Glycemic and Insulinemic Responses Are Affected by Age of Horse and Method of Feed Processing

Obesity and obesity-associated metabolic disease conditions in Connemara ponies in Ireland

BACKGROUND

Equine obesity combined with insulin dysregulation (ID) is a major risk factor associated with laminitis. Some pony breeds appear to be at increased risk. However, little is known regarding the prevalence of obesity or hyperinsulinaemia as evidence of ID in Irish ponies.

OBJECTIVE

To investigate the prevalence of obesity and associated endocrine/metabolic disease conditions in Connemara ponies and to determine if hyperinsulinaemia in these ponies could be predicted by morphometric or metabolic markers.

STUDY DESIGN

Cross-sectional study.

METHODS

The study population included registered Connemara ponies recruited through public and veterinary social media posts. Ponies underwent a physical examination and information on their management and clinical history was obtained via owner questionnaire. The body condition score (BCS) was measured using the Henneke system; cresty neck score (CNS) and regionalised adiposity were also assessed. Hyperinsulinaemia was confirmed by measuring serum basal insulin concentration (BIC) or insulin concentration after an oral sugar test (OST). Blood glucose and triglyceride concentrations were measured. Characteristics of hyperinsulinaemic and insulin-sensitive ponies were compared by logistic regression.

RESULTS

Two hundred ponies were included; 59 ponies (29.5%) had a BCS ≥7, 58 (29.0%) had a CNS ≥2.5 and 135 (67.5%) had regionalised adiposity; 137 (68.5%) ponies had at least one of these abnormalities. Owner-reported history or clinical evidence of chronic laminitis was found in 92 ponies (46.0%). Hyperinsulinaemia was confirmed in 32 ponies (16.0%), including 23 of 91 (25.3%) detected by OST and 9 of 109 (8.3%) by BIC. Hypertriglyceridaemia was observed in 12 of 198 ponies (6.1%) ponies and hyperglycaemia in 11 of 197 ponies (5.6%) ponies. The odds of hyperinsulinaemia increased by a factor of 6.53 (95% confidence interval: 2.95, 15.21) when BCS was ≥7.

MAIN LIMITATIONS

The OST was not performed in all ponies.

CONCLUSIONS

Increased adiposity, laminitis and metabolic derangements are prevalent in this native Irish pony breed.

Development of a Web App to Convert Blood Insulin Concentrations among Various Immunoassays Used in Horses

The measurement of the blood insulin concentration, and comparison to cut-offs, is essential in diagnosing insulin dysregulation, a common equine endocrinopathy. However, different insulin assays provide disparate results. We aimed to ease comparison between assays by compiling original and published data into a web app to convert insulin measurements from one assay to another. Data were available for ADVIA Centaur insulin chemiluminescent immunoassay (CLIA), Beckman Coulter insulin radioimmunoassay (RIA), Immulite 1000 CLIA, Immulite 2000 CLIA, Immulite 2000 XPi CLIA, Mercodia equine insulin enzyme-linked immunosorbent assay (ELISA), and Millipore porcine insulin RIA. Linear models were fitted for 13 assay pairs using non-decreasing splines, and integrated into this app. Assay comparisons including data from several studies showed a lower performance. This indicates technical variation between laboratories, which has not been described before, but is relevant when diagnostic measurements and cut-offs are provided by different laboratories. Nevertheless, the models' overall high performance (median r2 = 0.94; range 0.57-1.00) supports their use to interpret results from diagnostic insulin measurements when the reference assay is unavailable, and to compare values obtained from different assays.

Variation in insulin response to oral sugar test in a cohort of horses throughout the year and evaluation of risk factors for insulin dysregulation

BACKGROUND

The oral sugar test (OST) is commonly used to diagnose insulin dysregulation (ID) and equine metabolic syndrome; however, possible seasonal changes in OST results have not been evaluated.

OBJECTIVE

To determine the possible variation in insulin response to OST throughout the year and risk factors associated with maximum insulin concentration (InsMax) and ID.

STUDY DESIGN

Prospective, longitudinal cohort study.

METHODS

The OST was performed on 29 Finnhorses every other month six times. Serum total adiponectin concentration and phenotypic variables related to obesity were also measured. Changes in InsMax, adiponectin, scale weight, body condition score, cresty neck score (CNS), and fasting glucose concentration were assessed. Risk factor analyses were performed on InsMax and ID status, and ID groups were compared with each other.

RESULTS

Fourteen horses were categorised with non-ID each time and 15 as having ID at least once during the follow-up period. The ID status of 12 horses varied throughout the year, but neither the insulin variables measured during the OST nor adiponectin expressed significant seasonal variation. Increasing age and CNS, and decreasing adiponectin were observed as risk factors for a high InsMax after OST. The risk of ID was higher in horses with no exercise compared to horses with exercise (OR 7.6, 95% CI 1.2-49.3, P = .03). Horses with ID had lower serum adiponectin concentrations, longer neck circumference and larger height than horses in the non-ID group.

MAIN LIMITATIONS

The environmental conditions (feeding, exercise) were not constant for all horses throughout the study and only one breed was used.

CONCLUSIONS

Neither OST results nor adiponectin varies with season; however, there were a substantial number of horses with variable ID status throughout the year, in which repeated OSTs may be beneficial. Lack of exercise was a risk factor for ID.

Chromium propionate increases insulin sensitivity in horses following oral and intravenous carbohydrate administration

Forty-eight Quarter Horse geldings (3 to 8 yr of age) were used to determine the effects of dietary chromium (Cr), in the form of Cr propionate (Cr Prop) on insulin sensitivity. Horses were blocked by age, body condition score, and glucose response to concentrate feeding on day 0 and randomly assigned to treatments. Treatments consisted of 0, 2, 4, or 8 mg Cr/d from Cr Prop. Horses were fed daily a concentrate mix at a rate of 0.2 kg/100 kg body weight (BW) and grass hay at 1.75 to 2.0 kg/100 kg BW. All horses were fed the control diet for 7 d prior to the initiation of the study. After an overnight fast, blood samples from the jugular vein were obtained at 0, 2, and 4 h after concentrate feeding on days 0 and 28 for the determination of glucose, nonesterified fatty acids, and insulin. A glucose tolerance test (GTT) was conducted on day 42. Glucose was infused via jugular vein catheters, and blood samples were collected at various times relative to dosing for glucose and insulin determination. Plasma glucose on day 28 was affected (P < 0.05) by treatment, time, and treatment × time. Horses fed 4 mg Cr/d had lesser (P < 0.05) plasma glucose concentrations than those in the other treatments at 0 h. At 2 h post-feeding glucose concentrations were greater (P < 0.05) in horses fed 0 or 8 mg Cr/d than in those given 4 mg Cr. Horses fed 2 mg Cr/d had lesser (P < 0.05) plasma glucose at 4 h post feeding compared with those fed 0 or 8 mg Cr. Plasma glucose did not differ among horses receiving 2 or 4 mg Cr/d at 2 or 4 h. Serum insulin was affected (P < 0.05) by treatment, time, and treatment × time. Insulin concentrations were greater (P < 0.05) in horses fed 0 or 2 mg Cr/d than in those given 4 or 8 mg Cr at 0 h. At 4 h post-feeding insulin concentrations were greater (P < 0.05) in horses given 0 or 8 mg Cr than in those fed 2 or 4 mg Cr/d. Plasma glucose was affected (P < 0.05) by treatment and time, but not by treatment × time following the GTT. Mean plasma glucose (across sampling times) concentrations were greater (P < 0.05) in controls than in horses fed 2 or 4 mg Cr/d. Glucose concentrations following the GTT did not differ among controls and horses given 8 mg Cr/d. Following glucose infusion, serum insulin concentrations were greater (P < 0.05) in horses fed 2 or 4 mg Cr and tended to be greater in those fed 8 mg Cr/d compared with controls. The results of this study indicate that 2 or 4 mg Cr/d from Cr Prop increased insulin sensitivity in adult horses following oral carbohydrate consumption.

Glucose and Insulin Responses to an Intravenous Glucose Load in Thoroughbred and Paso Fino Horses

Certain breeds of horses may be genetically predisposed to developing insulin dysregulation, which is a risk factor for development of endocrinopathic laminitis in horses. This study was performed to test the hypotheses that Paso Fino horses exhibit evidence of insulin dysregulation compared with Thoroughbred horses and that obesity exaggerates the insulin dysregulation. Intravenous glucose tolerance tests were performed in 14 moderate-weight Thoroughbreds, 12 moderate-weight Paso Finos, and 12 overweight Paso Finos. Moderate Paso Finos had greater baseline serum insulin concentrations, area under the insulin concentration curve, peak insulin, insulin-to-glucose ratio, area under the insulin to glucose curve, and modified glucose-to-insulin ratio compared with moderate Thoroughbreds. The reciprocal inverse square of basal insulin (RISQI) and glucose-to-insulin ratio were significantly lower in moderate Paso Finos compared with moderate Thoroughbreds. Overweight Paso Finos had greater baseline insulin concentrations, area under the insulin concentration curve, time to peak insulin, baseline plasma glucose concentration, insulin-to-glucose ratio, and area under the insulin to glucose curve compared with moderate Paso Finos. The RISQI and glucose-to-insulin ratio were significantly lower in overweight Paso Finos compared with moderate Paso Finos. In conclusion, moderate-weight Paso Finos had higher baseline serum insulin concentrations and an excessive hyperinsulinemic response to an intravenous glucose load when compared with moderate-weight Thoroughbreds. Overweight Paso Finos had even greater baseline insulin concentrations and hyperinsulinemic responses to glucose compared with moderate Paso Finos, as well as greater baseline plasma glucose concentrations. Paso Finos exhibit insulin dysregulation compared with Thoroughbreds.

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.

Effects of age and diet on glucose and insulin dynamics in the horse

BACKGROUND

Age and diet may affect insulin sensitivity (SI) but these factors have received limited investigation in horses.

OBJECTIVES

To measure minimal model parameters during an insulin-modified frequently sampled intravenous glucose tolerance test (FSIGTT) after adaptation to a forage only diet (HAY) or forage supplemented with either starch/sugar-rich (SS) or oil/fibre-rich (FF) concentrate feeds; and to assess glucose and insulin responses to a standardised meal challenge (SMC, 4 g/kg BW of SS) after diet adaptation in adult and aged mares.

STUDY DESIGN

Latin square design with eight adult (5-12 years) and nine aged (>19 years) healthy mares.

METHODS

Diets were fed for 6 weeks, and the FSIGTT and SMC were performed after 31-32 and 41 days on each diet respectively. Data were analysed by a mixed ANOVA for repeated measures.

RESULTS

Acute insulin response to glucose (AIRg) was greater and SI was lower in aged horses, compared with adults, regardless of diet. Both AIRg and SI were greater in aged mares after adaptation to SS, as compared with HAY. Similar trends, although not statistically significant, were observed after adaptation to SS in adult mares. Peak insulin concentration and area under the insulin vs. time curve during the SMC were greater in aged than adult mares with all diets. Furthermore, area under the glucose vs. time curve was lower after adaptation to SS, when compared with other diets, in both groups.

MAIN LIMITATIONS

Transient weight loss occurred at the beginning of the study and only one sex was included. Incomplete ingestion of the SMC by four mares was another limitation.

CONCLUSIONS

Insulin responses to i.v. and enteral nonstructural carbohydrate challenge increase with age in healthy horses, regardless of diet fed.

Effect of age and dietary carbohydrate profiles on glucose and insulin dynamics in horses

BACKGROUND

Glucose and insulin dynamics may be different in adult and aged horses.

OBJECTIVES

To determine the effects of age and dietary carbohydrates on glucose and insulin dynamics in healthy horses.

STUDY DESIGN

Balanced Latin square with four isocaloric diets: CONTROL (hay plus restricted-starch-and-sugar fortified pellets), STARCH (control plus kibbled corn), FIBER (control plus unmolassed sugar beet pulp/soybean hull pellets) and SUGAR (control plus dextrose powder).

METHODS

A total of 16 healthy Thoroughbreds and Standardbreds divided into two age groups: ADULT (8.8 ± 2.9 years; n = 8) and AGED (20.6 ± 2.1 years; n = 8). Following dietary adaptation, horses underwent an insulin-modified frequently sampled intravenous glucose tolerance test (FSIGTT), modified oral sugar test (OST) and dietary meal challenge. Outcome variables included: insulin sensitivity (SI), disposition index (DI), glucose effectiveness (Sg) and acute insulin response to glucose (AIRg) from the FSIGTT; peak glucose, peak insulin, time to peak, area under the curve for glucose (AUCg) and insulin (AUCi) from the OST and dietary meal challenge. Data were analyzed using multivariable linear mixed regression modelling.

RESULTS

AIRg was higher in AGED (mean [95% confidence interval]; 582.0 [455.0-709.0]) vs. ADULT (358.0 [224.0-491.0]; P = 0.03). ADULT and AGED horses had a higher SI on STARCH (adult: 3.3 [2.3-4.2]; aged: 2.8 [1.9-3.7]) and SUGAR (adult: 3.4 [2.5-4.3]; aged: 4.0 [3.1-4.9]) diets compared with CONTROL (adult: 2.0 [1.1-2.9], P = 0.029 (starch), P = 0.009 (sugar); aged: 1.4 [0.5-2.2], P = 0.009 (starch), P < 0.001 (sugar)). Feeding a STARCH (adult: 21581.0 [15029.0-28133.0]; aged: 35205.0 [29194.0-41216.0]) or SUGAR (adult: 26050.0 [19885.0-32215.0]; aged: 25720.0 [19770.0-31670.0]) meal resulted in postprandial hyperinsulinaemia (AUCi).

MAIN LIMITATIONS

Study cohort contained two insulin-sensitive breeds and no insulin-resistant breeds.

CONCLUSIONS

Age and diet should be considered when evaluating glucose and insulin dynamics.

Mobile bag starch prececal disappearance and postprandial glycemic response of four forms of barley in horses

To determine prececal starch digestibili-ty and estimate glucose uptake from the digestion of 4 forms of barley in the small intestine, 4 mature cecally fistulated geldings (449 ± 41 kg BW) fed a 62:38 (wt/wt) meadow hay:concentrate diet at 1.7 kg DM/100 kg BW were included in a 4 × 4 Latin square design experiment. During each period, horses received 80% DM of their concentrate as 1 of the 4 forms of a same batch of barley, whole grain, 2.5 mm ground, steam flaked, and pelleted. Hay was offered in 2 equal meals and concentrate in 2 unequal meals. The starch supply in the morning meal amounted 2.7 g starch/kg BW. At each period, mobile bag DM and starch disappearance was determined. Except for ground barley, each form of barley was 4 mm ground before being introduced in the bag. Nylon bags containing each substrate were intubated in the horse receiving the pelleted barley. Bags were collected in the cecum for 10 h postintubation. At each period, postprandial glycemia was measured on blood samples collected on the 4 horses via an indwelling jugular catheter just before the concentrate morning meal and for 8 h. No hay in the morning meal was given the day of the measurements. Whole blood glucose was analyzed with a portable blood glucose meter. Mobile bag prececal DM disappearance and starch disappearance depended (P < 0.01) on barley form. Prececal starch disappearance of whole barley was the lowest but no difference (P > 0.05) was detected among the 3 processed grains. No significant effect of barley form was found whatever the glycemic parameters. No significant correlation was reported between glycemic parameters and the amount of prececal mobile bag disappeared starch calculated as the starch intake in the morning meal by the mobile bag starch disappearance. To conclude, the whole form of barley exhibited the lowest prececal mobile bag starch disappearance whereas, in relationship with large individual variations, no significant variation has been shown in glycemic parameters. Further investigations should be performed to improve methods for estimating prececal starch digestion of processed cereals in the different digestive segments of horses.

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.

The effect of different feed delivery methods on time to consume feed and the resulting changes in postprandial metabolite concentrations in horses

Management techniques that reduce the insulin response to feeding in horses have application in preventing insulin resistance (IR) and potential associations (e.g., laminitis). Eight mature idle horses of BCS between 5 and 6.5 and with no previous indication of IR were fed a meal of concentrate under 4 feed delivery treatments in a repeated Latin Square design. Treatments were all based on a bucket of equal dimensions. The treatments included a control (CON) and 3 treatments hypothesized to increase time to consume feed (TCF): mobile obstacles above the feed (BALL), stationary obstacles below the feed (WAFF), and feed with water added (WTR). Jugular venous blood samples were taken at feed delivery, every 10 min for the first hour, and then every 30 min until 300 min after feed delivery. The TCF was different across treatment and was greater (P < 0.05) for BALL and WAFF when compared with CON and WTR. Glucose and insulin concentrations increased after feeding (P < 0.05) and tended to differ among treatments (P < 0.10). Peak insulin and glucose concentrations were affected by treatment as were the time to peak insulin and the area under the curve of insulin (P < 0.05). Therefore, feed delivery methods that include obstacles effectively increase TCF and attenuate postprandial glucose and insulin concentrations. A second experiment was designed to determine if the TCF changes associated with BALL and WAFF in Exp. 1 remain effective over a 4-d period. Four horses with no recent or regular history of consuming concentrates were fed concentrate meals for 4 consecutive d using the same treatments described in Exp. 1 and a Latin square design. Horses were subject to a 4-d adaptation period and were randomly assigned to 4-d treatment periods using the 4 previously described treatments. During adaptation, TCF decreased over time (P = 0.02). After adaptation, WAFF had greater TCF when compared with CON and WTR (P < 0.05) whereas WTR had the lowest TCF overall. Using obstacles to increase TCF on a daily basis may be an effective method to reduce postprandial glucose and insulin concentrations, thereby decreasing the risk of IR development in horses.