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Supplement: WALTHAM International Science Symposium: Nature, Nurture, and the Case for Nutrition

Exocrine Pancreatic Insufficiency and Adverse Reaction to Food in Dogs: A Positive Response to a High-Fat, Soy Isolate Hydrolysate–Based Diet^1,2

Vincent C. Biourge^*,3 and Jacques Fontaine

^* Royal Canin, Research Center, 30470 Aimargues, France and Veterinary Clinic, Brussels, Belgium

³ To whom correspondence should be addressed. E-mail: vbiourge{at}royal-canin.fr.

KEY WORDS: • exocrine pancreatic insufficiency • soy hydrolysate • fat

Exocrine pancreatic insufficiency (EPI)⁴ is a disease characterized by inadequate production of pancreatic digestive enzymes that will result in a syndrome of maldigestion/malabsorption (1). The diagnosis of EPI is based on history, clinical signs, and low levels of serum canine trypsin-like immunoreactivity (TLI) (1). The management of EPI is lifelong and includes supplementing each meal with pancreatic enzyme extracts, feeding a highly digestible diet, and giving, at least initially, an antibiotic treatment to control small intestinal bacterial overgrowth (2). Restriction of dietary fat is commonly recommended in the management of EPI (3). However, one study failed to demonstrate a benefit of severe dietary fat restriction (4). Moreover, recent work suggests that a high-fat diet is better tolerated than a low-fat diet by dogs with experimental EPI (5).

Dermatological signs compatible with adverse reaction to food are common in dogs with EPI, especially in German Shepherd dogs (2). The morphologic and functional changes induced by EPI in the intestinal mucosa would account for this observation (2,6). Dermatological signs respond poorly to the usual management of EPI.

Recently, protein hydrolysate–based diets have become available in the management of dogs exhibiting adverse reactions to foods. Because these diets are highly digestible and their protein is predigested, they could be of interest in the management of EPI, especially when complicated with dermatological disease. This case report describes the response of three German Shepherd dogs suffering from both EPI and skin disease to a 19% fat, soy isolate hydrolysate and rice dry expanded diet.

	MATERIALS AND METHODS

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Dogs

Three male German Shepherd dogs, 5.0–9.0 y of age, body weight 32–40 kg, were included in the study (Table 1). All dogs were known to suffer from EPI based on history, clinical signs, indirect pancreatic function test (1) (1 dog), and serum canine TLI (2 dogs, 0.88 and 2.5 µg/L, respectively, normal for the laboratory = 5.4–32 µg/L), for several years. At the time of presentation to a specialty dermatology clinic, 1 dog (case no. 3) had liquid diarrhea and the remaining 2 dogs had recurrent bouts of soft feces that were not fully controlled with highly digestible and/or novel ingredient diets, pancreatic enzyme supplementation, and occasional antibiotic therapy. Two dogs were lean [body condition score (BCS) of 2 on a scale of 5] and 1 dog did not reach fully its optimal body condition (BCS: 2.5/5). All 3 dogs showed various signs of skin disease compatible with adverse reactions to food: severe pruritus (3–4 on a scale of 5), erythema, seborrhea, and recurrent pyoderma (Table 1).

Diet

Dogs were fed a commercial soy hydrolysate and rice-based diet⁵. Aside from rice and soy isolate hydrolysate, other main ingredients included poultry fat, beet pulp, poultry liver hydrolysate (as a flavor), soy and borage oil, zeolite, fructo-oligosaccharides, and fish oil. In normal dogs using the American Association Feed Control Officials digestibility procedures (7), the digestibility of dry matter, protein, and fat in the diet were, respectively, 87.6, 88.9, and 96.6%.

	RESULTS

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After receiving the hydrolysate-based diet for 7 d, all 3 dogs produced well-formed feces (score of 4 on a scale of 5; Table 1) and no episode of diarrhea was observed over the 3-mo follow-up (Table 1). Within 2 mo, all 3 dogs reached optimal body condition (BCS = 3/5) after gaining 4–10 kg body weight. The pruritus (pruritus score 0/5) as well as the signs of skin disease were completely controlled in 2 of the 3 dogs and markedly improved in the remaining dog after 3 mo. In this latter case, a mild pruritus persisted (pruritus score 1/5), as well as a few focal lesions of erythema and plaque with crusts and mild hyperpigmentation.

	DISCUSSION

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All three dogs included in this case report had been diagnosed with EPI for several years before their presentation for skin disease. As it is often the case in the long-term management of EPI, the gastrointestinal signs (soft feces, flatulence, diarrhea) of those 3 dogs improved but did not completely resolve after pancreatic enzymes replacement, highly digestible, and/or novel ingredient diets, as well as with repeated antibiotic treatment for small intestinal bacterial overgrowth (2). Moreover, 2 dogs remained lean and 1 dog never reached its optimal body condition (BCS < 3). Within 1 wk on the high-fat soy hydrolysate–based diet and for the duration of the study, owners noticed a substantial improvement in fecal quality (fecal score of 4/5) and a disappearance of the episodes of diarrhea. Within 2 mo, the 3 dogs had gained from 4 to 10 kg.

Feeding dogs moderate- to low-fat (30–10% of the calories) and highly digestible diets is usually recommended in the management of EPI (3,4). The rationale behind lowering fat intake is that bacteria metabolize unabsorbed fat to hydroxy-fatty acids, which will in turn stimulate secretion of fluids in the distal portion of the small intestine and colon (4). The diet used in this case report provided 40.8% of its calories from fat. In a canine model of EPI, animals fed 43% of their calories as fat, absorbed protein, fat, and carbohydrate more efficiently than when fat represented 18 or 27% of their calories (5). A better preservation of exogenous pancreatic enzymes, especially lipase, would explain this observation (5). A study in 21 EPI dogs, to evaluate the benefit of feeding a low-fat (13% of calories) and low-fiber diet failed to show any significant benefit compared to their usual diets (4). Those findings suggest that high-fat (40% of the calories; 20–22% fat on a dry matter basis) and highly digestible diets not only are not contra-indicated, but could be more efficient in the management of EPI. Moreover, as most EPI dogs are underweight at the time of presentation, those high-fat diets could promote a more rapid restoration of optimal body weight as illustrated in this case report. Aside from fat, rice that is one of the most digestible sources of carbohydrate (3), as well as soy hydrolysate, a source of predigested protein, probably contributed to the tolerance of the diet.

All 3 dogs were presented to a dermatology specialty practice for severe pruritus and various signs of skin disease compatible with adverse reactions to food. Adverse reactions to food are abnormal responses to the ingestion of certain foodstuffs that will result in the appearance of clinical signs (6). The signs are usually dermatological (pruritus, erythema, self-induced trauma, pyoderma, otitis, etc.) or gastrointestinal (vomiting, diarrhea, flatulence, abdominal discomfort). Appearance of dermatological signs during the long-term follow-up of EPI dogs is common, especially in German Shepherds (2). Poor digestibility of proteins, a defective mucosal barrier, and increased mucosal permeability would explain this sensitivity (1,2,6).

Diets based on protein hydrolysates have recently become available for the management of adverse reaction to food in dogs. Hydrolysates are produced by enzymatic proteolysis of native proteins that results in an array of peptides, small enough so that they would no longer be recognized by, or trigger a reaction by, the immune system (6). These peptides are also highly digestible, therefore reducing their retention time in the lumen of the intestine. Soy hydrolysates have been used extensively in the prevention of food sensitivity in babies and in calves (8,9). Preliminary results in the management and the diagnosis of adverse reaction to food in dogs are encouraging (10). Pruritus and the associated self-trauma, erythema, seborrhea, and pyoderma in the 3 dogs of this study responded well to the dietary and 30-d antibiotic treatments. After 3 mo, 2 of the 3 dogs were completely controlled and the third one showed a marked improvement. This latter dog had been suffering from chronic deep pyoderma for years and its owner was very satisfied with the result.

This case report suggests that a soy hydrolysate and rice-based diet could significantly improve the clinical condition of dogs suffering both from EPI and skin disease, a condition reported difficult to control (2). A high level of fat (40.8% of the calories) was very well tolerated by those patients and suggests that high-fat and highly digestible diets are not contra-indicated in the management of EPI, moreover, they could be beneficial in restoring body condition.

	FOOTNOTES

 
¹ Presented as part of the WALTHAM International Science Symposium: Nature, Nurture, and the Case for Nutrition held in Bangkok, Thailand, October 28–31, 2003. This symposium and the publication of the symposium proceedings were sponsored by the WALTHAM Centre for Pet Nutrition, a division of Mars, Inc. Symposium proceedings were published as a supplement to The Journal of Nutrition. Guest editors for this supplement were D'Ann Finley, James G. Morris, and Quinton R. Rogers, University of California, Davis.

² Financial support for this study was provided by Royal Canin, Aimargues, France.

⁴ Abbreviations used: BCS, body condition score; EPI, exocrine pancreatic insufficiency; TLI, trypsin-like immunoreactivity.

⁵ Hypoallergenic, Royal Canin, Aimargues, France. Proximate analysis as fed: moisture 9%, crude protein 21%, crude fat 19%, crude fiber 2.2%, total dietary fiber 5.4%, minerals 8%. Metabolizable energy [measured according to Association of American Feed Control Officials protocol (7)]: 1.75 MJ/kg.

	LITERATURE CITED

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1. Williams, D. A. (1996) The pancreas. In: Strombeck's Small Animal Gastroenterology. (Guilford, W.G., Center, S. A., Strombeck, D. R., Williams, D. A. & Meyer, D. J., eds.), pp. 381–410. W. B. Saunders, Philadelphia, PA.

2. Wiberg, M. E., Lautala, H.-M. & Westermarck, E. (1998) Response to long-term enzyme replacement treatment in dogs with exocrine pancreatic insufficiency. J. Am. Vet. Med. Assoc. 213: 86–90.[Medline]

3. Guilford, W. G. (1996) Nutritional management of gastrointestinal diseases. In: Strombeck's Small Animal Gastroenterology. (Guilford, W. G., Center, S. A., Strombeck, D. R., Williams, D. A. & Meyer, D. J., eds.), pp.889–910. W. B. Saunders, Philadelphia, PA.

4. Westermarck, E., Junttila, J. T. & Wiberg, M. E. (1995) Role of low dietary fat in the treatment of dogs with exocrine pancreatic insufficiency. Am. J. Vet. Res. 56: 600–605.[Medline]

5. Suzuki, A., Mizumoto, A., Rerknimitr, R., Sarr, M. G. & DiMagno, E. P. (1999) Effect of bacterial or porcine lipase with low- or high-fat diets on nutrient absorption in pancreatic insufficient dogs. Gastroenterology 116: 431–437.[Medline]

6. Guilford, W. G. (1996) Adverse reactions to food. In: Strombeck's Small Animal Gastroenterology. (Guilford, W. G., Center, S. A., Strombeck, D. R., Williams, D. A. & Meyer, D. J., eds.), pp.436–450. W. B. Saunders, Philadelphia, PA.

7. Association of American Feed Control Officials. (2003) Dog and cat food metabolizable energy protocols. In: Official Publication of Association of American Feed Control Officials Incorporated. pp.154–157. Oxford, IN.

8. Terracciano, L., Isoardi, P., Arrigoni, S., Zoja, A. & Martelli, A. (2002) Use of hydrolysates in the treatment of cow's milk allergy. Ann. Allergy Asthma Immunol. 89 (Suppl. 1): 86–90.

9. Lallès, J. P., Toullec, R., Branco Pardal, P. & Sissons, J. W. (1995) Hydrolyzed soy protein isolate sustains high nutritional performance in veal calves. J. Dairy Sci. 78: 194–204.[Abstract]

10. Van Pottelberge, D., Biourge, V. C., Marniquet, P. & Sergheraert, R. (2002) Efficacy of a hypoallergenic diet containing soy isolate hydrolysate for the diagnosis and management of food hypersensitivity in dogs: a multicentric field study. In: Proceeding of the Joint Nutrition Symposium. Antwerpen, Belgium. 17 (abs.).

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