Equine clinical nutrition clinical nutrition2018.pdf · Killing with kindness: Refeeding syndrome „Refeeding syndrome was first described in Far East prisoners of war after the

Equine clinical nutrition

Orsolya Kutasi

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

Which horse has a higher risk for laminitis?

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 overload, sudden diet changePasture-associated laminitis/grass founder

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

Sarvation/chronic

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.

Thank you for attention!