Poblanno Silva Francisco Manuel, Grant Caitlin Elizabeth, Ribeiro Érico de Mello, Verbrugghe Adronie
Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
Front Vet Sci. 2023 Dec 11;10:1215447. doi: 10.3389/fvets.2023.1215447. eCollection 2023.
A 4-year-old, female-spayed American Bulldog presented to the Ontario Veterinary College's Health Sciences Center's Clinical Nutrition Service for nutritional management of hepatic enzymopathy and suspected copper-associated hepatitis. Medical history revealed a 3-month history of gradually increasing serum ALT. Additional diagnostics included negative titters, normal bile acids, and laparoscopic liver biopsy. Histopathology findings were consistent with diffuse moderate vacuole hepatocellular degeneration, mild positive copper staining, mild chronic lymphoplasmacytic hepatitis both portal and central, and mild biliary hyperplasia. Hepatic copper quantification results were above normal ranges (630 μg/g dry tissue), but below those seen in familial copper-associated hepatitis (>800-1,000 μg/g dry tissue). The patient was prescribed ursodeoxycholic acid, recommended to be fed a homemade diet (HMD), and referred for a nutrition consult. Two days before the nutrition consult, serum ALT fell within the normal range. The body condition score was 5/9, with a good muscle condition score and the dog's appetite and body weight remained stable. Energy intake was appropriate for maintenance. Key nutrient levels of all diets reported were compared to industry standards (AAFCO, NRC, and FEDIAF). Diet history included a commercially available raw meat-based diet (RMBD), of unknown copper content; a high energy commercial dry food (HEC), with copper content higher than the maximum recommended by FEDIAF and immediately prior to nutrition consult the patient had been eating an unbalanced homemade diet (HMD1) for 4 weeks. HMD1 was low in copper and deficient in the hepatoprotectant nutrients vitamin E and zinc. As per the owner's preference and to accommodate the patient's unique nutritional needs, a homemade diet addressing key nutrients for liver disease was formulated (HMD2), with copper content just above the recommended minimum. The new diet was found palatable and the patient's body weight, body, and muscle condition scores remained unchanged. Two months after starting HMD2, all bloodwork values remained within the normal range, including ALT. The reduction of dietary copper content likely reduced serum ALT. However, unbalanced diets cause a risk of nutrient deficiencies and excess. This dog was maintained with no known adverse effects on a complete and balanced HMD diet with a moderately low copper content, moderate protein, and inclusion of hepatoprotective nutrients.
一只4岁已绝育的雌性美国斗牛犬因肝酶病和疑似铜相关肝炎的营养管理问题，被送至安大略兽医学院健康科学中心的临床营养服务部门。病史显示血清谷丙转氨酶（ALT）逐渐升高已有3个月。其他诊断结果包括滴度阴性、胆汁酸正常以及腹腔镜肝脏活检。组织病理学检查结果显示符合弥漫性中度空泡性肝细胞变性、轻度铜染色阳性、门静脉和中央静脉区轻度慢性淋巴细胞浆细胞性肝炎以及轻度胆管增生。肝脏铜定量结果高于正常范围（630μg/g干组织），但低于家族性铜相关肝炎中的所见水平（>800 - 1000μg/g干组织）。该患者被开了熊去氧胆酸，建议喂食自制饮食（HMD），并被转介进行营养咨询。在营养咨询前两天，血清ALT降至正常范围内。身体状况评分为5/9，肌肉状况评分良好，且狗狗的食欲和体重保持稳定。能量摄入适合维持身体状况。将报告的所有饮食的关键营养水平与行业标准（美国饲料管理协会、美国国家研究委员会和欧洲宠物食品工业联合会）进行了比较。饮食史包括一种铜含量未知的市售生肉为主的饮食（RMBD）；一种高能量商业干粮（HEC），其铜含量高于欧洲宠物食品工业联合会推荐的最大值，并且在营养咨询前患者已经食用不均衡的自制饮食（HMD1）4周。HMD1铜含量低，且缺乏肝脏保护营养物质维生素E和锌。根据主人的偏好并为满足患者独特的营养需求，制定了一种针对肝病关键营养物质的自制饮食（HMD2）——其铜含量略高于推荐的最低值。新饮食被认为可口，且患者的体重、身体和肌肉状况评分保持不变。开始食用HMD2两个月后，所有血液检测值包括ALT仍保持在正常范围内。饮食中铜含量的降低可能降低了血清ALT。然而，不均衡的饮食会导致营养缺乏和过量的风险。这只狗狗食用一种铜含量适中、蛋白质含量适中且包含肝脏保护营养物质的完整均衡的自制饮食，未出现已知的不良反应。
