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INTRODUCTIONThere are limited descriptive data on dogs and cats receiving homemade or non-commercially prepared (NCP) diets. Available data focuses primarily on the prevalence of this feeding practice, which reports that less than 3% of pet owners in the United States and Australia were exclusively feeding NCP diets (Laflamme et

al. 2008). Interestingly, this study also found that 10% of dogs and 3% of cats received at least half of their daily calories from NCP sources. The specific demographics of this subset of pets from the study, which covered all types of feeding practices, were not specified. It is also unknown how many of these pets were receiving a NCP food for

therapeutic reasons. NCP diets may address particular medical needs not met by over-the-counter and/or commercially prepared (CP) therapeutic foods. The purpose of this study was to summarize information about canine and feline patients for which NCP diets were created by veterinarians using the online formulation software, Balance IT®a.

MATERIALS & METHODSThe Balance IT® online formulation software generates custom NCP recipes based on user-entered pet or patient information, user-selected preferred human foods, and a series of algorithms. During the recipe generation process pet or patient information is collected and stored in a centralized structured query language (SQL) database. Information about canine and feline patients entered by veterinarians and used to create recipes for NCP diets between June 7, 2007 and March 5, 2012 was retrieved from the database and

summarized. Patient species, age, gender, neuter status, weight, body condition score (BCS), and up to three concurrent medical conditions were extracted. The geographic location of the veterinarian creating the recipe was also retrieved.

Data were summarized using commercially available softwareb. Summary statistics and proportions were calculated on a per recipe and a per pet basis and were broken out by species and state/province. Proportions per state or province were compared with

the overall averages for North America by testing the null hypothesis that the state or province proportion was equivalent to the overall proportion and the z-statistic was calculated to determine the p-value. A difference was considered significant if the one-sided p-value was less than the cutoff for that particular test. The cutoff (sig. cutoff) was chosen using the Bonferroni correction to control for the error over all of the states/provinces being compared to the overall average for that particular test.

RESULTSA total of 20,152 recipes were generated representing 6,337 visits to the site and 5,609 unique patient-veterinarian combinations, of which 88.2% were for dogs and 11.8% were for cats. The average patient age was 7.8 yr for dogs and 10.4 yr for cats. Neutered females represented 47% of patients, while 45% were neutered males. These proportions were similar for cats and dogs except that neutered male cats were slightly overrepresented (56% of cats). The average weight of dogs was 16.9 kg and of cats 4.9 kg with average BCSs of 5.0/9 and 4.8/9, respectively.

The most common conditions for dogs were adverse reactions to food (ARF; 15.7%), advanced renal disease and/or protein losing nephropathy (9.2%), and early renal disease (5.8%), and for cats were renal disease (25.2%), ARF (23.1%), and “low carbohydrate” (6.5%; FIGURES 1 & 2). Seventeen percent of animals had multiple conditions.

Veterinarians in North America created 97.1% of the recipes. Veterinarians in North Carolina, Pennsylvania, Oregon,

Massachusetts, New York, Washington, California, Delaware, Idaho, Minnesota, and the District of Columbia were significantly more likely to create NCP recipes for dogs compared to North America as a whole (sig. cutoff 0.00116; FIGURE 3). There were no statistically significant geographical differences for the likelihood of a veterinarian creating a NCP feline recipe (FIGURE 4).

For the two most common health conditions that were analyzed, there were significant geographical differences in frequency. Veterinarians in Alaska, Iowa, Kansas, Montana, Nova Scotia, South Carolina, Utah, Victoria British Columbia, West Virginia, Idaho, Hawaii, Oklahoma, and Arizona were less likely to create recipes for dogs with adverse reactions to food compared to other US states/areas and Canadian provinces (sig. cutoff 0.000847; FIGURE 5). Veterinarians in Florida, Idaho, District of Columbia, Kentucky, Montana, Nebraska, Nova Scotia, Prince Edward Island, Rhode Island, South Carolina, South Dakota, and West Virginia were less likely to create

recipes for dogs with advanced renal disease compared to other US states/areas and Canadian provinces (sig. cutoff 0.000847; FIGURE 6). Veterinarians in Indiana, Kansas, New Mexico, Victoria British Columbia, and Outside of North America were more likely to create recipes for cats with renal disease compared to other regions. Veterinarians in Minnesota, Alaska, Connecticut, Iowa, Idaho, Massachusetts, Manitoba, Missouri, Montana, New Hampshire, Nova Scotia, Nevada, Prince Edward Island, Utah, and Vermont were less likely to create recipes for cats with renal disease compared to other regions (sig. cutoff 0.001; FIGURE 7). Veterinarians in Indiana, Missouri, Montana, Nevada, and South Carolina were more likely to create recipes for cats with adverse reactions to food compared to other regions. Veterinarians in North Carolina, Alaska, Arizona, Delaware, Iowa, Kansas, Manitoba, New Hampshire, New Mexico, Nova Scotia, Prince Edward Island, Utah, and Victoria British Columbia were less likely to create recipes for cats with adverse reactions to food compared to other regions (sig. cutoff 0.001; FIGURE 8).

CONCLUSIONThis study summarizes the demographics of canine and feline patients used to generate recipes for NCP diets by veterinarians through Balance IT®, a commonly used online formulation software program. There are regional differences in the likelihood that a veterinarian will create a recipe for a NCP diet. It is unclear if these differences relate to different software use patterns, different use of recipes, and/or geographic differences in patient conditions. Additional study is needed to further define potential

differences in software resource awareness, therapeutic approach preferences of veterinarians, and regional differences in condition prevalence.

Recipes for NCP diets seem to be considered more frequently for certain conditions. This may reflect the enhanced flexibility that NCP diets provide. For example, when tolerated and/or novel CP options are exhausted, alternative foods can be used to create NCP diets that

are appropriate for patients with adverse reactions to food. Similarly, as learned aversions develop with renal disease progression, NCP diets may provide food options or combinations that can help improve food intake and maintenance of an appropriate BCS. One limitation of this study is a lack of knowledge of the actual use and effectiveness of NCP diets; further studies are needed to explore this important aspect of this therapeutic modality.

REFERENCESAVMA. U.S. Pet Ownership & Demographics Sourcebook. 2007 ed. Schaumburg, IL: American Veterinary Medical Association.

Laflamme DP, Abood SK, Fascetti AJ, Fleeman LM, Freeman LM, Michel KE, Bauer C, Kemp BL, Doren JR, and Willoughby KN. “Pet feeding practices of dog and cat owners in the United States and Australia.” JAVMA 2008; 232(5):687-94.

aVet Express subsite of BalanceIT.com, DVM Consulting, Inc. bExcel, Microsoft, Inc.

Population demographics of patients receiving homemade diets.

“Balance IT” is a registered trademark of DVM Consulting, Inc. Patents pending.

Proportion of Canine Patients with Adverse Reactions to Food

0.00 0.01 - 0.25 0.26 - 0.35 0.36 - 0.50 0.51 - 1.00

Proportion of Canine Patients with Advanced Renal Disease

0.00 0.01 - 0.25 0.26 - 0.35 0.36 - 0.50 0.51 - 1.00

Canine Patients per 100,000 Dogs

0.0 - 2.5 2.6 - 5.0 5.1 - 12.5 12.6 - 25.0 25.1 - 105.0

Proportion of Feline Patients with Renal Disease

0.00 0.01 - 0.25 0.26 - 0.35 0.36 - 0.50 0.51 - 1.00

Proportion of Feline Patients with Adverse Reactions to Food

0.00 0.01 - 0.25 0.26 - 0.35 0.36 - 0.50 0.51 - 1.00

Feline Patients per 100,000 Cats

0.0 - 0.5 0.6 - 1.0 1.1 - 1.5 1.6 - 2.5 2.6 - 20.0

FIGURE 3. Number of canine patients for which a NCP diet recipe was generated per 100,000 dogs based on 2007 Edition of the AVMA U.S. Pet Ownership & Demographics Sourcebook

FIGURE 6. Geographic proportion of entered canine patients with advanced renal disease

FIGURE 4. Number of feline patients for which a NCP diet recipe was generated per 100,000 cats based on 2007 Edition of the AVMA U.S. Pet Ownership & Demographics Sourcebook

FIGURE 7. Geographic proportion of entered feline patients with renal disease FIGURE 5. Geographic proportion of entered canine patients with adverse reactions to food FIGURE 8. Geographic proportion of entered feline patients with adverse reactions to food

Sean J. Delaney, DVM, MS, DACVN1, Rebecca Garabed, VMD, MPVM, PhD2,3, Aniel M. Santos, BS1, Jennifer A. Larsen, DVM, PhD, DACVN1,4

1Davis Veterinary Medical (DVM) Consulting, Inc., Davis, CA, 2College of Veterinary Medicine, The Ohio State University, Columbus, OH, 3Public Health Preparedness for Infectious Diseases Program, The Ohio State University, Columbus, OH, 4School of Veterinary Medicine, University of California, Davis, Davis, CA

FIGURE 1. Canine conditions as a proportion of all entered conditions for dogs used to generate a recipe for a NCP diet

FIGURE 2. Feline conditions as a proportion of all entered conditions for cats used to generate a recipe for a NCP diet