Relationship between plasma insulin and triglyceride concentrations in hypertriglyceridaemic donkeys

Refeeding syndrome in a miniature donkey

OBJECTIVE

To describe refeeding syndrome in an equid without a history of recognized risk factors.

CASE SUMMARY

Refeeding syndrome with marked hypophosphatemia developed in an aged miniature donkey gelding during treatment of suspected enterocolitis. Hypophosphatemia (manifested clinically as ileus and neuromuscular weakness) developed despite a short (3 day) history of hyporexia, increased body condition (7/9), and adherence to nutritional recommendations for critically ill equids. Nutritional support included nasogastric enteral feeding with a commercial equine nutrition product claiming to provide 100% of the National Research Council's daily recommended protein, vitamin, and mineral requirements for equids. Hypophosphatemia developed despite this enteral supplementation and was ultimately corrected by intravenous administration of sodium phosphate solution.

NEW OR UNIQUE INFORMATION PROVIDED

This case report suggests that risk factors for refeeding syndrome in equids may be broader than previously recognized. Specifically, critically ill equids at risk for insulin dysregulation may have unique nutritional co-morbidities and requirements. This report highlights the need for both broader recognition of risk factors for refeeding syndrome, and revised best-practice nutritional guidelines and supplementation products to improve equine critical care.

Energy hormone response to fasting-induced dyslipidemia in obese and non-obese donkeys

Metabolic and endocrine disorders, such as dyslipidemia, are common in donkeys. Negative energy balance due to fasting, stressful conditions, or disease is a major trigger for fat mobilization often leading to dyslipidemia. The hormonal response to fasting has not been well characterized in donkeys. Therefore, this work aimed to study variations in insulin, glucagon, leptin, total adiponectin, ghrelin, and insulin-like growth factor-1 concentrations, insulin-to-glucagon (IGR) and glucagon-to-insulin (GIR) molar ratios, and lipid and carbohydrate parameters during a 66 h fasting period in 8 adult donkeys, and to determine differences depending on body condition. Obese donkeys developed earlier lipid mobilization (increased plasma total triglyceride and total cholesterol concentrations) compared to non-obese donkeys. Plasma glucose and leptin concentrations decreased in obese animals. After 60 h fasting, obese donkeys showed a significant increase in glucagon and decrease in leptin. GIR significantly increased, while insulin and IGR decreased in both groups. These findings support faster lipid mobilization in response to negative energy status in obese donkeys during fasting, which could be linked to greater glucagonemia and could explain the predisposition of these animals to dyslipidemia.

Donkey Internal Medicine—Part I: Metabolic, Endocrine, and Alimentary Tract Disturbances

Metabolic and endocrine disturbances are common in donkeys. This species has an inherent ability to thrive with limited and poor-quality roughage. Donkeys are extremely efficient in energy storage and mobilization, which predisposes to hyperlipemia, obesity, and metabolic syndrome. The prevalence of dyslipidemias is higher in donkeys than other equids, which is more evident under stressful conditions. Diagnosis of endocrine and metabolic disorders in donkeys should be based on species-specific information considering that differences in a multitude of variables compared with horses have been demonstrated. Protocols to assess endocrine disorders (e.g., pituitary pars intermedia dysfunction, metabolic syndrome, and thyroid illness) are unavailable, and extrapolation from horse data can be misleading. Treatment guidelines for these conditions in donkeys are currently not reported. On the other hand, the typical stoic and hardy behavior of donkeys can hinder prompt diagnosis of gastrointestinal problems, specifically colic, which is commonly caused by dental issues in this species. Moreover, subclinical gastric ulcer syndrome appears to be a common pathology in this species, especially in working donkeys.

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Donkeys are different to horses.

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Numerous physiological and clinic-pathologic idiosyncrasies are reported in horses.

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Data published for horses should not be extrapolated for donkeys.

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Specific reference ranges, doses, and protocols have to be used for donkeys.

Efeitos do PEG 3350 e de uma solução enteral, associados ou não ao Ringer lactato, e do NaCl 0,9% sobre a glicose, o lactato, o cortisol e a insulina de equinos hígidos

Este estudo objetivou avaliar e comparar a glicose e o lactato plasmáticos, bem como a insulina e o cortisol séricos, em éguas hígidas, não gestantes, tratadas com: polietilenoglicol 3350 (PEG); ou polietilenoglicol 3350 associado ao Ringer lactato (PEG+RL); ou solução isotônica poliônica enteral (SIPE); ou solução isotônica poliônica enteral associada ao Ringer lactato (SIPE+RL); ou solução de cloreto de sódio a 0,9% (NaCl). A avaliação laboratorial foi realizada nos tempos: imediatamente antes do início dos tratamentos (T0h); com seis horas (T6h) e ao final dos tratamentos (T12h); com 24 (T24h) e 48 horas (T48h) após T0h. Não ocorreu alteração significativa no lactato plasmático. Ocorreu apenas um discreto aumento nos valores da glicose e da insulina no tratamento SIPE, ocasionado pela presença de maltodextrina. O cortisol aumentou nos animais de todos os tratamentos, porém menor nos animais do SIPE. Conclui-se que os tratamentos não alteraram os valores da glicose, do lactato e da insulina em éguas hígidas e que a hidratação enteral em fluxo contínuo realizada no tratamento SIPE ocasionou menos estresse nos animais.

Severe hypertriglyceridaemia in clinically ill horses: diagnosis, treatment and outcome

REASONS FOR PERFORMING STUDY

Sporadic measurement of serum triglycerides in depressed and inappetant clinically ill horses revealed severe hypertriglyceridaemia without visible evidence of lipaemia on several occasions, leading to the inclusion of serum triglyceride concentrations in the routine serum biochemistry evaluation of our hospital. Since then, more cases have been identified and treated for hypertriglyceridaemia, raising questions about the prevalence, predisposing factors and significance of these findings.

HYPOTHESES

1) Severe hypertriglyceridaemia without visible opacity of the serum occurs more commonly in clinically ill and inappetant horses than previously described and 2) appropriate treatment using i.v. dextrose and/or partial parenteral nutrition would decrease serum triglycerides to normal limits and might result in improved appetite and attitude of the patient.

METHODS

The laboratory computer database from 2000 and 2001 was searched for increased serum triglycerides (> 5.65 mmol/l) in any horse breed, ponies and miniature breeds excluded. Data analysed included subject details, diagnosis, clinical and laboratory parameters, treatment, response to treatment and outcome.

RESULTS

Severe hypertriglyceridaemia was identified in 13 horses, with serum triglyceride concentrations 6.17-18.29 mmol/l, while none showed visible lipaemia. All horses had clinical and laboratory findings consistent with systemic inflammatory response syndrome and all but one had an increased serum creatinine concentration. Treatment with i.v. dextrose and/or partial parenteral nutrition resulted in decrease of the serum triglycerides to normal limits.

CONCLUSIONS

Severe hypertriglyceridaemia occurs in inappetant and clinically ill horses without evidence of serum opacity more commonly than previously described. The presence of systemic inflammatory response syndrome might predispose horses to hypertriglyceridaemia, while the increased creatinine concentration might be a predisposing factor or result of the condition. Horses identified in our study readily responded to treatment and appetite and attitude improved coincident with decrease of the serum triglycerides to normal limits.

POTENTIAL RELEVANCE

Hypertriglyceridaemia could perpetuate inappetance and depression in clinically ill horses and potentially predispose to fatty infiltration of the liver and other organ systems.

Physical characteristics, blood hormone concentrations, and plasma lipid concentrations in obese horses with insulin resistance

OBJECTIVE

To compare obese horses with insulin resistance (IR) with nonobese horses and determine whether blood resting glucose, insulin, leptin, and lipid concentrations differed between groups and were correlated with combined glucose-insulin test (CGIT) results.

ANIMALS

7 obese adult horses with IR (OB-IR group) and 5 nonobese mares.

PROCEDURES

Physical measurements were taken, and blood samples were collected after horses had acclimated to the hospital for 3 days. Response to insulin was assessed by use of the CGIT, and maintenance of plasma glucose concentrations greater than the preinjection value for > or = 45 minutes was used to define IR. Area under the curve values for glucose (AUC(g)) and insulin (AUC(i)) concentrations were calculated.

RESULTS

Morgan, Paso Fino, Quarter Horse, and Tennessee Walking Horse breeds were represented in the OB-IR group. Mean neck circumference and BCS differed significantly between groups and were positively correlated with AUC values. Resting insulin and leptin concentrations were 6 and 14 times as high, respectively, in the OB-IR group, compared with the nonobese group, and were significantly correlated with AUC(g) and AUC(i). Plasma nonesterified fatty acid, very low-density lipoprotein, and high-density lipoprotein-cholesterol (HDL-C) concentrations were significantly higher (86%, 104%, and 29%, respectively) in OB-IR horses, and HDL-C concentrations were positively correlated with AUC values.

CONCLUSIONS AND CLINICAL RELEVANCE

Measurements of neck circumference and resting insulin and leptin concentrations can be used to screen obese horses for IR. Dyslipidemia is associated with IR in obese horses.

β-Adrenergic stimulated lipolysis in pony adipocytes is exclusively via a β2-subtype and is not affected by lactation

Catecholamines are important lipolytic agents in horses and ponies but the nature of the adrenergic receptor subtype distribution in their adipocytes is uncertain. A first objective was to identify the beta-adrenergic receptor subtype(s) present in adipocytes from horses and ponies. A second objective was to evaluate if the lipolytic responsiveness of isolated adipocytes to beta-adrenergic agonists is altered during lactation, a condition known to affect markedly maternal fat metabolism. Isoproterenol and salbutamol elicited strong lipolytic responses in adipocytes isolated from horse and pony subcutaneous adipose tissue. There were weak lipolytic responses to norepinephrine, dobutamine and BRL37344. The weak lipolytic response to NE compared to isoproterenol or salbutamol suggests an antilipolytic action from alpha2-adrenergic receptors. The relative order of potency for the beta-adrenergic agonists was isoproterenol>/=salbutamol>>dobutamine=BRL37344. There was expression of beta2-adrenergic receptor mRNA in pony and horse adipose tissues, as estimated by relative RT-PCR, but no expression of mRNAs for beta1- or beta3-adrenergic receptors. Early lactation did not alter the lipolytic responses to beta-adrenergic agonists, nor the expression of beta2-adrenergic receptor mRNA. Thus, these results indicate a dominant if not exclusive presence of beta2-adrenergic receptors in pony and horse adipocytes that is not affected by lactation.

Effect of withholding feed on concentration and composition of plasma very low density lipoprotein and serum nonesterified fatty acids in horses

OBJECTIVE

To measure and compare the concentration and composition of very low-density lipoprotein (VLDL) in plasma and selected lipids in serum of horses fed mixed grass hay ad libitum or denied feed for 36 hours.

ANIMALS

4 healthy adult mares.

PROCEDURE

Mares were either fed mixed grass hay ad libitum or denied feed for 36 hours beginning at 8:00 AM. Blood samples were collected every 2 hours during the study period and analyzed for nonesterified fatty acid (NEFA), triglyceride (TG), VLDL, and glucose concentrations and composition of VLDL.

RESULTS

Withholding feed significantly increased mean serum concentrations of NEFA. By 36 hours, a 16-fold increase in mean serum NEFA concentration and 2-fold increase in mean plasma VLDL concentration, compared with baseline values, were detected. Mean plasma TG concentrations significantly increased with time in feed-deprived horses. Significantly lower overall mean plasma glucose concentrations were detected in feed-deprived horses. Mean percentage of protein in VLDL was significantly lower in feed-deprived horses. Plasma VLDL concentrations varied widely among horses in response to withholding feed. Plasma TG and VLDL concentrations remained unaltered in 2 horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Withholding feed significantly increases blood lipid concentrations in horses, but individual horses respond differently. Serum NEFA concentrations were increased in all 4 horses denied feed, indicating mobilization of tissue triglyceride stores. Variation in plasma VLDL concentration in response to withholding feed suggests that its metabolism is strongly influenced by other, as yet undetermined, factors in horses. Differences in the plasma VLDL concentrations among horses in response to withholding feed may be used as an indication of susceptibility to the hyperlipemic syndrome of Equidae.