section epub:type=”chapter” id=”c0022″ role=”doc-chapter”> Martha Cline, Maryanne Murphy, Joseph W. Bartges, Angela Witzel-Rollins, Beth Hamper and Donna Raditic Many cat owners are sifting through information they find on the Internet (especially social media sites), in books, on television, or by word of mouth, and making their own dietary decisions. This chapter explores current controversial issues in feline nutrition by reviewing available research to help veterinarians make confident, informed recommendations to cat owners. cat; feline; nutrition; low-protein diets; carbohydrates; homemade diets; raw food diets This chapter explores current controversial issues in feline nutrition. By the end of this chapter, the reader will be familiar with the available research and should be able to make confident, informed recommendations (at least until the next new diet fad appears). A reduced protein intake is commonly recommended for management of chronic kidney disease (CKD) in cats to reduce nitrogenous wastes and proteinuria. The timing and necessity of reduced protein intake in cats to avoid protein malnutrition and loss of lean body mass (LBM) is controversial.1–3 Nitrogenous wastes can contribute to clinical signs associated with uremia and cause polyuria, polydipsia, and anemia. Proteinuria in cats is associated with the progression of CKD and decreased survival.4–6 Loss of LBM related to chronic illness, also referred to as cachexia, occurs in feline patients with CKD. Cachexia is associated with altered strength, immune function, wound healing, and overall survival although more specific research in cats is needed.7 In one study, cats with a body weight of <4.2 kg (9.2 lb) at the time of CKD diagnosis had a significantly shorter survival time compared to cats ≥4.2 kg (9.2 lb).8 Additionally, this study found that cats lost a median of 8.9% of body weight in the 12 months preceding the diagnosis of CKD and weight loss accelerated after diagnosis. While the topic of protein intake remains controversial, the optimal protein intake for cats with CKD is likely multifactorial depending upon patient factors, including the stage and substage, and a complete nutritional assessment as well as dietary factors including protein digestibility, amino acid profile, and other nutritional factors such as fiber content that can alter digestibility. Clinicians are also limited in their ability to assess the protein status of veterinary patients. Subjectively this can be done with muscle condition scoring (see Fig. 3.3). In cats, measurement of mean epaxial muscle height at the 13th thoracic vertebrae correlates (r = 0.65, P <0.001) with body weight; however, it has not been correlated with muscle mass, per se.9 Protein requirements in cats have traditionally been determined using nitrogen balance studies, wherein nitrogen loss is equivalent to nitrogen intake, and growth rates. The National Research Council (NRC) establishes a minimum requirement and recommended allowance (RA) for protein in cats.10 The minimum protein requirements are determined using purified diets with a high digestibility and bioavailability, therefore the NRC RA and Association of American Feed Control Officials (AAFCO) minimum requirement accounts for the use of nonpurified diets with lower digestibility and bioavailability.11 A study evaluated the protein requirement of healthy adult male cats based on the maintenance of LBM over a 2-month period.12 This study suggested that while 1.5 grams of protein/kg body weight was required for nitrogen balance, 5.2 grams of protein/kg body weight is recommended to maintain LBM. This demonstrates that nitrogen balance can be achieved on a low-protein diet, but it may be at the expense of LBM using endogenous proteins. While the results of this study suggest that further evaluation of protein requirements in healthy cats should be performed, these results should not be extrapolated into nutritional recommendations for cats with CKD without further investigation. Suboptimal protein intake is more likely to occur when caloric requirements are not met due to hyporexia or anorexia which commonly occurs in cats with CKD. Failure to meet energy needs and subsequent protein malnutrition can lead to loss of LBM, use of dietary protein for energy, and can increase the production of uremic toxins through protein catabolism. Therapeutic kidney diets (TKD) are recommended by the International Renal Interest Society (IRIS) to control serum phosphate levels in cats with stage 2 disease.13 In addition to being phosphorus restricted, TKDs have several characteristics, including a reduced protein and sodium content and added omega-3 fatty acids. The quality of evidence relating to dietary intervention for increased longevity and improved quality of life in cats is considered good in the International Society of Feline Medicine Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease14 and in an evidence-based review of the literature by BestBETs for Vets (Box 22.1). Several studies have compared the efficacy of TKDs to adult maintenance diets (AMD) in feline patients with IRIS stage 2 or higher CKD. In a double-blinded, randomized, controlled clinical trial, cats with spontaneous IRIS stage 2 and stage 3 CKD were fed either a TKC or AMD for 24 months.15 No cats fed a TKD experienced a uremic crisis or kidney-related death. Twenty-six percent of cats in the AMD group had a uremic crisis and approximately 22% of cats experienced a kidney-related death. A study of client-owned cats with spontaneous CKD found that cats fed a TKD had a median survival time of 633 days compared to 264 days for cats fed an AMD.16 A retrospective study comparing the efficacy of seven TKDs versus conventional diets in cats with CKD found the median survival time for cats on a conventional diet was 7 months versus 16 months for cats on a TKD.17 These studies demonstrate that TKDs can be used to improve quality of life by controlling signs of uremia and increasing lifespan by altering disease progression in cats. At this time, the protein content of TKDs exceeds the NRC RA and some may exceed the AAFCO minimum requirement (Table 22.1). Some pet owners perceive that feeding a TKD means feeding under the patient’s minimum protein requirement; however, this is not the case. Lower amounts of high-quality protein are also recommended. High-quality protein typically relates to digestibility. Reduced protein digestibility is reported to occur in some geriatric cats.18 Therapeutic kidney diets are formulated using known amino acid profiles and digestibility coefficients to ensure protein quality and nutritional adequacy. Introducing a TKD is recommended in patients with CKD before the clinical signs associated with uremia occur. Table 22.1 AAFCO, Association of American Feed Control Officials NRC, National Research Council. Currently, there is no definitive conclusion in the veterinary literature of which is better: a diet with moderate to high levels of protein and the remaining features of a TKD versus a reduced protein TKD. The answer to this question is likely dependent on IRIS stage and substage, as well as dietary factors. Evidence is lacking to support the premise that protein content, by itself, has a major effect on progression of CKD in the cat. Studies demonstrating improved survival of cats fed a TKD compared to an AMD are limited to those with confounding dietary variables such as phosphorus restriction. However, there is no evidence at this time that increasing dietary protein concentration above what is currently found in TKDs provides a clinical benefit. This area of controversy is hopefully one that will be further explored to optimize dietary strategies for feline patients with CKD. Cats are obligate carnivores that have naturally evolved to maintain blood glucose in the face of a low carbohydrate intake. The classic example of a low-carbohydrate feline diet is the rat carcass, which is 55% protein, 38.1% fat, 9.1% carbohydrate, and 1.2% fiber on a dry matter basis.19 Because cats are carnivores, the adaptation to a high-protein diet such as the rat carcass is necessary because adult cats require two to three times more protein than adult omnivores, and kittens require 1.5 times more protein than the young of noncarnivorous species.20 Cats also have constant hepatic glucose production from amino acids (gluconeogenesis) and a delay in dietary carbohydrate use (low glucokinase activity).21 The combination of the natural adaptation to a high-protein diet and delay in dietary carbohydrate use has shaped the argument that carbohydrates should make up a small fraction of the average domesticated cat’s diet. The one caveat to keep in mind regarding this argument is that most carbohydrates in pet foods are composed of complex carbohydrates, not simple sugars, as is common in processed human foods.22 This is an important distinction because diets high in sucrose and simple sugars are not efficiently metabolized in the cat, but complex carbohydrates used in processed pet foods can be fully metabolized. With a diet high in carbohydrates, blood glucose rises, causing an increase in insulin requirements. Lipoprotein lipase activity increases as more glucose enters adipose cells for conversion into fatty acids, with subsequent storage as fat. With a low-carbohydrate diet, blood glucose and insulin levels are lower and enzyme pathways are altered to conserve glucose, limit gluconeogenesis from amino acids (to conserve body proteins) and mobilize fats. There is higher fat and protein consumption, and higher protein levels are needed to support increased hepatic gluconeogenesis. The hepatic glucose production is responsible for a slow and steady rate of glucose release into the bloodstream, maintaining a consistent glucose level.23 In healthy, neutered male cats fed to maintain body weight, urea production and leucine oxidation were three times greater in cats fed a 65% crude protein diet when compared with those fed a 15% crude protein diet and 1.6 times greater in cats fed a 40% crude protein diet when compared with those fed a 15% crude protein diet.24 Leucine oxidation was 59% in cats fed 65% crude protein when compared with 39% in cats fed 40% and 15% crude protein. Cats fed 65% crude protein were in a positive nitrogen balance compared with those fed 15% crude protein. These results suggest that the high protein requirement of cats combined with a low rate of whole-body protein synthesis ensures that an obligate demand for amino acids for energy or glucose (or both) can be met with a diet high in protein with very little or no carbohydrate.24 It appears that domestic cats, when given the choice, select for a macronutrient profile (52% of metabolizable energy [ME] from protein) similar to the diet of wild cats.25 This concept is the basis of the Atkins diet for people, with the idea that low dietary carbohydrate will cause a shift in metabolic drive from glucose oxidation to fat metabolism as the primary energy source. This leads to a lower serum glucose and limited drive for insulin secretion from the pancreas. The purported benefits of this low-carbohydrate, high-protein diet in people are appetite control, increased calorie loss by way of futile cycling and ketone loss, improved insulin sensitivity, shift from glucose oxidation and lipogenesis to lipolysis, and weight loss.26 Whether discussing the low-carbohydrate concept in cats or people, it is important to keep in mind that fat, protein, or both must increase to account for the loss of energy that would have been provided by carbohydrates.23 Several published reports (Table 22.2) have evaluated the implications of replacing a low-carbohydrate diet with one higher in fat. One of these studies found that during growth, fat deposition was 2.5 times greater when a high-fat (HF) diet was fed to mice and fat deposition was lower in the high-carbohydrate (HC) group.27 Total fat deposition in cats is less when a HC diet is fed compared with a HF diet.22 In one study, healthy cats were fed three dry diets: low-carbohydrate, high-protein; HC, HF; and HC, high-fiber. The low-carbohydrate, high-protein diet resulted in a lower postprandial serum glucose concentration over a short period of time (10 hours) compared with preprandial levels, but it also resulted in twice as much postprandial insulin as the HC, high-fiber diet over the same period.28 This effect may have been due to the low-carbohydrate, high-protein diet’s higher fat content, which can lead to insulin resistance, or its higher arginine level, which also increases insulin secretion in cats.28 In another study, healthy cats consuming a very high-protein and low-starch diet and a high-protein and moderate-starch diet had lower fructosamine and mean and peak glucose concentrations than when they consumed moderate-protein and high-starch diets.29 In nondiabetic obese cats fed a diet supplemented with glucose, maltose, corn starch, and trehalose, differences were observed in postprandial glucose, insulin, and nonesterified fatty acid area under the curve (AUC) with the highest postprandial glucose and insulin AUC associated with consumption of glucose and maltose and lowest with consumption of trehalose, although trehalose was also associated with a higher incidence of adverse effects.30 In a study of 39 cats, four foods formulated to provide 24% to 53% of ME as protein and 11% to 43% as carbohydrate with fat providing 36%, it was found that cats voluntarily regulated their macronutrient intake to attain an overall diet composition providing 53% of ME as protein and 11% as carbohydrate.31 The protein contribution corresponded to approximately 6 grams of protein/kg body weight/day and the high protein/low carbohydrate diets were eaten preferentially over the low-protein/high-carbohydrate foods. Furthermore, when low-protein/high-carbohydrate diets were offered, cats limited their food intake to a carbohydrate intake less than 3 grams of carbohydrate/kg body weight/day. In a prospective randomized study, three groups of cats were fed diets high in either protein (46% of ME), fat (47% ME), or carbohydrate (47% ME). Glucose and insulin were measured during glucose tolerance, ad libitum, and meal-feeding tests.32 Regardless of the feeding pattern, cats fed the HC diet had 10%–31% higher peak and mean glucose compared with both other diets; peak glucose in some cats reached 10.4 mmol/L (188 mg/dL) in cats fed 47% ME carbohydrate and 9.0 mmol/L (162 mg/dL) in cats fed 23% ME. Thus, HC diets increase postprandial hyperglycemia in healthy cats compared with diets high in fat or protein, although energy intake is lower.32 Diet has an effect on the gastrointestinal microbiome in cats and it has been shown that there are changes not only in the microbiome but also in metabolic profiles between kittens fed a high-protein, low-carbohydrate diet and a moderate-protein, moderate-carbohydrate diet.33 Table 22.2 HC, High carbohydrate; HF, high fat; HFb, high fiber; HP, high protein; LC, low carbohydrate; LF, low fat; LFb, low fiber; LMC, low to moderate carbohydrate; MC, moderate carbohydrate; MHC, moderate to high carbohydrate. aCaloric density of diets was not provided in study so dry matter calculations were made with the assumption of a 4000 kcal metabolizable/kg dry matter diet. The problem with a direct cross-correlation of these studies is that the diets varied in more than just the protein, fat, and carbohydrate content in that they were formulated by different manufacturers with different base ingredients. Thiess and colleagues studied isonitrogenous diets in healthy male cats to diminish unwanted variation between diets.34 A HC diet was compared with a HF diet (see Table 22.2), resulting in a slightly elongated glucose clearance and decreased acute insulin response to glucose administration. These results suggest diminished pancreatic insulin secretion, beta cell responsiveness to glucose, or both, with a HF diet.34 Backus and colleagues also limited for unwanted variability between experimental diets.35 The researchers studied 24 cats before and after gonadectomy with ad libitum feeding of one of four diets differing in carbohydrate content (see Table 22.2). Any difference in carbohydrate content among the diets was replaced with fat, whereas the same protein level remained across all diets. Metabolizable energy intake and body weight increased in all groups after gonadectomy, especially in females. The highest-fat diet (64% ME)/lowest-carbohydrate diet combination was associated with weight gain and increased insulin concentration, potentially indicating a risk factor for insulin resistance and subsequent diabetes mellitus (DM). It is possible that less insulin resistance will be seen when feeding a high-protein diet because of increased heat production. Hoenig and colleagues noted increased heat production in lean cats consuming isocaloric amounts of a high-protein diet compared with those consuming a HC diet (see Table 22.2).36 A long-term study is necessary to investigate whether cats with the same caloric intake develop less obesity and show less insulin resistance when fed a high-protein diet compared with a HC diet. Canned food typically contains fewer carbohydrates, but specific differences between outcomes of feeding canned carbohydrates versus dry carbohydrates have not been studied. Despite this lack of data, many veterinarians now recommend that cat owners feed canned diets exclusively to limit carbohydrate intake. Most domesticated cats are neutered, which, as previously discussed, is associated with decreased metabolic rate and increased food intake. In surveys, owners are more likely to provide cats with dry food ad libitum rather than feed a specific amount of food in discrete meals, as they would with canned food.22 Some veterinarians have expressed the concern that dry food may be a risk factor for development of obesity and DM. A survey-based study of 96 diabetic cats versus 192 matched controls showed indoor confinement and physical inactivity are risk factors for DM, not the proportion of dry food consumed.37 Obesity is one of the most prevalent conditions affecting domestic cats worldwide, which has led to widespread interest in nutritional intervention to limit its occurrence. Epidemiologic data have suggested that HF, rather than HC, foods play a role in obesity.38 Further data show that total energy intake affects weight change in cats, with HF diets promoting excessive calorie intake, not HC content.22 Crossover research was conducted involving 12 lean and 16 obese neutered cats fed either a HC (38.1 grams/100 grams) or a high-protein (45.2 grams/100 grams) diet each for 4 months to maintain weight (see Table 22.2). After this 8-month period, obese cats remained on their current experimental diet and intake was decreased to obtain approximately 1.5% body weight loss weekly to return to original lean weight. When obese cats on the high-protein diet lost weight, it comprised more total fat loss than for cats on the HC diet, but both groups lost the same total amount of weight. It was noted that obesity, not protein or carbohydrate level of the diet, led to severe insulin resistance and a marked decrease in glucose effectiveness. The authors calculated each kilogram increase in weight led to approximately 30% loss in insulin sensitivity and glucose effectiveness, which is instrumental in DM development.36 In another study using 24 group-housed adult cats, HC versus low-carbohydrate diets from different manufacturers were fed (see Table 22.2). Body condition and energy intake, not type of diet, influenced weight, but the cats were group housed and individual energy intake was not assessed.39 Healthy cats fed a high-fat (HF) diet (30% fat and 26% carbohydrate as fed) experienced a significant increase in body fat (P = 0.001) and body weight (P = 0.043) in contrast to cats consuming the HC diet (11% fat and 47% carbohydrate, as fed) that experienced no change in body fat or body weight throughout the study.40 Overall, energy expenditure was similar between diets and respiratory quotient declined with exposure to the HF diet consistent with fat metabolism and increased with exposure to the HC diet consistent with carbohydrate metabolism. There was no difference in insulin sensitivity as an overall effect of diet. Overall, cats appear to be able to adapt to dietary macronutrient content.40 In another study of healthy cats fed ad libitum a high-protein/low-carbohydrate diet (HPLC, 23% and 47 of ME) or a low-protein/HC diet (LPHC, 51% and 21% ME), postprandial glucose and insulin concentrations were highest with consumption of the HPLC diet but it was also associated with greater weight gain.41 As mentioned previously, it is difficult to make direct correlations among studies because of the variation in ingredients used and final macronutrient composition of the diets. The data do, however, shape an argument that the amount of calories fed is inherently more important in weight gain with potential predisposition to DM than the specific nutrient composition of the food. The goals of nutritional management of DM are to blunt postprandial hyperglycemia, control body weight, support altered nutrient needs, improve peripheral insulin sensitivity, avoid diabetic complications, coordinate peak nutrient uptake, and achieve diabetic remission when possible.23 To achieve these goals, using the metabolic adaptations mentioned in the preceding section, it has been hypothesized that a low-carbohydrate diet (<10% to 20% dry matter) is best.19 Multiple authors have reported improved glycemic control in healthy and diabetic cats fed low-carbohydrate (<15% dry matter) diets (see Table 22.2).42–44 Weight control and subsequent improved insulin sensitivity are also critical to the success of low-carbohydrate food.23 In one study, obese cats were fed four commercial dry diets including Hill’s Prescription Diet c/d Feline (general use diet: moderate protein, moderate fat, HC, low fiber), Hill’s Prescription Diet m/d Feline (DM diet: high protein, HF, low carbohydrate, high fiber), Hill’s Prescription Diet w/d Feline (DM diet: high protein, low fat, HC, high fiber) and Royal Canin Veterinary Diet Feline Diabetic (DM diet: high protein, low fat, low carbohydrate, high fiber).45 A significant reduction (10%–13%) in postprandial glucose AUC was observed with the Hill’s m/d and Royal Canin Diabetic diets, which both contained lower concentrations of carbohydrates than the Hill’s c/d diet. An accompanying significant reduction (30%–36%) in postprandial insulin AUC was also observed with the three DM diets, which all had higher amounts of fiber, as compared with the Hill’s c/d diet. Lastly, a significant increase (32%–65%) in postprandial, nonesterified fatty acids AUC was observed with the Hill’s m/d and Royal Canin Diabetic diets as compared with the Hill’s c/d diet. Therefore, dietary amounts of carbohydrates and fiber, as opposed to protein content or dietary fat, appear to have a significant impact on postprandial glycemia and subsequent insulin requirement levels in obese cats.45 In another study, feeding a low-carbohydrate canned food to 18 diabetic cats with or without acarbose (an α-amylase inhibitor) resulted in declines of blood glucose and serum fructosamine levels along with exogenous insulin requirements. More than 60% of cats fed the low-carbohydrate food reverted to a nondiabetic state.44 Low-carbohydrate versus high-fiber, HC diets were studied in 63 cats with naturally occurring DM. Within 4 months of diet change, approximately 68% of cats consuming low-carbohydrate diets and 41% of cats in the high-fiber group discontinued insulin, but none of the cats that had been diabetic for longer than 36 months reverted to a non–insulin-dependent state. The authors concluded that diabetic cats fed low-carbohydrate foods are three times more likely to discontinue insulin and revert to a nondiabetic state.42 To the authors’ knowledge, there are currently no published studies showing a benefit to feeding less than 12% (dry matter) of dietary calories as carbohydrate, which is the level in the aforementioned study. It is also interesting to note the similarity of 9.1% dry matter to the carbohydrate content of the average rat carcass. Both aforementioned studies used variations in carbohydrate and fat in their diet formulations. Because fat is known to increase insulin resistance and decrease glucose tolerance, Thiess and colleagues suggested that it is logical to replace carbohydrates with protein. Anecdotal evidence that a high-protein diet leads to improved glucose homeostasis and lowering of insulin requirements was not found, insofar as the diet had no effect on insulin sensitivity.34 The research team did find that the high-protein group exhibited significantly higher heat production, which may have eventually led to decreased food intake. Further study into this subject is warranted before making such conclusions. Diabetic ketoacidosis (DKA) can be a complication of uncontrolled DM. The production of β-hydroxybutyrate is favored in cats with increased fat metabolism. However, urine ketone sticks react only with acetoacetate and acetone, so a positive reaction is not seen until ketones increase significantly, as with uncontrolled DM. Low-carbohydrate food improves weight loss and increases blood ketone levels because these diets also invariably have a higher fat level. It is important to keep in mind that diet-mediated ketosis is minimal compared with poor diabetic regulation, meaning that a positive urine ketone stick should not be considered a result of a low-carbohydrate diet.23 Any condition requiring protein or fat restriction should be carefully considered before recommending low-carbohydrate diets. This includes renal disease, severe hepatic disease, hepatoencephalitis, and possibly pancreatitis. Diet recommendations for cats with pancreatitis are somewhat controversial, with some experts advising moderate protein, low-fat, HC diets and others calling for high-protein, HF, low-carbohydrate diets.23 In a study using three isoenergetic homemade diets (low-protein versus low-fat versus low-carbohydrate), effects on glucose and insulin response were evaluated. Every 3 weeks, nine lean cats were exposed to one of three diets in a Latin square design until all cats had consumed each diet. There was no difference in glucose levels among diets. Although all diets did exhibit a bimodal insulin peak, the second peak insulin was delayed with the low-carbohydrate diet (45% dry matter protein, 48% dry matter fat). If followed long-term, this diet may have led to an insulin-resistant state that could have produced beta cell exhaustion. The authors also suggest the effect of carbohydrate on insulin sensitivity might be a U-shaped response in which extremely low- and extremely HC levels cause diminished insulin sensitivity. It is possible that a long-term evaluation of both diet conditions would exhibit eventual beta cell exhaustion.46 Another thought-provoking study examined kittens fed diets differing only in carbohydrate and protein content while in utero and after weaning during growth. Although the difference was not significant, kittens fed the high-protein diet tended to have a higher total average physical activity level. This trend may be related to the high thermal effect of protein consumption in lean cats noted by Hoenig and colleagues. The kittens fed the high-protein diet also tended to have more LBM compared with the kittens receiving the HC diets, but there was no difference in body fat mass between groups at 8 months of age. The trends lend themselves to a conclusion that food intake had greater influence on body composition than dietary macronutrient composition.47 It will be interesting to compare results from these cats as adults in the future. Will the HC group become more obese than the high-protein group, or will long-term follow-up dispel all our current thoughts on cats and carbohydrates? As of this writing, there is still not enough concrete evidence to mandate the ideal carbohydrate content of a domestic cat’s diet. Although cats are obligate carnivores requiring meat-containing diets to provide all the essential dietary nutrients, they are also able to effectively metabolize complex carbohydrates. Certain metabolic conditions will necessitate limited protein or fat with an unavoidable increase in dietary carbohydrate. The burden is still on the veterinarian’s shoulders to consider each individual patient and determine the ideal nutritional strategy depending on that patient’s life stage and disease status. At this point it should be possible to reach a consensus that total energy consumption and weight management are paramount for both prevention of DM and induction of diabetic remission along with overall health. Perhaps in the future, when more long-term studies are published, there will be a standard recommendation for macronutrient composition of the average healthy cat’s diet. For now, it seems wise for the veterinarian to focus on helping the cat achieve a lean body weight rather than concentrating on the carbohydrate content or on whether the food is coming from a can or bag. Cat owners may want to prepare meals for their pets in their own home for several reasons that fall in the following general categories:
Current Controversies in Feline Nutrition
Abstract
Keywords
INTRODUCTION
CHRONIC KIDNEY DISEASE AND REDUCED DIETARY PROTEIN
Meeting Protein Requirements in Cats
Efficacy of Therapeutic Kidney Diets
Dietary Protein in Therapeutic Kidney Diets
Protein (grams/1000 kcal)
NRC Minimum Requirement
40
NRC Recommended Allowance
50
AAFCO Minimum Requirement
65
Therapeutic Kidney Diets
58–82
The Bottom Line
CATS AND CARBOHYDRATES
Fate of Carbohydrates in the Cat
Hoenig et al. 2007
Mazzaferro et al. 2003
Thiess et al. 2004
Michel et al. 2005
Bennett et al. 2006a
Backus et al. 2007
Frank et al. 2001
Verbrugghe et al. 2010
HC
HP
LC
HC
HF
HC
LC
MC, HFb
LC, LFb
LC
LMC
MHC
HC
HFb
HP
LP
LF
LC
Protein
31
48
49
37
50
39
63
46
42
47
41
36
33
42
57
19
32
30
Fat
18
17
36
15
30
10
20
19
24
40
24
12
4
17
24
12
8
13
Carbohydrate
43
26
7
40
13
44
16
30
14
4
27
45
56
24
8
19
16
4
Crude fiber
1
1
—
2
1
7
1
12
0.4
—
—
—
—
11
4
0.2
0.2
0.3
Dashes (—) indicate information not provided in referenced study.
Canned Versus Dry Carbohydrates
Clinical Disease Concerns
Obesity
Diabetes Mellitus
Contraindications for Low Carbohydrate Diets
The Bottom Line
HOMEMADE DIETS
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