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The legal status of AAS varies from country to country: Losing weight too quickly may cause you to make less milk and leave you feeling sluggish. Disturbance of the umbilical circulation during or after liver reduction causes fetal death. Compared with individuals that did not use steroids, young adult males that used AAS reported greater involvement in violent behaviors even after controlling for the effects of key demographic variables, previous violent behavior, and polydrug use. Only a few reports of TCA associated with small bowel atresia and volvulus can be found 3, 7. PepsiCo does not conduct or directly fund any animal tests. This disassociation is less marked in humans, where all AAS have significant androgenic effects.

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Since then we have been working with suppliers, civil society and industry peers to implement this commitment. Creating a healthier relationship between people and food is integral to our business. While we are transforming the nutritional profile of many of our products by reducing added sugars, sodium and saturated fat, we are also building our portfolio of nutritious products, accelerating a journey that we began before the turn of the 21 st century.

As part of our Performance with Purpose PwP agenda, we have set the following goals related to nutrition:.

To learn more about what we are doing to achieve these ambitious goals as well as our PepsiCo Nutrition Criteria, see our Nutrition page. As a global company with brands that reach consumers more than a billion times every day, it is important for PepsiCo to provide fact-based, simple and easy-to-understand information about how the key nutrients in each product fit in a balanced and healthy diet.

We are continuously looking for ways to improve our labeling. In , PepsiCo voluntarily committed to display calorie count and key nutrients on our packaging— where feasible to print and where permissible by local regulations— for all of our products in Brazil, Canada, China, India, Mexico, Russia, Saudi Arabia, Turkey, the U. Packaging plays a unique role in the way our products are presented to consumers and customers.

As a business, we design our packaging materials around several critical criteria, including compliance with food safety regulations, freshness and quality of the product, environmental sustainability, affordability, and consumer preferences, including convenience.

At the beginning of every packaging design effort, we balance these criteria to arrive at a final packaging design. As part of our Performance with Purpose PwP agenda, we have set the following goals related to packaging:. In , PepsiCo launched its Palm Oil Action Plan, committing to help advance the sustainability of the palm oil industry.

We are committed to sourcing percent certified RSPO sustainable palm oil. Through our policies and actions, PepsiCo seeks to uphold standards for sustainable palm oil by addressing our own supply chain first and then partnering with others to drive improvement more widely. In this way, we hope that our collective actions will improve palm oil production across the industry.

Our third Annual Progress Report was published in June and provides detailed information on the strides we are making toward our goals. PepsiCo has robust, long-standing processes for managing pay programs that ensure pay equity across employee groups. Building on that history, we have increased the rigor of our pay equity review processes, as part of our Performance with Purpose PwP agenda, with a goal to achieve pay equity by implementing a more comprehensive global pay equity review process.

As of the end of , we have implemented this process in 21 countries that collectively make up 62 percent of the salaried employee population[1]. Our results show that in this population, women and men are paid within 1 percent of each other and in the U. This gives us confidence that our efforts to achieve pay equity are producing good results. Importantly, we are also gaining insights into how we can advance pay equity in every country in which we operate.

In the years ahead, we will continue this process across additional markets. As part of this pledge, we set a goal to implement a comprehensive, global annual review process to support pay equity for women. As a Fortune 50 company, we felt it was important to add our voice to this conversation and take a leadership position in regards to pay equity. Pesticides are substances designed to control pests such as weeds and insects, and responsible use of pesticides is an important aspect of sustainable agriculture.

By increasing the yield from farms and plantations, pesticides help ensure a reliable food chain and reduce pressure to convert more land to agriculture, which helps to prevent deforestation. By protecting crops, pesticides also help to keep food affordable for consumers while supporting farmer incomes. Pesticide use has led to concerns around the potential for unintended environmental and health impacts.

PepsiCo understands these concerns and takes pesticide issues seriously. Get more information about our approach to pesticides. In each of the more than countries and territories in which our products are made, manufactured, distributed or sold, we abide by the local laws and regulations governing interaction with government officials and political giving.

In the democratic societies in which we operate, the health of those societies depends on citizens being responsibly engaged in the political process. Food safety is our highest priority. PepsiCo products are sold in nearly every country around the world, and we have a responsibility to our consumers and to the health of our business to develop products that people can trust. In fact, two of the six guiding principles that make up PepsiCo's Values speak to this directly:. To live by these values, we take comprehensive measures so our products can meet the highest food safety and quality standards.

Abiding by the local laws and regulations governing interaction with government officials and PepsiCo's strong Code of Conduct, our public policy engagement goal is to promote a healthy business environment that supports our ability to achieve sustainable growth in the years ahead. As part of our goal to reduce our absolute greenhouse gas GHG emissions by 20 percent by , PepsiCo is increasingly shifting towards renewable energy. This is a journey we are in the early stages of today, but have begun in markets like Mexico.

In March , our Mexico Foods business initiated a power purchase agreement to source a large portion of its power from wind energy. From April-December , this business sourced 73 percent of its power via wind energy, on an average monthly basis.

These partnerships are informing our renewable energy procurement strategy. PepsiCo's research processes and those of our partners are confidential for competitive reasons. However, PepsiCo does not conduct or fund research — including research funded by PepsiCo but performed by third parties — that utilizes any human tissue or cell lines derived from embryos or fetuses. Informed by the guidelines on energy intake provided by the World Health Organization WHO and other authorities, we have set a goal that helps consumers reduce the amount of saturated fat in their diets.

Our goal, as part of our Performance with Purpose PwP agenda, is that by , three-fourths of our food portfolio will have saturated fat levels that do not exceed 1. Reducing saturated fat in our products not only benefits consumers, and our business as a result, it helps PepsiCo to address regulatory needs.

Informed by the guidelines on sodium intake provided by the World Health Organization WHO and other authorities, we have set a goal that helps consumers reduce the amount of sodium in their diets. Our goal, as part of our Performance with Purpose PwP agenda, is that by , three-fourths of our global foods portfolio will have sodium levels that do not exceed 1.

Reducing sodium in our products not only benefits consumers, and our business as a result, it helps PepsiCo to address regulatory needs. We value the views of our shareholders and other stakeholders, including customers, consumers, shareholders, employees and a wide range of organizations, and the input that we receive from them is a cornerstone of how we developed, implement and evolve our Performance with Purpose PwP agenda.

These engagements help us learn about emerging sustainability topics, better inform our efforts, and help PepsiCo work to create value for our company and society. We use a variety of mechanisms to solicit feedback from our stakeholders, including bilateral meetings and participation in stakeholder networks, outreach programs, webinars and partnerships on a variety of topics. Engaging with a wide range of stakeholders is important, including organizations that are critical of our actions, in order to understand and address their concerns.

Informed by the guidelines on added sugars intake provided by the FDA, we have set a goal that helps consumers reduce the amount of added sugars in their diets. Our goal, as part of our Performance with Purpose PwP agenda, is that by , at least two thirds of our global beverage portfolio volume will have Calories or fewer from added sugars per 12 ounce serving.

We will do this by expanding our portfolio of lower-calorie beverages and reducing added sugars in our overall beverage portfolio. PepsiCo is committed to purchasing from a supplier base representative of our employees, consumers, retail customers and communities.

Developing partnerships with diverse suppliers helps us build the world-class supplier base we need. It creates mutually beneficial relationships that expand PepsiCo's sphere of activity. It helps build community infrastructure by providing employment, training, role models, buying from other minority and women-owned businesses and supporting community organizations. This includes Tier 2 spend reported by non-diverse suppliers, which demonstrates PepsiCo's goal of expanding engagement of diverse suppliers in its supply chain.

Beginning in , we broadened our supplier diversity program to include LGBT, Veteran and Disabled-owned enterprises. To learn more, please visit www. Supplier Diversity Registration Portal. We believe strong sustainability governance is the foundation for delivering on our Performance with Purpose PwP vision to provide top-tier financial performance over the long-term by integrating sustainability into our business strategy.

At PepsiCo, sustainability topics are integrated into, and not separate from, our business. To learn more about the role that our Board, senior leadership, and employees throughout the company play in managing sustainability at PepsiCo, please visit our Sustainability Governance page.

We hold our suppliers to the same standards of integrity to which we hold ourselves. An unethical or illegal act by a supplier may hurt PepsiCo's reputation as a world-class company and cause a loss of goodwill in the communities we serve. Therefore, all suppliers are expected to follow our Supplier Code of Conduct, and relevant policies and commitments as a condition of doing business with us. To attract the best talent, PepsiCo strives to maintain our reputation as a great place to work.

The future of PepsiCo will be shaped by our commitment to hiring and developing the most talented associates by building strong, diverse teams through offering rewarding and challenging careers. These cooking oils contain minimal amounts of TFAs that can develop during the refining process.

For example, flour has been fortified with iron, zinc, folic acid and other B vitamins such as thiamine, riboflavin, niacin and vitamin B Treating malnutrition, mostly through fortifying foods with micronutrients vitamins and minerals , improves lives at a lower cost and shorter time than other forms of aid , according to the World Bank. In those with diarrhea, once an initial four-hour rehydration period is completed, zinc supplementation is recommended.

Daily zinc increases the chances of reducing the severity and duration of the diarrhea, and continuing with daily zinc for ten to fourteen days makes diarrhea less likely recur in the next two to three months.

In addition, malnourished children need both potassium and magnesium. For a malnourished child with diarrhea from any cause, this should include foods rich in potassium such as bananas, green coconut water, and unsweetened fresh fruit juice. The World Health Organization WHO recommends rehydrating a severely undernourished child who has diarrhea relatively slowly. The preferred method is with fluids by mouth using a drink called oral rehydration solution ORS.

The oral rehydration solution is both slightly sweet and slightly salty and the one recommended in those with severe undernutrition should have half the usual sodium and greater potassium. Fluids by nasogastric tube may be use in those who do not drink.

Intravenous fluids are recommended only in those who have significant dehydration due to their potential complications. These complications include congestive heart failure. This switch from type of fluid to amount of fluid was crucial in order to prevent dehydration from diarrhea.

Breast feeding and eating should resume as soon as possible. To prevent dehydration readily available fluids, preferably with a modest amount of sugars and salt such as vegetable broth or salted rice water, may be used. The drinking of additional clean water is also recommended. Once dehydration develops oral rehydration solutions are preferred. As much of these drinks as the person wants can be given, unless there are signs of swelling. If vomiting occurs, fluids can be paused for 5—10 minutes and then restarting more slowly.

Vomiting rarely prevents rehydration as fluid are still absorbed and the vomiting rarely last long. For babies a dropper or syringe without the needle can be used to put small amounts of fluid into the mouth; for children under 2, a teaspoon every one to two minutes; and for older children and adults, frequent sips directly from a cup.

After the first two hours of rehydration it is recommended that to alternate between rehydration and food. Malnourished children have an excess of body sodium. Hypoglycemia , whether known or suspected, can be treated with a mixture of sugar and water. If the child is conscious, the initial dose of sugar and water can be given by mouth.

If seizures occur after despite glucose, rectal diazepam is recommended. Blood sugar levels should be re-checked on two hour intervals. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child. Prolonged bathing or prolonged medical exams should be avoided. Warming methods are usually most important at night.

The figures provided in this section on epidemiology all refer to undernutrition even if the term malnutrition is used which, by definition, could also apply to too much nutrition. There were million undernourished people in the world in Malnutrition, as of , was the cause of 1. Mortality due to malnutrition accounted for 58 percent of the total mortality in In protein-energy malnutrition resulted in , deaths down from , deaths in According to the World Health Organization, malnutrition is the biggest contributor to child mortality , present in half of all cases.

Poor or non-existent breastfeeding causes another 1. Other deficiencies, such as lack of vitamin A or zinc , for example, account for 1 million. Malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower education achievement. Their own children tend to be smaller. Malnutrition was previously [ when? This helps their communities have more balanced diets and become more resilient to pests and drought.

Finger millet is very high in calcium, rich in iron and fiber, and has a better energy content than other cereals. These characteristics make it ideal for feeding to infants and the elderly. Some organizations have begun working with teachers, policymakers, and managed food service contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university-level institutions.

Health and nutrition have been proven to have close links with overall educational success. Undernutrition is an important determinant of maternal and child health, accounting for more than a third of child deaths and more than 10 percent of the total global disease burden according to studies.

The World Health Organization estimates that malnutrition accounts for 54 percent of child mortality worldwide, [31] about 1 million children. As underweight children are more vulnerable to almost all infectious diseases, the indirect disease burden of malnutrition is estimated to be an order of magnitude higher than the disease burden of the direct effects of malnutrition.

Researchers from the Centre for World Food Studies in found that the gap between levels of undernutrition in men and women is generally small, but that the gap varies from region to region and from country to country. Intra-country variation also occurs, with frequent high gaps between regional undernutrition rates.

Studies on nutrition concerning gender bias within households look at patterns of food allocation, and one study from suggested that women often receive a lower share of food requirements than men.

Within the household, there may be differences in levels of malnutrition between men and women, and these differences have been shown to vary significantly from one region to another, with problem areas showing relative deprivation of women. Women in some societies are traditionally given less food than men since men are perceived to have heavier workloads. Women have unique nutritional requirements, and in some cases need more nutrients than men; for example, women need twice as much calcium as men.

During pregnancy and breastfeeding, women must ingest enough nutrients for themselves and their child, so they need significantly more protein and calories during these periods, as well as more vitamins and minerals especially iron, iodine, calcium, folic acid, and vitamins A, C, and K. Frequent pregnancies with short intervals between them and long periods of breastfeeding add an additional nutritional burden.

According to the FAO, women are often responsible for preparing food and have the chance to educate their children about beneficial food and health habits, giving mothers another chance to improve the nutrition of their children. Malnutrition and being underweight are more common in the elderly than in adults of other ages. Rates of malnutrition tend to increase with age with less than 10 percent of the "young" elderly up to age 75 malnourished, while 30 to 65 percent of the elderly in home care, long-term care facilities, or acute hospitals are malnourished.

In Australia malnutrition or risk of malnutrition occurs in 80 percent of elderly people presented to hospitals for admission.

From Wikipedia, the free encyclopedia. Redirected from Nutrition disorder. Medical condition that results from eating too little, too much, or the wrong nutrients. For the concept in metalworking, see Underfeeder.

Stunted growth and Wasting. List of types of malnutrition. United Nations Children's Fund. Intern Emerg Med Review. Retrieved July 4, Evidence for Action ' " PDF. Department for International Development. Retrieved July 5, Foley; Navin Ramankutty; Kate A. Gerber; Matt Johnston; Nathaniel D. West; Christian Balzer; Elena M. Food and Agricultural Organization of the United Nations.

Retrieved June 19, Recurrent pregnancy loss 2nd ed. Encyclopedia of human nutrition 2nd ed. Guidelines for the inpatient treatment of severely malnourished children.

Food and Agriculture Organization of the United Nations. Retrieved July 1, World Hunger Routledge Introductions to Development.

Principles and practice of geriatric surgery 2nd ed. Alam June 19, Clinical Nutrition in Practice. Retrieved February 10, Journal of Bangladesh Society of Physiologist. Studies in the History of Medicine and Health. Global and regional exposures and health consequences".

Pediatric Clinics of North America. Time for a change? Bulletin of the World Health Organization. Complex Mechanisms and Global Impacts". Management of diarrhoea with severe malnutrition". The Treatment of diarrhoea: A Review of Human and Animal Studies". Archived from the original PDF on May 10, Retrieved March 3, Should we be focusing on households, communities or both?

Mandell, Douglas, and Bennett's principles and practice of infectious diseases 7th ed. Annual Review of Anthropology. In Survival of cats with naturally occurring chronic renal failure: Some of the cats presumably in both groups were also given phosphorus binders. The cats fed the therapeutic kidney diet survived longer than the other cats, but it is not clear whether this was due to the reduction in phosphorus intake rather than the reduction in protein intake.

This is the first prospective dietary study involving naturally occurring feline CKD cases where survival from first diagnosis has been assessed. The studies described above were focusing on whether a reduced protein intake might slow the progression of kidney disease and help the cat live longer.

The other issue is whether feeding reduced protein might help the cat feel better. This study found that feeding a therapeutic kidney diet helped to keep BUN levels lower and appeared to help prevent metabolic acidosis in cats with more advanced CKD. Thus in this study the therapeutic kidney diet not only appeared to reduce the number of deaths, but the cats also exhibited fewer signs of illness.

This is because, during the breakdown of dietary protein in the digestive process, waste substances are created which are filtered out of the blood by the kidneys and excreted via urination. This is sometimes referred to as the removal of nitrogenous wastes.

Contrary to popular opinion, BUN and creatinine are not toxins themselves. However, BUN levels correlate with uraemic toxin levels, i. If you feed a reduced protein diet, this reduces the amount of nitrogenous wastes that must be processed by the kidneys.

This usually leads to a reduction in BUN levels and in turn the cat will often feel and act better. These clinical signs, that are often referred to as uremia, can be caused by an accumulation of the breakdown products of protein metabolism sometimes referred to as nitrogenous waste products.

This protein comes from both the protein in your animal's diet, as well as mobilization and degradation of their own body's protein stores. Consumption of protein in amounts greater than what your animal needs to maintain normal bodily functions can exacerbate these clinical signs.

Anemia enhances the weakness and reluctance to eat in animals with renal failure. Anemia can occur for several reasons with renal disease, but one factor that is believed to make it worse is excessive dietary protein.

Nitrogenous waste products are believed to contribute to anemia by reducing the life span of red blood cells. The waste products may also enhance blood loss by leading to the formation of gastrointestinal ulcers and a reduction in blood clotting ability. It must also be remembered that when vets recommend therapeutic kidney diets, they are not only recommending reduced protein levels. Therapeutic kidney diets have other attributes, for example reduced protein diets also tend to contain less phosphorus, and phosphorus control is extremely important in CKD cats.

These foods also contain additional levels of potassium and essential fatty acids see below. You can read more about the attributes of therapeutic kidney diets on the Which Foods to Feed page. Of course, nothing is ever simple when it comes to cats, so there are also potential downsides with reduced protein intake. One common problem with reduced protein for cats, as you might expect, is weight loss.

One study using healthy cats, Determining protein requirements: In study one, percent weight loss increased in a linear manner with decreasing protein intake. Feeding cats with different nutritional needs: As a result, there may or may not be weight loss, but there will be muscle wasting as well as a deterioration in the hair coat quality. Because protein is component in antibodies, immune function may be compromised; anemia may be exacerbated due to the lack of building blocks for hemoglobin; albumin levels may decrease and tissue healing will be affected.

Protein is a preferred flavour, so if a cat is already inappetant, restricting protein may result in inadequate intake of all nutrients, and the protein intake may fall below that required for normal function. Slowing the progression of chronic renal failure Grauer GF states "There are, however, potential undesirable effects associated with dietary protein reduction.

Reduced protein diets are also of concern for cats with metabolic acidosis, because, according to Nutrition and renal function in cats and dogs: Sufficient, High Quality Protein. As discussed previously, during the breakdown of dietary protein in the digestive process, waste substances are created which are filtered out of the blood by the kidneys and excrete d via urination.

Unfortunately damaged kidneys find it harder to do this, which is why your CKD cat may feel poorly. You will note the reference to not feeding more protein than your cat's body needs to maintain normal function. This is the crux of the matter. You do not want to feed an extremely low level of protein so your cat suffers weight loss and malnutrition; but nor do you want to be loading your cat's body with unnecessarily high levels of protein which contribute to your cat feeling ill.

The goal in CKD is not to feed low protein or high protein. The goal is to feed sufficient protein with the correct balance and number of amino acids to maintain the cat's health and body weight, but in a form which needs as little breaking down as possible. When talking about CKD, that is what we mean by "high quality protein", not reaching for organic, high quality meat. In addition to the amount of protein, patients with CKD should receive protein of high biologic value.

For most people, the easiest way to achieve this is to feed a therapeutic kidney diet because these diets have a protein level in this range. This does not mean they are low protein foods. If you find your cat starts to exhibit weight or muscle loss, you could consider trying one of the therapeutic kidney diets with protein at the higher end of the suggested range.

A good choice would be egg whites. If you cannot persuade your cat to eat a therapeutic kidney diet see Which Foods to Feed for tips on how to do this , you can also check the food data tables to find other foods which are relatively low in protein; but don't forget the therapeutic kidney diets have other important attributes, and the protein they do contain is good quality from the CKD perspective, something which is not always easy to replicate with non-therapeutic kidney foods.

When To Feed Reduced Protein. IRIS Stages 1 and 2. Because of the potential downsides of protein restriction, it is not necessarily a good idea to feed reduced protein food in all cases.

However for cats with proteinuria , it states "feed a renal clinical diet" regardless of the stage the cat is in. The study concludes "Our results suggest that cats with early renal insufficiency fed a test food designed to promote healthy aging, over a 6 month period, were more likely to have stable renal function evidenced by stable serum SDMA concentrations compared with cats fed owner's-choice foods.

It is also difficult to compare the effect of the therapeutic kidney diet because not enough is known about the alternative foods that were fed. Other vets believe that it is better to wait until the disease is more advanced before starting a therapeutic kidney diet. M anaging chronic diseases in cats Veterinary Medicine Little S states "Don't restrict dietary protein for cats experiencing mild to moderate chronic renal insufficiency creatinine 1.

These cats require adequate protein and calories to maintain body weight and to avoid muscle wasting and anemia. If your cat also has hyperthyroidism, it can be even more of a concern since hyperthyroid cats are prone to weight loss and muscle wasting. Diet and nutritional management for hyperthyroid cats Peterson ME the man who discovered hyperthyroidism in cats states that "The major problem that I have with some of the prescription kidney diets is that they restrict protein to the point that some cats — especially those with concurrent hyperthyroidism —will continue to catabolize their own muscle mass despite adequate control of the thyroid condition.

Unfortunately, it can often be easier to switch a cat to a reduced protein diet when the cat is stable with lower numbers. Treatment recommendations for CKD in cats International Renal Interest Society says that introducing a therapeutic diet "may be accomplished more easily early in the course of CKD, before inappetance develops.

If you are concerned, consider adding foods with high biologic value but minimal nitrogenous waste to your cat's therapeutic kidney diet. If you decide not to feed reduced protein to your CKD cat, please do ensure that your cat has a low phosphorus intake and an increased essential fatty acids intake. IRIS Stages 3 and 4. Cats who are in Stages 3 and 4 would therefore also be advised to eat a therapeutic kidney diet. Another factor to consider is your cat's BUN level.

Since BUN is influenced by protein intake, it does often help the cat feel better if you restrict protein intake as your cat's BUN levels rise.

In Slowing the progression of chronic renal failure Dr GF Grauer states that "As the renal failure progresses, additional dietary protein reduction will likely be necessary.

You may panic if you cannot get your cat to eat a reduced protein food. Take a deep breath. M anaging chronic diseases in cats Veterinary Medicine Little S states "Never try to force an anorexic patient with chronic renal insufficiency to eat a protein-restricted diet. Instead, concentrate on encouraging anorexic patients to eat. See the Which Foods to Feed page for more tips on getting your cat to eat the therapeutic kidney diet and what to do if you can't succeed.

Consider feeding tube intervention e. See the Persuading Your Cat To Eat page for more information on feeding tubes and tips on getting your cat to eat. Whatever you do, monitor your cat's weight and muscle status closely. Controlling phosphorus levels is extremely important for CKD cats, because high phosphorus levels are very damaging to their health and can make the disease progress more quickly.

This is such an important topic that I have an entire page devoted to phosphorus control. Please read it and do everything you can to keep your cat's phosphorus levels low - it can make all the difference to your cat's wellbeing and can also prolong survival. Just as cats need a diet relatively high in protein, so they also need relatively high levels of fat compared to a human or dog. Older cats may process fat less efficiently than younger cats, which may be a factor in weight loss.

Fat does not result in a lot of waste products like protein, so processing it is not a strain on the kidneys; plus cholesterol is not an issue for cats the way it is for humans.

Studies indicate that cat foods containing even higher amounts of fat are safe. In most therapeutic kidney foods, the fat content is increased to compensate for the lower protein levels.

Some senior cat foods also have relatively high levels of fat and relatively low levels of protein; as a bonus, they often also have low phosphorus levels.

Therefore, if your cat won't eat a therapeutic kidney diet, it is worth considering senior foods, although do check the protein level is not too low. The kidneys cannot process sodium as effectively in CKD, which increases the risk of hypertension high blood pressure in humans. It used to be thought that the same applied to cats, and it was therefore recommended that sodium intake should be restricted. Research in Applied Veterinary Medicine 7 4 pp found that sodium intake appeared to have no effect on in blood pressure in CKD cats, but that levels of BUN, creatinine and phosphorus were higher in the cats eating a high sodium diet compared to those eating a low sodium diet.

Even in cats with creatinine over 1. These results are consistent with the majority of other studies evaluating sodium intake in cats, as well as with the National Research Council's assessment, all of which indicate that sodium at 1. Effects of dietary salt intake on renal function: The study concludes "The results of this 2 year study do not support the suggestion that chronic increases in dietary salt intake are harmful to renal function in older cats. Increased dietary sodium increases urine output and may decrease the risk of forming calcium oxalate uroliths due to the decrease in relative supersaturation of solutes.

However, caution should be used in increasing the sodium intake of patients with renal disease as increased dietary sodium may have a negative effect on the kidneys independent of any effect on blood pressure. So should you restrict sodium intake or not? Treatment recommendations for CKD in cats International Renal Interest Society states on page 5 that there is no evidence that reducing sodium intake is helpful for CKD cats, and that it should certainly not take the place of medication for hypertension , but if you do opt to reduce your cat's sodium intake, you should do it gradually.

The food data tables provide information about the sodium content of many cat foods available in the USA and UK. This occurs because potassium is easily lost through increased urination and vomiting.

Therapeutic kidney diets contain extra potassium all cat foods need some potassium , and this is usually in the form of potassium citrate, because potassium citrate may help with a problem seen in some CKD cats called metabolic acidosis. If your cat refuses to eat a therapeutic diet, your vet can give you a potassium supplement instead, if appropriate; some cats need a potassium supplement whether or not they eat the therapeutic kidney diet.

Many commercial cat foods are acidified in order to reduce the risk of FLUTD feline lower urinary tract disease. These foods often say that they are designed to maintain urinary tract health; or they may contain cranberries or additional Vitamin C.

However, these foods which are actually designed to treat a different kind of problem to CKD may have the effect of increasing the amounts of potassium lost in the urine, which is bad for CKD cats. It is therefore best not to feed acidified foods to CKD cats, who tend to have quite high acid levels anyway. Please see the Potassium page for more information about potassium.

It also states "Our analysis indicates that cats have a ceiling for carbohydrate intake, which limits ingestion and constrains them to deficits in protein and fat intake relative to their target on high-carbohydrate foods. In The carnivore connection to nutrition in cats Zoran D Journal of the American Veterinary Medical Association pp, Dr Zoran writes "It is clear that cats have a greater need than dogs or other omnivores for protein in their diet.

Cats also have several physiologic adaptations that reflect their expected low CHO [carbohydrate] intake These specific differences do not mean cats cannot use starch. In fact, cats are extremely efficient in their use of simple sugars. However, it does underscore their development as carnivores and the expected low amounts of grain in their typical diet.

These digestive differences may mean that high amounts of CHO in diets may have untoward effects on cats. Therefore, if you are trying to reduce your CKD cat's protein intake, I would recommend increasing the fat in the diet see above rather than the carbohydrates.

If you are feeding a therapeutic kidney diet, this will often be done automatically - many of these diets increase the fat content rather than the carbohydrates in order to offset the reduced protein content. Pet Education has an interesting article about carbohydrates in the feline diet. Fibre is the non-digestible component of complex carbohydrate. It is important for good digestive health. Increased fibre may help with elevated calcium levels in the body hypercalcaemia , although one type of fibre, fructooligosaccharides or FOS, may actually increase calcium levels in the body see below.

It may also assist with two commonly seen CKD problems, toxin reduction and the control of constipation. There are a number of ways of categorising fibre types, but one way is to divide it into fermentable and non-fermentable. Which fibres are fermentable depends upon the species of bacteria eating the fibre in the cat's gastrointestinal tract. Diet and large intestinal disease in dogs and cats JW Simpson The Journal of Nutrition SS has a table showing soluble and fermentable fibres.

In terms of general health, you do not necessarily want the most fermentable fibres. Dietary fiber for cats: It concludes that the diet "which contained the most fermentable fibers, severely decreased nutrient digestibility and resulted in poor stool characteristics. Diets that contain moderately fermentable fiber provide fermentation end products that may be important in maintaining the health of the gastrointestinal tract of the cat.

There has long been interest in whether other bodily mechanisms might be useful for relieving the load on damaged CKD kidneys. Bowel as a substitute in renal failure EA Friedman American Journal of Kidney Diseases 28 6 pp states "Extraction, modification, or recycling of nitrogenous wastes by the gastrointestinal tract is a potentially low-cost means of substituting for missing renal function.

Multiple approaches to the bowel as a substitute kidney have been attempted. One way of doing this may be via increased fibre intake in the form of fermentable fibre prebiotics.

Fermentable fibre provides a source of carbohydrate for the bacteria in the gut. These bacteria, which are essential to health, increase in number when provided with additional fermentable fibre, and the more bacteria there are, the more nitrogen is excreted in the faeces.

This increased faecal excretion may help to reduce the load on the kidneys by diverting the excretion of urea from the kidneys. You can read more about this in the Treatments chapter. Non-fermentable fibre can be helpful for CKD cats because it reduces the risk of constipation, a common problem in CKD cats, by holding water in the stool. Most commercial cat foods have sufficient levels of fibre for a healthy cat, but if your cat suffers from constipation you may wish to add more fibre in the form of something such as pumpkin, baby peas or psyllium.

Please see Constipation for more information on dealing with constipation. Feline Constipation explains more about fibre and gut health. Side Effects and Interactions. Some forms of fibre, such as fructooligosaccharides FOS , may also bind calcium in the small intestine and lead to an increase in calcium levels in the body hypercalcaemia.

This can be a problem for cats who already have high blood calcium levels. Inulin and guar gum may do this, as may slippery elm bark and lactulose , two treatments commonly used for constipation in CKD cats. Fibre may also affect taurine levels in some foods. I would therefore recommend discussing additional fibre with your vet before adding it, and avoiding its use in a cat who already has high calcium levels.

They are essential because the cat's body cannot synthesise them in sufficient amounts, so they have to be obtained from food. Commercial diets tend to contain far more Omega-6, partly because Omega-6 EFAs are cheaper and more stable, but this may create a potentially harmful imbalance.

The correct balance is not yet known, though some believe it is probably around 5: Essential fatty acids are important for many bodily functions. It has been known for many years that they have an effect on the skin - the first signs of an imbalance or deficiency are usually a dry coat, itchy skin or matted fur. Recently it appears that they may have an important role in controlling inflammation. Research in rats and humans indicates that the addition of omega-3 fatty acids to the diet may delay the progression of CKD.

Small Animal Practice 38 1 pp added essential fatty acid supplements in the form of fish oil to dog foods. It concludes "newer data indicate that dietary supplementation with specific antioxidants is an important consideration for limiting renal oxidant stress and progression of CKD. Nutritional management of renal disease: Dietary omega-3 fatty acid supplementation in the form of fish oil can have beneficial effects in reducing GCP.

This ties in with what one kidney specialist vet has informed me, that oversupplementation can throw off the correct ratio of Omega-3s to Omega-6s, and might be detrimental in some cases. Omega-3 fatty acid supplementation for dogs and cats with heart disease Nutrition Service at Cummings Veterinary Medical Center at Tufts University states "Potential risk factors include decreased platelet function and coagulation, and possibly suppressed wound healing Other potential effects include soft feces, diarrhea, flatulence, vomiting, and halitosis.

Nutrition and renal function: At higher levels of supplementation, renal function was actually increased in normal cats. These data support the assertion that this dietary maneuver is safe for normal cats and provides some encouragement for further consideration for dietary n-3 PUFA supplementation in cats with renal disease, systemic hypertension, or hypersensitivity reactions. Almost everybody I know of who has added essential fatty acids to their cat's treatment plan, whether in a therapeutic kidney diet or as a supplement, has been happy with the results, reporting an improvement in general wellbeing.

Additional EFAs do cause vomiting in some cats though, and I've heard from a number of people whose cats had pancreatitis and who felt essential fatty acids did not agree with these cats, causing problems such as diarrhoea. However, there are no reports of omega-3 fatty acid or fish oil supplements causing pancreatitis in dogs, cats, or humans.

Theoretically, omega-3 fatty acids could prevent pancreatitis because of decreased blood triglyceride concentrations. An extremely high dosage of omega-3 fatty acids or a fish oil supplement in addition to a very high fat diet would likely be required to induce pancreatitis. An increased level of essential fatty acids compared to standard cat foods is one of the features of therapeutic kidney diets.

If you wish to give additional essential fatty acids, ask your vet if they are appropriate for your cat.

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