The importance of muscle condition scoring in veterinary patients.
As veterinarians, one of the important parts of managing chronic cases not only good record keeping but attention to subtle changes in parameters such as weight or body condition. As part of our medical record keeping such parameters play an important role in our long-term patients and changes in either may be a subtle indication that out patients’ diet is not meeting their nutritional needs, or there has been a change in their condition, which may prompt further testing. There is more discussion now about the need to perform muscle condition scoring (MCS) in addition to body condition scoring (BCS), especially in our geriatric patients, or those with chronic medical conditions. Muscle condition scoring involves subjective evaluation of the patients’ muscle mass, including assessment of the musculature of the spine, scapula, ilium and head. Epaxial muscle wasting is often the first area in which muscle loss can be appreciated. The WSAVA provide charts on how to perform this particular test and the patient is then graded as normal, mild loss, moderate loss, or severe loss.
We know that with many chronic diseases and ageing in general, muscle loss leads to increased morbidity and mortality in our patients. A subtle loss in muscle condition in a patient with chronic disease may prompt further discussion with owners in regards to eating habits, caloric intake, food interest or other diets fed. Furthermore, it may prompt reassessment of the medical condition, or investigation of any potential co-morbidities.
While muscle condition scoring can be quite obvious and easy in the lean patient, MCS becomes particularly important in the patient with a normal to increased BCS. Muscle loss can be subtle in these patients but may alert the practitioner to changed condition within the patient.
Cachexia is a complex metabolic syndrome characterised by the loss of lean muscle mass associated with an underlying disease process (e.g. heart disease, kidney disease). Overall, chronic inflammation alters metabolic processes to promote catabolism. While sarcopaenia is defined as the loss of muscle mass associated with ageing in the absence of disease, many of these patients can have normal to increased body condition scores, and the loss of lean muscle mass is not always obvious. Upregulation of proinflammatory pathways are also thought to play a role, and the underlying approach to patients with cachexia and sarcopaenia can be similar.
From a nutritional standpoint, dietary considerations in patient with poor muscle condition includes the following:
- Omega 3 fatty acids:
-Down regulates pro-inflammatory pathways and promote anti-inflammatory pathways.
- L-carnitine:
-This promotes the use of fats (instead of amino acids) for the production of energy.
- Amino acid profile of the diet:
-Optimal availability of amino acids to be incorporated into proteins.
- Flavour enhancement in diet (e.g. E.A.T. technology) and the use of appetite stimulants:
-These help to promote increase in calorie intake.
Emily Cook BVSc (Hons I), FANZCVS (Small Animal Medicine)
Emily recently passed her Fellowship examinations in Small Animal Medicine after completing her residency training at the University of Queensland. She now works at the Animal Referral Hospital in Brisbane and enjoys all aspects of Internal Medicine.