Protein-losing enteropathy (PLE) is characterized by intestinal protein loss, often as a consequence of various intestinal disorders (eg, intestinal lymphangiectasia, chronic enteropathy). Therapies involve immunosuppressive agents and dietary modifications (ie, novel or hydrolyzed protein, fat restriction). Dogs with PLE carry a poor prognosis, with many becoming refractory to standard therapy. Recent studies have suggested that ultra-low–fat diets may be of benefit to dogs with PLE, especially those with intestinal lymphangiectasia.1-4
This retrospective study describes clinical characteristics of dogs with PLE (n = 33). Diagnosis of PLE was based on presence of hypoalbuminemia (albumin <2.6 g/dL) after exclusion of other causes of hypoalbuminemia. Dogs with concurrent disorders (eg, intestinal lymphoma, pancreatitis, hepatic dysfunction), with other causes of hypoalbuminemia (eg, renal protein loss), and/or that were lost to follow-up were excluded.
Of the 33 dogs, 27 received a homemade, boiled, ultra-low–fat diet as initial management. The diet consisted of 1 part skinless chicken breast and 2 parts rice or white potato without skin.4 Fat content was 0.35 g/100 kcal.
Response was defined as a decrease in clinical activity (see Suggested Reading), and responders were subclassified as complete (ie, normal serum albumin [≥2.6 g/dL], no requirement for additional prednisolone treatment) or partial (ie, only partial improvement in serum albumin and/or required additional prednisolone). Of the 27 dogs receiving the ultra-low–fat diet, 23 (85%) responded; of those, 12 were classified as complete and 11 as partial. Median duration to response was 15 days (range, 6-32 days). Responders had significantly lower clinical activity scores as compared with nonresponders. Survival times were longer in responders as compared with nonresponders.
After initial improvement, dogs were gradually transitioned (median, 47 days) to either a commercial dry low-fat (fat content, 2.03 g/100 kcal or 2.3 g/100 kcal) or hydrolyzed diet (fat content, 4.25 g/100 kcal) to prevent secondary nutritional deficiencies.