intolerance An abnormal response to a food component that is not caused by an allergy. Mechanisms
of intolerance include the animal not having an enzyme needed to digest the component,
the animal being particularly susceptible to a food component that others can handle, food
spoilage (where the food goes off), or food poisoning (where the food is contaminated by a
toxin or pathogen)
Nutritional inadequacy Intake of nutrients that is lower than the estimated average requirement
Obesity Abnormal or excessive fat accumulation that presents a risk to health
Obligate carnivore Depend only on meat for survival
Omnivore Animals that obtain their nutrition from eating meat- or plant-based foods
Optimal Ideal
Palatability Refers to whether or not a food tastes good and is appealing to eat. Food that tastes good
and is appealing to eat can be said to be highly palatable
Pathogen A microorganism that has the potential to cause disease. Most pathogens are bacteria,
viruses, fungi, or parasites
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BSAVA GUIDE TO NUTRITION Appendix
Term Definition
Pathogenic The potential for a microorganism to be a pathogen
Plant-based diets Comprised of cooked, plant-based ingredients, usually vegetarian or vegan
Proprietary food Commercially manufactured food
Purified diets Diets that are formulated with a more refined and restricted set of ingredients
Restricted activity The normal activity of a pet is less than normal due to aging, disease or injury
Satiety The state or condition of fullness gratified beyond the point of satisfaction
Sustainability The ability to maintain or support a process continually over time
Therapeutic diet A diet that is formulated to support an animal with a particular disease or to prevent a
disease from developing
Trachea Also known as the ‘windpipe’
Zoonotic infection An infection that can pass from animals to humans

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Updated August 2023

BRITISH SMALL ANIMAL VETERINARY ASSOCIATION,

Feeding for specific situations and conditions

Appendix: Glossary of terms 118

Delivered by BSAVA to:

Delivered by BSAVA to:

What are commercially manufactured diets?

Types of commercially manufactured diet

■ Raw diets (for further information, see ‘Raw diets’).

● Produced most commonly via an extrusion method:

● Available in tins, trays and pouches

− Tend to have a higher moisture content (similar to wet foods)

What are the advantages of feeding a commercially manufactured diet?

Diet claim Available evidence

● Be free from pathogens

● Deliver complete and balanced nutrition

Agency, 2018a; 2019b)

Advantages of the ■ Dry kibble:

● Proportionally less packaging quantity needed

− More environmentally friendly than wet products

fresh or wet foods

− Cats in their senior years

wet and some dry foods daily (PDSA, 2019) ➟

Diet claim Available evidence

research is required to determine its efficacy

Low preparation time ■ No need for significant preparation of food

− PhD in animal nutrition

and availability of ingredients to the producer

less tolerant of dietary changes, potentially resulting in digestive disturbances

Variety ■ A wide variety of types are available

What are the disadvantages of feeding a commercially manufactured

Commercially manufactured ■ There is no evidence for these claims

Dogs and cats cannot digest ■ There is no evidence for this

Commercially manufactured ■ There is no scientific evidence to support this claim

Disadvantage claim Available evidence

Can commercially manufactured diets provide balanced nutrition?

What safety measures are there for feeding commercially manufactured

Considerations for feeding commercially manufactured diets in healthy

Considerations for feeding commercially manufactured diets in dogs

patients (Polzin, 2019)

How to talk to owners about commercially manufactured diets

Delivered by BSAVA to:

What are commercially manufactured diets?

Types of commercially manufactured diet

● Produced most commonly via an extrusion method:

● Available in tins, trays and pouches

− Tend to have a higher moisture content (similar to wet foods)

What are the advantages of feeding a commercially manufactured diet?

Diet claim Available evidence

● Be free from pathogens

● Deliver complete and balanced nutrition

■ Occasional failures in pathogen control procedures have been documented in a small

● Listeria – found in uncooked commercially manufactured diets

● Mycobacterium bovis – found in uncooked commercially manufactured cat food

● Excess vitamin D – wet food

America in 2007. No pet foods were affected outside North America

Diet claim Available evidence

Advantages of the ■ Dry kibble:

● Proportionally less packaging quantity needed

− More environmentally friendly than wet products

● Distribution can be quick and effective, so foods are conveniently available

fresh or wet foods

− Cats in their senior years