Dietary restriction in combination with a nutraceutical supplement for the management of equine metabolic syndrome in horses

Comparison of one novel and four established diagnostic tests for insulin dysregulation in ponies

Several tests have been advocated for diagnosis of insulin dysregulation (ID). Tests using simple sugars may not reflect the response to naturally ingested carbohydrates. This study aimed to evaluate agreement between the oral glucose test (OGT), the oral sugar test (OST), a novel oral test using a proprietary cereal (WEET), the IV combined glucose-insulin tolerance test (CGIT) and fasted basal insulin (FI) for diagnosis of ID. Each of the five tests above was performed on a group of six normal and six insulin dysregulated mixed-breed ponies in a randomised crossover study. Area under the curve (AUC) and maximum concentration of insulin from OGT, OST and WEET showed strong to very strong bivariate correlations (r = 0.85-0.94, and r = 0.87-0.92, respectively; P ≤ 0.001) and were significantly different between tests (associated with dose of carbohydrate) and between CGIT-positive and -negative ponies. Dichotomous results showed substantial agreement between OST and both WEET (κ = 0.65; P = 0.02) and OGT (κ = 0.67; P = 0.01) and between CGIT and both OST (κ = 0.63; P = 0.03) and OGT (κ = 0.67; P = 0.01), and no agreement between FI, which had low sensitivity, and all other tests (κ = 0.15 - 0.31; P > 0. 05). Palatability of WEET was variable, resulting in one pony being excluded for analysis of WEET data. Further work on development of an oral test using a more palatable feedstuff and appropriate cut-offs or diagnostic thresholds for tests of ID is warranted.

Genome-wide association study suggests genetic candidate loci of insulin dysregulation in Finnhorses

Equine metabolic syndrome (EMS) is a common welfare problem in horses worldwide. It is characterized by insulin dysregulation (ID), predisposition to laminitis and often obesity. EMS is multifactorial by nature, with both the environment and genetics contributing to the phenotype. Environmental factors, such as feeding and exercise, can be controlled, thus forming the basis for treatment and prevention. Genetic factors, by contrast, are less well-known and not easily controllable. The aim of this study was to identify potential genetic loci influencing ID/EMS in Finnhorses. A single-breed (Finnhorse) case-control genome-wide association study (GWAS) of ID was conducted with controls that included age-appropriate non-ID horses. ID status was determined with an oral sugar test (OST) for fasted horses. Seventy-one Finnhorses participated (n = 34 ID, n = 37 control). DNA samples (hair roots) were genotyped for 65 157 single-nucleotide polymorphisms (SNPs) with the Illumina Equine SNP70 BeadChip, and these data were analysed for association and FST outliers with genomic tools. P-values that exceeded the suggestive threshold (P = 1.00 ×10-5) were found in SNP BIEC2_383954 (P = 3.45 ×10-6) in chromosome 17 and SNP BIEC2_312374 (P = 1.89 ×10-5) in chromosome 15. Hierarchical and Bayesian FST outlier tests also detected these SNPs. Potential candidate genes associated with the ID close to SNP BIEC2_383954, with functions in carbohydrate metabolism, were Arginine and Glutamate Rich 1 (ARGLU1) and Ephrin-B2 (EFNB2).

Confidence does not mediate a relationship between owner experience and likelihood of using weight management approaches for native ponies

Native ponies are at increased risk of obesity and metabolic perturbations, such as insulin dysregulation (ID), a key risk factor for endocrinopathic laminitis. Management and feeding practices can be adapted to maintain healthy body condition and support metabolic health, but owners may inadvertently provide their ponies with inappropriate management leading to obesity and exacerbating risk of metabolic disease. Adoption of preventative weight management approaches (WMAs), including regular monitoring of body condition, providing appropriate preserved forage, promoting seasonal weight loss, and using exercise accordingly, are key in supporting native ponies' metabolic health. The factors influencing the adoption of WMAs, such as owners' experience and confidence, require exploration. The aim of the current study was to understand factors influencing owners' likelihood to undertake certain WMAs, to develop our understanding of suitable intervention targets. A total of 571 responses to an online cross-sectional questionnaire were analysed. Mediation analysis revealed that whilst long term (≥20 years) experience caring for native ponies was associated with owners increased, self-reported confidence in identifying disease and managing their native ponies, this did not translate to an increased likelihood of implementing WMAs. Conversely, respondents who managed ponies with dietary requirements related to obesity, laminitis, or equine metabolic syndrome were more likely to use WMAs related to feeding, seasonal weight management and exercise. Owner confidence was assessed and rejected as a mediator of the relationship between experience and WMA use. These results highlight the need for further work that elucidates the pathways leading owners to undertake action against obesity without the need for ponies to develop overt disease, as well as suggesting a need for long term managers of native ponies to update management practices with preventative care as the focus.

Equine Endocrine Disease: Challenges With Case Definition for Research

Equine endocrine disease is an important area for equine research, requiring an appropriate case definition for inclusion and criteria for exclusion from disease. Defining a case for research may be different from criteria for clinical diagnosis. Further, clinical diagnosis recommendations have been changing regularly, making this area challenging for equine scientists. This review discusses the diagnosis of major equine endocrine diseases, pituitary pars intermedia dysfunction, equine metabolic syndrome and insulin dysregulation, focusing on the most appropriate diagnostic methods for research case definitions. Different diagnostic methods, including use of reference intervals and clinical decision limits, will be discussed with their relative merits for use in case definition for research.

A starch-rich treat affects enteroinsular responses in ponies

OBJECTIVE

To determine the effect of a starch-rich treat, added to the daily diet of ponies for 10 days, on enteroinsular responses to meal consumption.

ANIMALS

10 mixed-breed adult ponies owned by Queensland University of Technology were used in the study. Six ponies were metabolically healthy, and 4 were insulin dysregulated at the start of the study, according to the results of an in-feed oral glucose test.

PROCEDURES

A bread-based treat was offered twice daily for 10 days, adding 0.36 ± 0.04 g/kg body weight (BW) carbohydrates to the daily diet. Before and after treatment, the intestinal capacity for simple carbohydrate absorption was approximated with a modified D-xylose absorption test. Plasma glucagon-like peptide-2 (GLP-2), blood glucose, and serum insulin responses to eating were also measured before and after treatment.

RESULTS

The absorption of D-xylose (area under the curve [AUC]) increased 1.6-fold (P < .001) after 10 days of eating the treat. In addition, while basal (fasted) GLP-2 concentrations were not affected, GLP-2 AUC increased 1.4-fold in response to eating (P = .005). The treat did not change blood glucose or serum insulin concentrations, before, during, or after eating.

CLINICAL RELEVANCE

A small amount of additional carbohydrate each day in the form of a treat can cause a measurable change in the enteroinsular responses to eating.

Dietary supplements of vitamins E, C, and β-carotene to reduce oxidative stress in horses: An overview

Oxidative stress is the excess generation of free radicals and/or a decrease in the response of the antioxidant system. It is known to cause damage to the equine health by unbalancing the stable molecules. The supplements of vitamins E, C, and β-carotene in the diet cause beneficial effect on horses' health. These supplements could transform free radicals into the stable radicals, thereby showing importance in the prevention of diseases associated with oxidative stress. Adding vitamins E, C, and β-carotene to the horses' diets in stressful conditions could decrease the production of free radicals that cause inflammation and tissue damage, the typical characteristics that have been associated with oxidative stress. This review spotlights the available evidence of the benefits of dietary supplements of vitamins E, C, and β-carotene towards the reduction of oxidative stress in horses.

UK Horse Carers' Experiences of Restricting Grazing When Aiming to Prevent Health Issues in Their Horses

Laminitis and obesity are leading welfare issues for UK leisure horses. Limiting grass intake is a common preventative measure but may result in other aspects of welfare being compromised. This study aimed to determine how commonly different restricted grazing methods are used in the UK, barriers limiting their accessibility, and the potential benefits and welfare issues associated with each. A cross-sectional online survey was distributed with questions relating to horse carers' opinions of different restricted grazing practices, which methods they used, and how they implemented these. Closed questions were analyzed using descriptive statistics and non-parametric tests. Free text questions underwent content analysis. 503 respondents completed the questionnaire, 468 (93.0%) had practiced restricted grazing. Strip grazing was the most commonly tried method (67.7% of restricted grazers), followed by grazing muzzles (61.3%), starvation paddocks (57.4%), stabling (49.9%), crew yards (27.5%) and track systems (15.3%). Perception of welfare impact differed significantly between methods for both those who had (P < .001) and had not (P < .001) restricted grazing. Both groups considered strip grazing best for welfare and stabling worst. Barriers (including ease of implementation [52.0%], yard restrictions [24.0%], cost/affordability [23.7%]) prevented some from using their preferred methods. Respondents had similar priorities when choosing a restricted grazing method but did not agree which methods met these criteria. Strip grazing was favored by the greatest proportion of respondents whilst grazing muzzles and stabling polarized opinion. This study has provided initial insights into the challenges faced by horse carers when aiming to restrict grazing to combat equine health issues.

A Multiomic Approach to Investigate the Effects of a Weight Loss Program on the Intestinal Health of Overweight Horses

Obesity is endemic in human populations in the western society, and with mounting evidence that the intestinal ecological environment plays a major role in its pathogenesis, identification of therapies based on intestinal microbiota modulation are gaining attention. Obesity in companion animals is also a common clinical problem. We set out using a multidimensional approach, to determine the effectiveness and safety of a weight loss program for horses incorporating diet restriction and exercise. In addition, we aimed to investigate the effect of this program on the overall intestinal health of overweight sedentary horses. The investigation comprised of a randomized, controlled, 6-week study of 14 overweight sedentary horses and ponies who were blocked for age, gender, and breed (controls n = 7, treatment n = 7). The treatment group were fed a restricted diet (1.4% of body weight dry matter intake) and the control group a maintenance diet (2% of body weight as dry matter intake) over the study period. The treatment group were subjected to a prescribed exercise regime, while the control group were exercised to mimic foraging conditions. Several clinical measurements were taken at the start and end of the study, including morphological parameters, ultrasound measurements of subcutaneous fat, and blood pressure. Fecal microbiota analysis was performed using 16S rRNA gene sequence analysis, and fecal metabolome was analyzed using NMR spectroscopy, on samples taken at weeks 1, 3, and 6 of the study. All horses completed the study period successfully. However, two of the treatment group had to have modified exercise regimes. The treatment group showed significant weight loss (p < 0.00001) and an associated decrease in waste circumference (p < 0.0001) when compared with the control group. The alpha-diversity of the fecal microbiota in the treatment group showed a significant increase from the start to the end of the study period (p < 0.05); however, there was no significant difference between groups at any sampling point. There were significant changes (p < 0.05) in the metabolome in both groups between the start and end of the study, but not between groups at any sampling point. Finally, the resting blood pressure of all horses was significantly lower by the end of the study.

Nutritional Considerations When Dealing with an Obese Adult Equine

Equine obesity is common, reducing quality of life and requiring dietary energy restriction. Equine obesity is identified using subjective body condition scoring. Considerations are given for life stage and health status when managing obese equines. Every effort should be made to maximize feeding duration, and minimize time spent without feed while meeting all essential nutrient requirements. Limiting total daily dry matter intake to 2% of current bodyweight per day of a low caloric, forage-based diet may result in adequate body weight loss. Weight loss and weight management plans should be monitored for success and potential gastrointestinal, metabolic, and/or behavioral complications.

Exploring horse owners' understanding of obese body condition and weight management in UK leisure horses

BACKGROUND

Equine obesity is considered one of the most serious welfare concerns in UK leisure horses, yet little is known about how horse owners conceptualise their horse's weight as part of its health, or how they plan and carry out weight management.

OBJECTIVES

This study aimed to further our understanding of leisure horse owners' perceptions of equine health and awareness of excess fat in order to clarify our understanding of successful strategies for managing equine weight.

STUDY DESIGN

This study used a qualitative research methodology.

METHODS

Data comprised 16 threads from online UK equine discussion fora, 28 individual interviews with leisure horse owners, 19 interviews with equine professionals such as vets and nutritionists, and two focus groups with a further 21 horse owners. Data were anonymised and analysed using a grounded theory approach.

RESULTS

Awareness of excess fat was a complex issue, with owners finding it difficult to differentiate equine obesity from the shape they thought the horse was "meant to be", particularly if the horse was a heavier breed such as a native pony or cob. Owners were not necessarily "aware" or "unaware" of fat, but instead equine body fat was constructed as an integral part of the equine body. For example, owners might say that they thought their horse was an ideal weight yet describe their horse's overall body shape as "like a Thelwell". When owners became aware of fat as a changeable part of the horse's body, and/or a threat to health, the presence of fat was articulated as a strong-willed adversary, and weight management was considered a "battle" or "war". Owners found weight management difficult because they perceived that it had immediate negative welfare implications for the horse, and this therefore interfered with their preferred ownership practices and the horse-human relationship.

MAIN LIMITATIONS

Interview data are self-reported, and people may not always do what they say they do.

CONCLUSIONS

This study has provided valuable insight into how owners conceptualise weight and weight management, yielding important information about communicating with owners about weight, tailoring weight management strategies, and promoting positive welfare.

Inducing weight loss in native ponies: is straw a viable alternative to hay?

BACKGROUND

Obesity is a growing problem in UK equine population. Achieving weight loss in obese horses and ponies at risk of laminitis is an important but often challenging objective.

METHODS

We hypothesised that supplementing poor winter pasture with a mix of barley straw and hay (50:50) rather than hay alone (group B) would lead to weight loss in grazing equids over winter. For this purpose, a group of 40 horses were fed either the straw mix (group A) or hay alone (group B) over winter.

RESULTS

Over the study period, all animals in group A (n=25) lost weight with a mean weight change of -27±17 kg, while in group B (n=15) only 3 out of 15 lost weight (20 per cent), and overall, group B gained weight (+6±18 kg).

CONCLUSIONS

This study suggests that straw is a cost-effective and low-energy roughage, which may be a useful alternative to hay alone when trying to induce weight loss in grazing equids over winter. There were no episodes of colic or laminitis during the study period in either group.

The equine gastrointestinal microbiome: impacts of weight-loss

Background

Obesity is an important equine welfare issue. Whilst dietary restriction is the most effective weight-loss tool, individual animals range in their weight-loss propensity. Gastrointestinal-derived bacteria play a fundamental role in host-health and have been associated with obesity and weight-loss in other species. This study evaluated the faecal microbiome (next-generation sequencing of 16S rRNA genes) of 15 obese Welsh Mountain pony mares, in the same 11-week period across 2 years (n = 8 Year 1; n = 7 Year 2). Following a 4-week acclimation period (pre-diet phase) during which time individuals were fed the same hay to maintenance (2% body mass (BM) as daily dry matter (DM) intake), animals underwent a 7-week period of dietary restriction (1% BM hay as daily DM intake). Faeces were sampled on the final 3 days of the pre-diet phase and the final 3 days of the dietary restriction phase. Bacterial communities were determined using Next Generation Sequencing of amplified V1-V2 hypervariable regions of bacterial 16S rRNA.

Results

Losses in body mass ranged from 7.11 to 11.59%. Changes in the faecal microbiome composition following weight-loss included a reduction in the relative abundance of Firmicutes and Tenericutes and a reduction in indices of bacterial diversity. Pre-diet diversity was negatively associated with weight-loss. Pre-diet faecal acetate concentration was a strong predictor of subsequent weight-loss and negatively associated with Sphaerochaeta (Spirochaetes phylum) abundance. When animals were divided into 3 groups (high, mid, low) based overall weight loss, pre-diet bacterial community structure was found to have the greatest divergence between the high and low weight-loss groups (R = 0.67, p <  0.01), following PERMANOVA and ANOSIM analysis.

Conclusions

Weight-loss in this group of ponies was associated with lower pre-diet faecal bacterial diversity and greater pre-diet acetate concentration. Overall, these data support a role for the faecal microbiome in weight-loss propensity in ponies and provide a baseline for research evaluating elements of the faecal microbiome in predicting weight-loss success in larger cohorts.

Investigation of the Effects of a Dietary Supplement on Insulin and Adipokine Concentrations in Equine Metabolic Syndrome/Insulin Dysregulation

High insulin concentrations are a common clinical feature of equine metabolic syndrome (EMS) and insulin dysregulation. Hyperinsulinemia can induce laminitis, so reduction of insulin concentrations in response to an oral challenge should decrease risk. In human studies, diets containing a polyphenol (resveratrol) led to improvements in insulin sensitivity. In rodents, the addition of leucine to a resveratrol supplement caused a decrease in the amount of resveratrol needed to achieve a clinical effect. We hypothesize a supplementation with a low dose of a synergistic polyphenol and amino acid blend including leucine (SPB+L) would improve metabolic health in EMS/insulin dysregulated horses. Fifteen EMS/ID horses received a high or low dose of SPB+ L daily for 6 weeks. Insulin during an oral sugar test (OST), body condition score, weight, baseline high-molecular-weight (HMW) adiponectin, triglycerides, nonesterified fatty acids, and tumor necrosis factor alpha were assessed before supplementation (PRE) and after supplementation (POST) via paired Student's t-tests and a repeated-measures mixed-model analysis of variance (significant at P < .05). There were no differences between doses. Horses in the POST group weighed significantly less, had significantly higher baseline HMW adiponectin concentrations, and had significantly lower insulin concentrations at 60- and 75-minute time points (P < .05). Insulin concentrations of the horsesin the POST group, but not in the PRE group, were lower and similar to results from the study conducted three years before the present study (PRIOR) for 0- and 60-minute time points (P < .002). An increased HMW adiponectin level supports increasing insulin sensitivity after supplementation. These results suggest that SPB + L supplementation at either dose leads to improvements in the clinical manifestations of EMS/insulin dysregulation, potentially reducing laminitis risk.

Effects of Docosahexaenoic Acid-Rich Microalgae Supplementation on Metabolic and Inflammatory Parameters in Horses With Equine Metabolic Syndrome

Much of the equine population is obese and therefore predisposed to the development of additional health concerns such as equine metabolic syndrome (EMS). However, pharmacologic treatments for EMS are limited. Omega-3 fatty acid supplementation is a therapeutic strategy in humans with metabolic dysfunction that improves insulin sensitivity and reduces inflammation, but the effects of omega-3 fatty acid supplementation in horses with EMS are unclear. Therefore, in this pilot study, 10 mixed-sex and mixed-breed horses with EMS were fed a docosahexaenoic acid (DHA)-rich microalgae containing 16 g DHA/horse/d or served as controls for 46 days. Inflammatory status was measured using serologic enzyme-linked immunosorbent assay and in peripheral blood mononuclear cells (PBMCs) using flow cytometry and reverse transcription polymerase chain reaction. Circulating fatty acids, triglyceride, leptin, and adiponectin concentrations were also determined. Insulin and glucose dynamics were assessed with oral sugar test (OST) and frequently sampled intravenous glucose tolerance testing. Postsupplementation, treated horses had an increase in many circulating fatty acids, including DHA (P < .001). Treated horses also had lower serum triglycerides postsupplementation (P = .02) and a trend (P = .07) for reduced PBMC tumor necrosis factor α. Interestingly, after 46 days, control horses had an increase in insulin responses to the OST (P = .01), whereas treated horses did not (P = .69). These pilot data indicate that DHA-rich microalgae supplementation alters circulating fatty acids, modulates metabolic parameters, and may reduce inflammation in horses with EMS.

Comparison of fasted basal insulin with the combined glucose-insulin test in horses and ponies with suspected insulin dysregulation

Fasting horses for measurement of basal serum insulin concentration (fasting insulin; FI) has been recommended to standardise testing for insulin dysregulation (ID), yet limited data exist comparing it to dynamic tests. This study aimed to compare FI with the combined glucose-insulin test (CGIT) in horses suspect for ID. We hypothesised that FI would have poor sensitivity for detecting ID compared to CGIT using conventional cut-offs. Records were retrieved from CGITs performed in horses fasted for approximately 8h. Serum insulin and glucose concentrations were measured before and for 150min following an IV bolus of glucose followed by insulin. Correlations between FI and CGIT values were assessed. Youden's index analysis was used to determine the optimal cut-off for FI. Logistic regression and Mann-Whitney U tests were used to determine factors affecting the results. CGITs (n=130) from 62 horses were evaluated. Compared to CGIT, sensitivity and specificity of FI for diagnosis of ID were 14.6% and 100% at a cut-off of 20μIU/mL and 63.4% and 87.2% at a cut-off of 5.2μIU/mL, respectively. FI was significantly correlated with insulin at 45min (r_s=0.66) and 75min (r_s=0.72); area under the curve for insulin (AUC_insulin; r_s=0.67); glucose at 45min (r_s=0.53); and AUC_glucose (r_s=0.50). Obesity was significantly associated with increased odds of a positive CGIT and horses with a positive CGIT were significantly older (P<0.05). In conclusion, FI correlated well with CGIT results and had adequate sensitivity and specificity at lower cut-offs, despite poor sensitivity at conventional cut-off values. Further research to derive cut-off values relevant to the fasting period is warranted.

The Haematococcus pluvialis extract enriched by bioaccumulation process with Mg(II) ions improves insulin resistance in equine adipose-derived stromal cells (EqASCs)

Insulin resistance (IR) is one of the characteristic features of equine metabolic syndrome (EMS). Presently, the only therapies of choice are caloric restrictions combined with mineral supplementation, which might improve insulin sensitivity. In this study we investigated the effect of Haematococcus pluvialis algae water extract enriched in bioaccumulation process in magnesium ions (Hp_Mg(II)) on equine adipose derived mesenchymal stromal stem cells, in which insulin resistance was induced by palmitic acid (IR-EqASCs). For this purpose, chemical characterization of H. pluvialis was performed with special emphasis on the analysis of minerals composition, total phenolic and carotenoids contents, as well as scavenging activity. To examine the influence of H. pluvialis extract on IR-EqASCs, various methods of molecular biology and microscopic observations (i.e., immunofluorescence staining, SEM, gene expression by RT-qPCR, proliferative and metabolic cells activity analysis) were applied to investigate in vitro viability, oxidative stress markers and apoptosis-related factor accumulation, along with insulin resistance-related genes expression. Obtained results show, that Hp_Mg(II) significantly improves proliferative and metabolic activity of IR-EqASCs, shortens their population doubling time, improves their clonogenic potential and reduces expression of apoptosis related genes. Moreover, anti-oxidative effect of extract was presented.

The efficacy and safety of velagliflozin over 16 weeks as a treatment for insulin dysregulation in ponies

BACKGROUND

A previous six-week (wk) study demonstrated the potential of the sodium-glucose linked transport inhibitor velagliflozin as a novel treatment for equine insulin dysregulation. The present study examined the safety and efficacy of velagliflozin over 16 wk. of treatment, and over 4 wk. of withdrawal. Twenty-four insulin dysregulated ponies were selected, based on their hyper-responsiveness to a diet challenge meal containing 3.8 g non-structural carbohydrates (NSC)/kg bodyweight (BW). Ponies with serum insulin > 90 μIU/mL either 2 or 4 h after feeding were enrolled, and randomly allocated to receive either velagliflozin (0.3 mg/kg BW orally once daily, n = 12), or a placebo (n = 10-12) for 16 wk. The subjects were fed 7.5 g NSC/kg BW/day to maintain a fat body condition. Safety was assessed through daily monitoring, veterinary examination, and the measurement of fasting blood glucose, biochemistry and haematology. Efficacy at reducing post-prandial hyperinsulinemia was assessed using a diet challenge every 8 wk. during treatment and 4 wk. after withdrawal.

RESULTS

Velagliflozin was well accepted by all subjects and caused no adverse effects or hypoglycaemia. Post-prandial serum insulin (insulin Cmax) did not change significantly in the control animals over the entire study period (P = 0.101). In contrast, insulin Cmax (mean ± SE) concentrations fell over time in the velagliflozin-treated group from 205 ± 25 μIU/mL in wk. 0, to 119 ± 19 μIU/mL (P = 0.015) and 117 ± 15 μIU/ml (P = 0.029) after 8 and 16 wk. of treatment, respectively. Although the insulin Cmax in this group was not significantly lower than in controls at wk-8 (P = 0.061), it was lower at wk-16 (P = 0.003), and all 12 treated ponies were below the previously-determined risk threshold for laminitis at this time. After 4 wk. withdrawal, the insulin Cmax returned to 199 ± 36 μIU/mL in the treated group, with no rebound effect.

CONCLUSIONS

Velagliflozin appears to be a promising and safe treatment for equine insulin dysregulation, bringing post-prandial insulin concentrations below the laminitis risk threshold, albeit without normalising them.

Identification of modifiable factors associated with owner-reported equine laminitis in Britain using a web-based cohort study approach

Background

Equine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences. There is a paucity of data that accounts for the multifactorial nature of laminitis and considers time-varying covariates that may be associated with disease development; particularly those that are modifiable and present potential interventions. A previous case-control study identified a number of novel, modifiable factors associated with laminitis which warranted further investigation and corroboration. The aim of this study was to identify factors associated with equine laminitis in horses/ponies in Great Britain (GB) using a prospective, web-based cohort study design, with particular interest in evaluating modifiable factors previously identified in the case-control study.

Results

Self-selected horse/pony owners in GB submitted initial baseline and follow-up health and management questionnaires for 1070 horses/ponies between August 2014 and December 2016. The enrolled horses/ponies contributed 1068 horse-years at risk with a median of 38 days between questionnaire submissions. Owners reported 123 owner-recognised and/or veterinary-diagnosed episodes of active laminitis using a previously-validated laminitis reporting form. Multivariable Cox regression modelling identified 16 risk/protective factors associated with laminitis development. In keeping with the previous case-control study, a prior history of laminitis (particularly non-veterinary-diagnosed episodes), soreness after shoeing/trimming and weight gain were associated with higher rates of laminitis. There is now strong evidence that these risk factors should be used to guide future recommendations in disease prevention. Factors with some prior evidence of association included breed, steroidal anti-inflammatory administration, transport and worming. The modifiable factors amongst these should be the focus of future laminitis studies. The remainder of the identified factors relating to health, turnout and grazing management and feeding are novel, and require further investigation to explore their relationship with laminitis and their applicability as potential interventions.

Conclusions

This study has demonstrated a temporal relationship between a number of horse- and management-level factors and laminitis, identifying potential interventions and important risk groups for which these interventions would be of particular importance. These results serve as a sound evidence-base towards the development of strategic recommendations for the horse/pony-owning population to reduce the rate of laminitis in GB.

Electronic supplementary material

The online version of this article (10.1186/s12917-019-1798-8) contains supplementary material, which is available to authorized users.

ECEIM consensus statement on equine metabolic syndrome

Equine metabolic syndrome (EMS) is a widely recognized collection of risk factors for endocrinopathic laminitis. The most important of these risk factors is insulin dysregulation (ID). Clinicians and horse owners must recognize the presence of these risk factors so that they can be targeted and controlled to reduce the risk of laminitis attacks. Diagnosis of EMS is based partly on the horse's history and clinical examination findings, and partly on laboratory testing. Several choices of test exist which examine different facets of ID and other related metabolic disturbances. EMS is controlled mainly by dietary strategies and exercise programs that aim to improve insulin regulation and decrease obesity where present. In some cases, pharmacologic aids might be useful. Management of an EMS case is a long‐term strategy requiring diligence and discipline by the horse's carer and support and guidance from their veterinarians.

Influence of dietary restriction and low-intensity exercise on weight loss and insulin sensitivity in obese equids

Background

The importance of including exercise with dietary modification for the management of obese equids is not clearly understood.

Objectives

To evaluate the effect of a practical low‐intensity exercise regimen, in addition to dietary restriction, on indices of insulin sensitivity (SI) and plasma adipokine concentrations in obese equids.

Animals

Twenty‐four obese (body condition score [BCS] ≥ 7/9) horses and ponies.

Methods

Over a 12‐week period, animals received either dietary restriction only (DIET) or dietary restriction plus low‐intensity exercise (DIET+EX). All animals were provided with a restricted ration of grass hay at 1.25% body weight (BW) on a dry matter basis, providing 82.5% estimated digestible energy requirements. The DIET+EX group undertook low‐intensity exercise 5 days per week on an automated horse walker. Before and after weight loss, total body fat mass (TBFM) was determined, indices of SI were calculated using minimal model analysis of a frequently sampled IV glucose tolerance test, and adipokines plus inflammatory biomarkers were measured using validated assays.

Results

Decreases in BCS, BW, and TBFM were similar between groups (all P > .05). After weight loss, animals in both groups had decreased basal insulin and leptin concentrations, and increased adiponectin concentrations (all P < .001). Furthermore, animals in the DIET+EX group had significantly improved SI and decreased serum amyloid A concentrations relative to animals in the DIET group (both P = .01).

Conclusions and Clinical Importance

Regular low‐intensity exercise provided additional health benefits compared with dietary restriction alone in this population of obese equids.

Pharmacokinetics of Metformin in Combination With Sitagliptin in Adult Horses After Enteral Administration

Insulin dysregulation (ID) is a common metabolic disorder in horses. Recently, incretin hormone release has been suggested to be involved in ID in horses. In human medicine, metformin and sitagliptin are commonly used in combination for metabolic syndrome. This combination could be useful in treating ID in horses. However, no pharmacokinetics data have been reported in this species. The objective of the present study was to establish the plasma concentration-time profile and to derive pharmacokinetics data for a combination of metformin and sitagliptin in horses after enteral administration. Six healthy adult Purebred Spanish horses were used. A metformin (15 mg/kg) plus sitagliptin (1.5 mg/kg) preparation was administered by intragastric route (IG) as an enteral solution. Blood samples were collected from 0 to 48 hours after IG drug administration. Plasma concentrations of metformin and sitagliptin were measured using high performance liquid chromatography methods. The t_½λz for metformin was 2.9 hours and for sitagliptin 21 hours. The C_max was 442 ± 84 mg/L within 0.9 hours for metformin and 94 ± 14 mg/L within 1.3 hours for sitagliptin. No adverse effects were observed, and the combination of metformin and sitagliptin was well tolerated. Therefore, these results suggest that metformin plus sitagliptin might be a combination to consider in horses with ID. Additional studies are needed to establish the effectiveness and tolerance in equids affected by endocrine disorders.

A comprehensive analysis of biosorption of metal ions by macroalgae using ICP-OES, SEM-EDX and FTIR techniques

In the present study, a comprehensive approach to the biosorption process was proposed. Biosorption of Cr(III), Mn(II) and Mg(II) ions by a freshwater macroalga Cladophora glomerata was examined using several advanced techniques including FTIR (Fourier Transform Infrared Spectroscopy), ICP-OES (Inductively Coupled Plasma-Optical Emission Spectrometry) and SEM-EDX (Scanning Electron Microscopy with Energy Dispersive X-Ray Spectroscopy). The enriched biomass can become a valuable, bioactive feed additive for different breeds of animals. Additionally, the collected algal biomass was soaked in water in order to reduce the content of carbohydrate, what is especially important for animals with metabolic disorders. The content of starch was reduced by 22% but additionally some elements-mainly Si, K and P were removed from the biomass. It was shown that the natural macroalga had better biosorption properties than soaked. Cr(III) ions were sorbed by the biomass in the highest extent, then Mn(II) and finally Mg(II) ions. The content of chromium in the enriched algal biomass increased almost ~200 000 times, manganese ~75 times and magnesium ~4.5 times (both for Mg(II) ions used from magnesium sulphate, as well as from magnesium chloride) when compared to the natural Cladophora glomerata. In the case of the soaked biomass the increase of the content of elements in the enriched biomass was as follows ~17 165 times for Cr, ~25 times for Mn and for Mg ~3.5 times for chloride and 3.8 times for sulphate. The type of magnesium salt (chloride or sulphate) had no significant effect on the algal sorption capacity. The proposed mechanism of the biosorption is ion exchange in which mainly potassium participated. The applied FTIR analysis enabled the identification of the functional groups that participated in the biosorption process-mainly carboxyl and hydroxyl. The main changes in the appearance of the spectra were observed for the following wavenumbers- 3300-3400; 2900; 1700; 1400-1500 and 1200-1300 cm-1. The application of SEM-EDX proved that the metal ions were sorbed on the surface of both tested algae.

Beyond scoring systems: usefulness of morphometry considering demographic variables, to evaluate neck and overall obesity in Andalusian horses

Morphometry has proven to be a useful tool, both for the clinician and horse owners, for evaluating the body condition in equids due to its objectivity, easiness and capacity for detection of important metabolic disturbances. However, limited information is available on the use of morphometric ratios to characterize regional and overall adiposity and much less about their application in different genders, ages and horses with different levels of obesity. The objectives were to evaluate body and neck absolute measurements and ratios; factors affecting them such as the influence of gender, age, appearance of the neck crest and overall body condition and; relationships among these measurements. A total of 154 Andalusian horses classified according to their gender, age, body score status and cresty neck condition were evaluated in this cross-sectional study. Two evaluators assigned a body condition score (BCS, 1 to 9) and a cresty neck score (CNS, 0 to 5) to each horse. Horses were divided into males and females; young (2 to 5 years) and adults (6 to 15 years); obese (BCS⩾7) and non-obese (BCS<7); cresty neck (CNS⩾3) and non-cresty neck horses (CNS<3). Morphometric measurements (cm) included were: height at the withers (HW); body length (BL), girth (GC) and waist (WC) circumferences; neck length (NL); three neck circumferences (NCs), over the first (NC25%), the second (NC50%) and the third part (NC75%) of the NL and neck crest height (NCH). These measurements were also used to calculate the following ratios: GC : HW, WC : HW, GC : BL, WC : BL, NC25% : HW, NC50% : HW, NC75% : HW, NC25% : BL, NC50% : BL, NC75% : BL, NC25% : NL, NC50% : NL, NC75% : NL, NC25% : NCH, NC50% : NCH and NC75% : NCH. The results showed that most of the absolute measurements and ratios were greater than those described in other light breeds. In addition, most neck ratios were higher (P<0.050) in males than in females, however, all body ratios were greater (P<0.001) in females. Among the absolute measurements, WC in obese horses and NC25% and NC75% in cresty neck horses highlighted as higher. Either GC : HW or WC : HW and NC75% : BL were alternative surrogates for the appraisal of overall and regional adiposity in Andalusians. Several interactions were observed between the gender and adiposity scoring systems affecting the morphometric evaluation. This study establishes absolute morphometric measurements and ratios in Andalusian horses. It also highlights the variability of morphometric values and how the outcome of these can be influenced by demographic variables and the breed analyzed. Further studies are necessary to set morphometric reference values in other breeds.

Effects of diet-induced weight gain and turnout to pasture on insulin sensitivity in moderately insulin resistant horses

OBJECTIVE

To quantify insulin sensitivity and monitor glucose, insulin, and lipid concentrations in a group of moderately insulin-resistant horses during induction of obesity by use of a forage diet supplemented with fat and during subsequent turnout to pasture. ANIMALS 9 adult Standardbred mares (11 to 20 years old).

PROCEDURES

Weight gain of horses was induced during 22 weeks by use of a forage diet supplemented with fat fed in gradually increasing amounts, followed by feeding of that fat-supplemented diet at 2.5 times the daily maintenance requirements. Horses were then turned out to pasture. Insulin sensitivity was measured with the euglycemic hyperinsulinemic clamp method before and after weight gain and after 4 weeks at pasture. Body weight, body condition score, and cresty neck score as well as fasting and postprandial concentrations of plasma insulin, plasma glucose, serum triglyceride, and serum nonesterified fatty acids were measured during the study.

RESULTS

Body weight typically increased by 10%, and body condition score (scale, 1 to 9) increased by > 1.5 from the start to the end of the weight-gain period. There was no difference in insulin sensitivity or metabolic clearance rate of insulin during the weight-gain period. Four weeks at pasture generally improved insulin sensitivity and metabolic clearance rate of insulin by 54% and 32%, respectively, but there was no change in body weight or body condition score.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings indicated that dietary composition played a more important role than did short-term weight gain on alterations in insulin sensitivity of horses.

Sustained, Low-Intensity Exercise Achieved by a Dynamic Feeding System Decreases Body Fat in Ponies

Background

Obesity in horses is increasing in prevalence and can be associated with insulin insensitivity and laminitis. Current treatment strategies for obesity include dietary restriction and exercise. However, whether exercise alone is effective for decreasing body fat is uncertain.

Hypothesis

Our hypothesis was that twice daily use of a dynamic feeding system for 3 months would induce sustained, low‐intensity exercise thereby decreasing adiposity and improving insulin sensitivity (SI).

Animals

Eight, university‐owned, mixed‐breed, adult ponies with body condition scores (BCS) ≥5/9 were used.

Methods

Two treatments (“feeder on” or “feeder off”) were administered for a 3‐month period by a randomized, crossover design (n = 4/treatment). An interim equilibration period of 6 weeks at pasture separated the 2 study phases. Measurements of body mass (body weight, BCS, cresty neck score [CrNS], and morphometry), body fat (determined before and after the “feeder on” treatment only), triglycerides, and insulin sensitivity (SI; combined glucose‐insulin test) were undertaken before and after treatments.

Results

The dynamic feeding system induced a 3.7‐fold increase in the daily distance travelled (n = 6), compared to with a stationary feeder, which significantly decreased mean BCS (6.53 ± 0.94 to 5.38 ± 1.71), CrNS (2.56 ± 1.12 to 1.63 ± 1.06) and body fat (by 4.95%). An improvement in SI did not occur in all ponies.

Conclusions and Clinical Importance

A dynamic feeding system can be used to induce sustained (daily), low‐intensity exercise that promotes weight loss in ponies. However, this exercise may not be sufficient to substantially improve SI.

Equine metabolic syndrome

Laminitis is one of the most common and frustrating clinical presentations in equine practice. While the principles of treatment for laminitis have not changed for several decades, there have been some important paradigm shifts in our understanding of laminitis. Most importantly, it is essential to consider laminitis as a clinical sign of disease and not as a disease in its own right. Once this shift in thinking has occurred, it is logical to then question what disease caused the laminitis. More than 90 per cent of horses presented with laminitis as their primary clinical sign will have developed it as a consequence of endocrine disease; most commonly equine metabolic syndrome (EMS). Given the fact that many horses will have painful protracted and/or chronic recurrent disease, a good understanding of the predisposing factors and how to diagnose and manage them is crucial. Current evidence suggests that early diagnosis and effective management of EMS should be a key aim for practising veterinary surgeons to prevent the devastating consequences of laminitis. This review will focus on EMS, its diagnosis and management.

Treatment of equine metabolic syndrome: A clinical case series

REASONS FOR PERFORMING STUDY

Treatment of equine metabolic syndrome (EMS) is essential to improve insulin sensitivity and reduce the risk of laminitis. Calorie restriction and increased exercise are the mainstays of treatment but there is potential for poor owner compliance.

OBJECTIVES

To determine whether significant weight loss accompanied by improvements in measures of insulin sensitivity can be achieved in horses and ponies with EMS managed by their owners in their normal environment under veterinary guidance.

STUDY DESIGN

Retrospective clinical case series.

METHODS

Horses and ponies attending 2 university hospitals for investigation and treatment of suspected EMS were eligible for inclusion in the study. Animals underwent a clinical examination, basal and dynamic endocrine testing; those with pituitary pars intermedia dysfunction (PPID) were excluded. Owners were given individually tailored diet and exercise programmes to follow for between 3 and 6 months. After the treatment period, clinical examination and endocrine tests were repeated and results compared to the initial assessment.

RESULTS

Nineteen animals were recruited to the study, 17 with a history of laminitis. All animals showed a reduction in body condition score (P<0.001) and 18/19 had a reduction in bodyweight (P<0.001) between assessments. There were significant (P<0.05) reductions in basal insulin, insulin at 45 min during a combined glucose insulin tolerance test (CGIT), time for blood glucose concentration to return to baseline during a CGIT and mean area under the glucose curve.

CONCLUSIONS

A diet and exercise programme tailored to the needs of the individual animal and implemented by the owner results in weight loss accompanied by improvements in insulin sensitivity.

Glucose homeostasis and the enteroinsular axis in the horse: a possible role in equine metabolic syndrome

One of the principal components of equine metabolic syndrome (EMS) is hyperinsulinaemia combined with insulin resistance. It has long been known that hyperinsulinaemia occurs after the development of insulin resistance. But it is also known that hyperinsulinaemia itself can induce insulin resistance and obesity and might play a key role in the development of metabolic syndrome. This review focuses on the physiology of glucose and insulin metabolism and the pathophysiological mechanisms in glucose homeostasis in the horse (compared with what is already known in humans) in order to gain insight into the pathophysiological principles underlying EMS. The review summarizes new insights on the oral uptake of glucose by the gut and the enteroinsular axis, the role of diet in incretin hormone and postprandial insulin responses, the handling of glucose by the liver, muscle and fat tissue, and the production and secretion of insulin by the pancreas under healthy and disrupted glucose homeostatic conditions in horses.