Frequently Asked Questions about the Dietary Treatment of Feline Hepatobiliary Diseases

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Cats with liver disease often have a decreased appetite or are anorexic. How can they be stimulated to eat?

The diet must be highly palatable and high in energy, and provide adequate protein, fat, and all essential micronutrients. Slightly warming the food, and feeding small amounts frequently can increase palatability. Force-feeding is in most cases contraindicated since it can lead to learned food aversion. Tube feeding, initially via a nasoesophageal tube, may be required in cats that are anorexic, since correction and prevention of malnutrition are essential to provide the building stones for hepatic repair and regeneration, and to prevent or treat hepatic lipidosis.

How do you feed a cat diagnosed with idiopathic hepatic lipidosis?

The key to treatment of cats with hepatic lipidosis is to supply adequate nutrients in order to reverse increased peripheral fat metabolism and metabolic derangements. Since these cats are typically profoundly anorexic, this is done usually through a feeding tube (esophagostomy or gastrostomy tube) until their metabolism normalizes. Feeding a high quality, moderate to high protein diet until the cat begins to eat on its own again, in general after 2 - 6 weeks, is the most important aspect of treatment.

What is the role of antioxidants in the diet of a cat with liver disease?

There is mounting evidence that free radical production is increased in many liver diseases and that it can play an important role in initiating and perpetuating liver injury. Cats with liver disease, especially hepatic lipidosis, also appear to have decreased liver concentrations of the endogenous antioxidant glutathione, and thus may be at greater risk of oxidant damage to hepatocytes. The diet should therefore contain adequate to increased amounts of antioxidants such as vitamin E and S-adenosyl-methionine. A combination of dietary antioxidants is better than a single one, since they appear to act synergistically.

Do cats with liver disease need additional vitamins?

Stores of B-vitamins are often depleted in liver disease, and supplementation of B vitamins is suggested to improve appetite and cellular metabolism. Some cats with severe cholestatic liver disease will develop malabsorption of fat-soluble vitamins, and added vitamin E and K may be necessary as well.