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nutritional considerations section ii nutritional disorders ggrreegg jj hhaarrrriissoonn ddvvmm ddiippll aabbvvpp aavviiaann ddiippll eeccaammss ddeebbrraa mmccddoonnaalldd pphhdd bbsscc hhoonnss ii nutritional disorders can result from malabsorption a thread is ...

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          Nutritional Considerations
          Section II
          Nutritional Disorders
          GGRREEGG  JJ..  HHAARRRRIISSOONN,,  DDVVMM,,  DDiippll AABBVVPP--AAvviiaann,,  DDiippll EECCAAMMSS  
          DDEEBBRRAA  MMccDDOONNAALLDD,,  PPhhDD,,  BBSScc ((HHOONNSS  II))
          Nutritional disorders can result from malabsorption, a             thread is the history of a basic seed and table food diet.
          deficient diet, over-supplementation and/or overeating.            Generally, at presentation of a “sick” bird, the IDC
          Deficiencies and excesses of nutrients can both be harm-           patient exhibits pansystemic clinical signs that often
          ful to birds.                                                      include various behavioral problems. Typically though,
                                                                             the earliest clinical signs are reflected in the integument,
          Companion birds have been maintained for decades on                followed closely by the digestive system. Often birds are
          diets that, while nutritionally inadequate, support lim-           not presented for evaluation until the reproductive or
          ited breeding in a few species. While there are numer-             respiratory system is affected. Behavioral problems can
          ous publications regarding nutritional requirements of             be the proximal cause of veterinary presentation when
          agricultural species, captive passerine energetics and             other clinical signs have been missed or ignored.
          feeding ecology, there are few controlled scientific stud-
          ies on aviary and companion birds or their wild con-               The IDC can be initiated from a nutrient imbalanced
          specifics. Variations in lifestyle and breeding ecology            diet as well as from influences, such as improper hus-
          result in differing nutritional requirements. Clinically,          bandry, diet handling and storage or over-supplementa-
          many health problems are correlated with nutritional               tion of nutrients in formulated diets. Therefore, when
          disorders. This chapter will provide an overview of these          evaluating nutritional disorders, consider the composi-
          conditions observed in companion birds, with reference             tion of the diet eaten, as well as the stability or availabil-
          to anecdotal observations in a clinical context and sum-           ity of nutrients in that diet. Pathological influences such
          maries of nutrient implications that have been predomi-            as parasite infestation, metal toxicoses, malabsorption
          nantly studied in agricultural species. Specific studies of        syndromes, pancreatitis and gastroenteritis produce 
          companion and wild birds will be discussed. Parallels              clinical signs similar to those seen in IDC, and therefore
          may exist between the following description of the                 need to be ruled out (Table 4.2.2a).
          improper diet cascade and the metabolic syndrome of
          humans and rats.90b                                                The IDC is the result of improper nutrient utilization,
                                                                             usually from malnutrition that weakens the body
                                                                             immunologically and structurally. This can allow inva-
          TThhee  IImmpprrooppeerr  DDiieett                                 sion of low level pathogens or commensals of viral, bac-
          CCaassccaaddee  ((IIDDCC))                                         terial, or fungal origin.
                                                                             Recent research by Dr. M. Beck, University of North
                                                                                      15
          The ‘improper diet cascade’ (IDC) (Table 4.2.1) has been           Carolina , showed that when the host is affected by a
          postulated by the author (GJH) from decades of clinical            nutritional deficiency, the invading pathogen is affected
          experience, reports from pathologists and nutritionists,           as well. By sequencing the viral isolates recovered from
          as well as consultations with companies that produce               selenium-deficient mice, she demonstrated mutations in
          commercially formulated diets. The IDC expresses itself            the viral genome associated with increased pathogenesis
          in a highly individualistic fashion. The most common               of the virus affected by nutrient deficiency. Bhaskaram
                                                                                                                         Chapter 4 | NUTRITIONAL CONSIDERATIONS: SECTION II                       109
                         Table 4.2.1 || Improper Diet Cascade (IDC)
                                                                                              Nutritional Imbalance
                                                                                            MULTISYSTEMIC ABNORMALITIES
                          Cellular                                    Structural                                 Functional                                 Immunologic 
                          Impaired metabolism                         Metaplasia of columnar epithelium          Goblet cells mucin production              Commensal organisms normally
                                                                                                                 impaired                                   bound to mucus are not excreted
                          Altered cell wall permeability              Increased mucous viscosity                 Loss of cleansing ability of mucous        Relationship with commensal 
                                                                                                                                                            organisms disrupted
                          Cellular autointoxication                   Loss of normal collagen elasticity         Normal glandular production of vari- Bone marrow suppression
                          Change in GI pH (less acidic)                                                          ous systems suppressed                     Decreased IgA, decreased 
                                                                                                                                                            lymphocytes 
                          Chronic: eg,                                Chronic: eg,                               Chronic: eg,                               Chronic: eg,
                          • Hepatic lipidosis, fibrosis, cirrhosis    • Abnormal cilia                           • Diabetes mellitus                        • Secondary microbial infections
                          • Iron storage disease                      • Renal tubular nephrosis                  • Deposits of high density lipids in       • Increased susceptibility to 
                          • Irreversible degradation of retinal       • Follicular atresia                         vasculature                                 neoplasia
                             cones leading to blindness               • Cataract formation                       • Exocrine pancreatic insufficiency
                                                                      • Bone/muscle abnormalities                • Infertility, decreased hatchability of
                                                                                                                   chicks
                                                                                                                 • Secondary hyperparathyroidism
                                                                                         ABNORMALITIES OF SPECIFIC SYSTEMS
                          Integument               Gastrointestinal         Respiratory              Renal                   Endocrine                Reproductive             Cardiovascular
                          • Skin                   • Oropharyngeal          • Nares                  • Glomeruli             • Pancreatic             • Ovarian                • Vasculature
                          • Feathers               • Pancreatic             • Infraorbital sinus     • Renal tubules         • Thyroid                • Uterovaginal           • Myocardium
                          • Beak                   • Hepatic                • Syrinx                 • Ureters               • Parathyroids           • Testicular             • Air capillaries
                          • Nails                  • Intestinal             • Air sacs               • Urodeum               • Intestinal             • Cloacal                • Pericardium
                          • Fat deposits                                                                                     • Gonadal                • Egg abnormalities
                          Biochemical                                               Hematological                                             Behavioral
                          • AST, ALT                                                • Increased WBC                                           (see subsequent section)
                          • Bile acid                                               • Altered total WBC
                          • Glucose
                          • HDL, LDL, Triglycerides
                          • Cytokines
                         Table 4.2.2a | Commonly Encountered Etiologies of Improper Nutrient Intake or Utilization
                          Congenital                       Individual                       Complicating Factors            Rule outs that impair
                          Developmental                                                                                     digestion and/or
                                                                                                                            absorption
                          Improper parental diet           Provision of improper diet       Little or no sunlight           Pancreatitis or organ failure
                          Improper handfeeding diet        Consumption of improper          Lack of bathing                 Malabsorption syndromes 
                                                           diet
                          Weaned to improper diet          Improper diet supplemen-         Lack of exercise                Viral, bacterial, fungal, or
                                                           tation                                                           parasitic gastroenteritis 
                          Diet constituents interfere      Improper food                                                    Metal toxicosis 
                          with nutrient utilization        packaging/handling or
                                                           storage
          110 Clinical Avian Medicine - Volume I
          expanded this theory by showing that several micronu-
          trients such as vitamin A, ß-carotene, folic acid, vitamin                   Table 4.2.2b | Nutrient Deficiencies of Seeds
          B , vitamin C, riboflavin, iron and selenium could be                        The seeds most commonly fed birds, such as oats, corn,
            12                                                                         sunflower, safflower and millet, are generally missing 32
                                                        17
          involved in such a scenario in humans. These micronu-                        ingredients (from eight groups) needed to keep birds
          trient-compromised viruses can lead to the emergence                         healthy. These include:
                               17                                                      • Vitamins - choline, niacin, pantothenic acid, 
          of new infections.      This hypothesis was further
                                    61                                                   riboflavin (B ), cyanocobalamine (B ), biotin (H), D , E, K,
          advanced by Lavender , who showed that, at least for                                       2                       12              3
          RNA viruses, host nutrient deficiencies and excesses can                       and folic acid (M)
          influence the genetic make-up of the pathogen. The                           • Minerals - calcium, phosphorous (70% tied up as non-
                                                                                         digestible phytates in plant products, such as grains),
          majority of viruses are RNA viruses.61                                         sodium
                                                                                       • Trace minerals - selenium, iron, copper, zinc, man-
          The importation of wild caught psittacines has tradition-                      ganese, iodine, chromium, vanadium, bismuth, tin, boron
          ally involved weeks to months of stress including severe                     • Pigments - chlorophyll, canthaxanthin
          nutrient imbalance. Such birds imported into the USA in                      • Protein - (amino acids) lysine, methionine
          the 1970s and 1980s were a part of a pandemic of new                         • Fiber - (mucopolysaccharide) both soluble and insoluble
          viral diseases. Psittacine beak and feather disease,                         • Vitamin precursors - ß-carotene, converted to vitamin A
                                                                                         in liver
          proventricular dilatation disease and papillomatosis are                     • Omega 3 Fatty Acids
          three that still plague us. The research community has
          not adequately addressed the role of malnutrition in
          viral pathogenesis. It is interesting to ponder this                      ciency not seen on other seed-based diets. The composi-
          hypothesis in light of the new expressions of these same                  tion of commercially raised seeds differs dramatically
          viruses occurring in the European Union countries that                    from wild seeds (see Section I of this Chapter).
          still import wild-caught birds.                                           Birds do not exhibit nutritional wisdom when selecting
           II MMPPRROOPPEERR  DDIIEETT  FFOORRMMUULLAATTIIOONN                      dietary ingredients; they show a preference for high-
                                                                                    energy, lipid-rich seeds, high carbohydrate seeds and
          There is a general perception that ‘fresh’ is best.                       fruits. The advent of formulated foods has diminished
          However, presenting a bird with an array of fresh pro-                    the incidence of nutritional disorders in the author’s
          duce, seeds and nuts does not necessarily provide a                       (GJH) practice. Yet not all formulated diets are created
          nutritionally balanced diet. Commonly fed seeds are                       equal (Tables 4.2.2c-e). For example, products that offer
          deficient in a number of nutrients (Table 4.2.2b).  Much                  the opportunity for selecting favored food items are
          of the produce is sold in its immature state of growth,                   poorly formulated and can be just as imbalanced as a
          and even when mature, it does not have the equivalent                     seed-based diet in the end. 
          nutrient profiles of wild food items. Thus such produce
          is unable to improve the nutrient profile of the diet.                    The Association of Avian Veterinarians (AAV) formed a
                                                                                    committee of nutrition experts who developed a list of
          It is imperative that bird owners be informed of the                      recommendations to assist veterinarians and owners in
          nutritional inadequacies of such diets. In the wild,                      feeding pet birds (Table 4.2.2f).
          psittacines usually balance their diets by feeding on a
          variety of seeds and other plant parts. Primary issues of                 While some essential nutrients are higher in organically
          concern with captive diets are vitamin levels (vitamins A,                certified plant products, a diet composed solely of
          D, E, and K and the water-soluble vitamins—biotin and                     organic seeds will present as many nutritional problems
          B ) and minerals. Seeds do not contain vitamin A and                      as a diet solely composed of non-organic seeds.
            12
          are generally low in the vitamin A precursor ß-carotene.                  There are also the issues of diminished availability of
          Hypovitaminosis A is particularly prevalent in birds on                   some nutrients by interference from other nutrients and
          all-seed diets. Mineral levels of seeds can vary among                    potential breakdown of key nutrients.
          plant species as well as geographically, depending on the
          composition of the parent soil. Calcium is deficient in                   OOVVEERR--SSUUPPPPLLEEMMEENNTTAATTIIOONN
          most seeds and, while adequate phosphorous may
          appear to be present, up to 70% may exist in phytate                      Vitamin toxicity is an aspect of dietary management that
          form that is generally indigestible. Fatty acid composi-                  is frequently overlooked, but can be responsible for a
          tion will also vary among seed species and an imbalance                   number of clinical signs of a disease. Many commercially
          can be an important cause of a number of health issues.                   formulated products contain excessive levels of the fat-
          Many seeds provide adequate total protein but do not                      soluble vitamins A and D. The addition of vitamin sup-
          contain the complete set of essential amino acids. A diet                 plements with high concentrations of these two vitamins
          of predominantly millet seed will result in a lysine defi-                compounds that excess. The generally low levels of 
                                                                                                                           Chapter 4 | NUTRITIONAL CONSIDERATIONS: SECTION II                         111
                          Table 4.2.2c | Provision of Improper Diet - Common Presentations
                           Excessive quantity of seeds or nuts         Excessive percentage of fruits and          Excessive quantity of  "table foods"        Improper/excessive vitamin-mineral
                           provided (minimal vitamin A precur-         vegetables (deficient in essential          such as the carbohydrate rich pastas        supplementation
                           sors, lysine deficient, decreased vita-     amino acids and essential fatty acids, and breads (in addition to the afore-            Potential toxicities  Competitive
                           min E absorption, inverted Ca:P             contain excessive sucrose)                  mentioned deficiencies, these pro-          eg, vitamin A,D ,     nutrient absorp-
                           ratio, excessive calories)                  *Nutritional deficiencies vary widely       vide a medium for yeast overgrowth                            3
                                                                       between fruits and vegetables - see         in susceptible individuals)                 iron, selenium        tion, eg, exces-
                                                                       Figs 4.1.2, 4.1.3 and Tables 4.1.8,                                                                           sive fatty acids,
                                                                       4.1.9 in section 1)                                                                                           phytates, and fat
                                                                                                                                                                                     soluble vitamins 
                          Table 4.2.2d | Consumption of Improper Diet - Common Presentations
                           Formulated diet over-supplemented           Diet provided requires bird to con-          Supplements needed to balance diet
                           with vitamins (vitamin A) or minerals       sume all components to achieve bal-          are provided as a coating on food
                           (iron). Deficiencies: lysine, L-carnitine   ance                                         that is not entirely consumed 
                          Table 4.2.2e | Preparation, Packaging and Storage Problems of Formulated Diets
                           Problems in Preparation                     Packaging Concerns                           Improper Storage
                           Inclusion of raw soybeans, oats or                       Use of oxygen-                  Continued mycotoxin production 
                           brown rice. Cooking soybeans                         permeable packaging
                           improves the availability of methion-
                                         14b
                           ine & cystine    & destroys trypsin                        Oxidation →
                           inhibitors. Oats & brown rice are
                           high in lipase [break down fats to                           Rancidity
                           free fatty acids & lipoxygenase (oxi-
                                                                   43b
                           dizes fatty acids to hydroperoxides)]
                           Inclusion of mycotoxin producing            Exposure to light
                           agents
                           Poor quality control                        Insect contamination
                           Over cooking →                              Pesticide contamination                      Insect infestation (eg, transmission of
                           degradation of nutrients and                                                             Sarcocystosis)
                           conversion of cis to trans fatty acids
                           Addition of artificial coloring/dyes        Soft plastics may act as                     Degradation of nutrients
                           long term effects unknown                   phytoestrogens
                           Preservatives (such as ethoxyquin) may be toxic or teratogenic. However, in the absence of preservatives, proper
                           packaging and storage are imperative to maintain quality and prevent rancidity.
                          vitamin E in both commercial diets and vitamin supple-                                       quality control of source products is essential. The expo-
                          ments may exacerbate toxicity. Dietary supplementation                                       sure to oxygen, moisture and heat act with the catalysts
                          should be undertaken only if there is an extensive                                           naturally present in grains (iron, copper) to accelerate
                          knowledge of the nutrient composition of both the diet                                       the deterioration process at all stages of grain handling
                          and the supplement. The common clinical practice of                                          and product manufacturing.
                          injecting vitamins into sick birds may not be defensible,
                          especially if the bird has been on a formulated and/or                                       These lipolytic enzymes act on lipids to release free fatty
                          supplemented diet. See Section 1, Nutrition and Dietary                                      acids and triglycerides. In the presence of oxygen, heat
                          Supplementation for a more in-depth discussion.                                              and moisture, these fatty acids and triglycerides are auto-
                                                                                                                       oxidized or acted upon by enzymes (primarily stored in
                          RRAANNCCIIDDIITTYY                                                                           the germ) called lipoxygenases. Polyunsaturated fatty
                                                                                                                       acids (oleic, linoleic, and linolenic) are the most likely to
                          Altering tissue structure mechanically (hulling, grinding,                                   be oxidized, and they are usually the most abundant
                          and crushing in the case of vegetable matter or macera-                                      fatty acids in nuts and seeds.43b This oxidation process
                          tion in the case of animal tissue) releases lipases.                                         produces free radicals in a dark environment. A similar
                                                                                                                       but slightly different reaction occurs when exposed to
                          Grains damaged at harvest also allow this lipase release                                     light. Both reactions end with the production of lipid
                          to occur. Similarly, micro-organisms (fungal contami-                                        hydroperoxides which further break down, causing ran-
                          nants) contain lipases that cause hydrolysis of fats.43b So                                  cidity. This process is often self perpetuating, starting
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...Nutritional considerations section ii disorders ggrreegg jj hhaarrrriissoonn ddvvmm ddiippll aabbvvpp aavviiaann eeccaammss ddeebbrraa mmccddoonnaalldd pphhdd bbsscc hhoonnss can result from malabsorption a thread is the history of basic seed and table food diet deficient over supplementation or overeating generally at presentation sick bird idc deficiencies excesses nutrients both be harm patient exhibits pansystemic clinical signs that often ful to birds include various behavioral problems typically though earliest are reflected in integument companion have been maintained for decades on followed closely by digestive system diets while nutritionally inadequate support lim not presented evaluation until reproductive ited breeding few species there numer respiratory affected ous publications regarding requirements proximal cause veterinary when agricultural captive passerine energetics other missed ignored feeding ecology controlled scientific stud ies aviary their wild con initiated n...

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