Problem list
▪ Obestity - Dysinsulinaemias
▪ Insulin resistence
▪ EMS: equine metabolic syndrome
▪ Pituitary pars intermedia dysfunction (equine Cushing’s disease)
▪ Laminitis
▪ Starvation
▪ Gastrointestinal diseases
▪ The asthmatic patient
▪ Muscular disorders
Obesity(Henneke 9-point system)
▪ body fat is likely to be greater than 20–25% of body mass
▪ overfed but undernourished
▪ BCS 7: overweight
▪ BCS of 8 or 9: obese
▪ breed
▪ obesity type
BCS7
BCS8 BCS9
cresty neck score
Leptin
Potential contributing factors for overweight/obesity
▪ imbalance between energy intake and expenditure: overfeeding
– inappropiate high E density feeds
– confinement hours – low level exercise - maintenance
– ponies: 24-hour access to pasture - consume DM up to 5% of BW
– „the grandma effect”
– husbandary factors mitigate winter-associated weight loss
▪ genetics: „easy keeper”
– inherited genetic traits that have facilitated survival on poor quality forages
▪ altered hormonal regulation
– leptin resitance
– hyperleptinemia – decreased insulin sensitivity
Conditions of Horses for Which Risk May Be Increased by Obesity
▪ Orthopedic disorders– Laminitis– Osteoarthritis
▪ Endocrine and metabolic disorders– Equine metabolic syndrome– Insulin resistance– Glucose intolerance– Hyperlipemia and hepatic lipidosis
▪ Abdominal/intestinal disorders– Pedunculated lipomas
▪ Miscellaneous– Heat intolerance– Exercise intolerance– Exacerbation of an aging-related pro-inflammatory state
Equine Metabolic Syndrome
▪ Obesity
▪ Insulin resistence
▪ Laminitis
– Clinical/subclinical
– Acute/chronic
▪ Dx: glucose/insulin test – Oral Glucose Tolerance Test
– Frequently Sampled Intravenous Glucose Tolerance Test
Weight loss and EMS diet
▪ increase exercise
▪ no grain – hay based: 2% 1,5% (1%) BW DMI
▪ soak hay to remove sugars
▪ limit grass (dry lot, grazing muzzle, turnout night)
▪ supplement: minerals, vitamins (1,000 IU/day E vitamin), Aas
▪ levothyroxin, metformine
average sugar, starch and NSC values
PPID (Equine Cushing’s disease)
▪ 15yrs<
▪ hypophysis adenoma (degenerative neurological disease)
▪ weightloss , skeletal muscle atrophy, local adiposity, hirsutism, laminitis, immunosuppression, lethargy, reproductive problems
▪ insulin resistence
▪ Dx: ACTH, TRH response
▪ Tx: pergolid
▪ Diet for insulin resistant but lean: alfalfa? + oil (omega3) + antioxidants + magnesium/chromium
Carbohydrate overloadPasture-associated laminitis/grass founder
▪ starch or fructan (oligofructose)
▪ altering the microbial flora, enhancing lactic acid production, lowering theintraluminal pH, and increasing intestinal permeability and osmotic pressure
▪ exotoxins, endotoxins, vasoactive amines, or other bacterial by-productsblood
systemic inflammatory response + insuline resistance triggers laminitis
▪ pasture grazing contributes to obesity
Obesity/EMS/PPID + Insulin resistence + laminitis
▪ Obese: pro-inflammatory state (TNFa is secreted from adipose tissues)
▪ Insulin:– vasoconstriction
– greater abundance of adhesion molecules on theendothelial surfaces of laminar vessels: facilitate neutrophilemigration into laminar tissues
▪ platelet activation: intestinal endotoxin + biogenamines
Starvation/ acute
• dangerous in obese ponies and donkeys: • insulin resistence• stress• pregnancy• diseases
• Catabolism of body fats and proteins• Fat is mobilizied –overproduction of VLDL by the liver
hyperlipaemia + hepatic lipidosis (no ketonaemia)Lab: increased triglyceridDiet: molasses coated grain + high quality hay
+BCAA
Killing with kindness: Refeeding syndrome
▪ „Refeeding syndrome was first described in Far East prisoners of war after the second world war.1 Starting to eat again after a period of prolonged starvation seemed to precipitate cardiac failure.”
▪ start slow and go slow
▪ environmental warming and separate management: clearly monitor DMI
▪ careful with insulin response –drives electrolytes IC Mg, K, P and vitamin depletion: hypophosphataemia
▪ triglycerid, leptin, urea high
▪ good quality hay or haylage, alfalfa (1kg/2hrs – then ad lib for week(s)-then go for concentrate)
▪ do not overwhelm forgut digestion
▪ vitamin E and B1
▪ Refeeding syndrome: arrhythmia, rhabdomyollysis, paralysis
GI diseases
▪ EGUS: see later
▪ Diarhea (carbohydrate overloead): see previously
▪ Impactions (gastric, ileal, cecal, large colon)– dentition
– fiber size
– feed quality– water
– ravenous eaters
▪ Sand Impaction/diarrhea: – old horse
– feeding from sandy ground
Psyllium Pellets
Equine Gastric Ulcer Syndrome EGUS
EGUS
ESquamousGD
Primary
management and nutrition
secondary
delayed gastric amptying
EGlandularGD)
EGUS types
ESGD: Equine Squamous Gastric Disease
EGGD: Equine Glandular Gastric Disease
No obvious connection! Both should be examined!
Clinical signs▪ loss of appetite, picky
▪ recumbent
▪ colicky, after feeding
▪ weight loss
▪ poor performance
▪ stereotyp behaviours, aggressive, nervous
EGUS risk:
▪ nutrition– concentrates (high starch)
– low fiber (buffer: fiber, protein, and mineral)
saliva low and high FFA
▪ management– no pasture
– training
– stress
– rare feeding occasions + large amounts of meals
EGUS diet
▪ TX: proton pump ihibitors
▪ pasture or roughage 16hrs
▪ 4-6 feeding occasion/daily, hay 1,5 kg /100 kg daily
▪ hay + granulates together (hay a little earlier)
▪ alfalfa and clover: buffer (calcium + protein)– hay, chaff or pellet
– Straw not good: low protein and Ca+ irritation
– calcium: 6–14 mg/g dm.
– CP: 17-20% dm.
EGUS diet
▪ max. 1-2 kg grain/concentrate, min. 6 hrs intervals
▪ <2 g/bwkg starch daily (1 g/bwkg/ meals)– oat (40% starch, 2,5 kg/500 kg)
– add chaffed alfalfa or hay
▪ cornoil: max. 100ml/100kg– E –vitamin
– Ω6:Ω3 = 53:1; (flaxseed oil: 0,26:1)
Asthmatic patients
▪ Inflammatory Airway Disease + Recurrent Airway Obstruction
▪ stable dust + dry poor quality hay-mould spores
Nutrition help
A/ pasture without hay supplementation
B/ haylage (botulism)
B/ steamed hay
C/ pelleted or other processed or complete feed: alpine mash, hay cobs, etc.
D/ less effective: soaked hay, E loss 5-10% (alfalfa has less resp. allergens)
+vitamin C
Muscular disorders
▪ HYPP: hyperkalaemic periodic paralysis (Impressive disease)– limit potassium intake, <1%
– keep stable insulin
▪ PSSM:polysacharid storage myopathy – amylsae resistent glycogen– gradual aerob training
– low carbohydrate, high fat, antioxidants
▪ RER: recurrent exertional rhabdomyolysis– Nutrition: similar as PSSM
▪ but not atypical myopathy (pasture associated, Acer sp., hypoglycin, carnitin mediated fat hydrolysis) – Nutriton: carbohydrate diet
HYPP links back to halter stallion, Impressive
The Belgian Draft is one breed with a very high prevalence of PSSM in their population.