Effects of soaking on the water-soluble carbohydrate and crude protein content of hay

Effects of soaked hay on lung function and airway inflammation in horses with severe asthma

BACKGROUND

Reducing inhaled dust particles improves lung function in horses with severe asthma. Soaked hay is commonly used by owners, but its efficacy in improving lung function and inflammation has not been documented.

OBJECTIVES

To measure the effects of soaked hay and alfalfa pellets in horses with severe asthma.

ANIMALS

Ten adult horses with severe asthma from a research colony.

METHODS

Prospective controlled trial. Horses in clinical exacerbation were housed indoors and allocated to be fed either soaked hay (n = 5) or alfalfa pellets (n = 5) for 6 weeks. Soaked hay was immersed for 45 minutes and dried out hay was discarded between meals. Pulmonary function and clinical scores were measured before and after 2, 4, and 6 weeks. Tracheal mucus scores and bronchoalveolar lavages were performed before and after 6 weeks. Lung function was analyzed with a linear mixed model using log-transformed data.

RESULTS

Lung resistance decreased from (median (range)) 2.47 (1.54-3.95) to 1.59 (0.52-2.10) cmH2 O/L/s in the pellets group and from 1.89 (1.2-3.54) to 0.61 (0.42-2.08) cmH2 O/L/s in the soaked hay group over the 6-week period for an average difference of 1.06 cmH2 O/L/s for pellets (95% confidence interval [95% CI]: 0.09-2.04, P = .03, not significant after correction) and 1.31 cmH2 O/L/s for soaked hay (95% CI: -0.23 to 2.85, P < .001, significant).

CONCLUSION AND CLINICAL IMPORTANCE

Soaked hay can control airway obstruction in horses with severe asthma. The strict protocol for soaking and discarding dried-out hay in this study could however be considered too great of an inconvenience by owners.

Effect of Hay Steaming on the Estimated Precaecal Digestibility of Crude Protein and Selected Amino Acids in Horses

Steaming hay is increasingly used to treat low-quality forage because it was proven to reduce inhalable allergens such as mould spores, bacteria, and airborne dust particles. Preliminary results have shown a substantial loss of precaecal (pc) digestibility (D) of crude protein (CP) and amino acids (AA). For this purpose, six different batches of hay from central Germany were divided into four subsamples, and each one was individually steamed. Native hay and four replicates of each steamed subsample were analysed for CP, AA, neutral detergent insoluble crude protein (NDICP), neutral detergent soluble crude protein (NDSCP) as well as pepsin insoluble CP (piCP). Based on the analytical parameters, pcD of CP, protein solubility (PS), piCP (% CP) and precaecal digestible (pcd) CP and pcdAA contents were calculated. Selected Maillard reaction products (MRP), namely furosine and carboxymethyllysine (CML), were also analysed. Steaming did not affect CP content (native = 69, steamed = 67 g/kg dry matter, DM; p > 0.05), but it had an impact on the insoluble part of CP. Thus, NDICP increased by 57% (native = 27, steamed = 42 g/kg DM; p < 0.05) and piCP by 15% overall (native = 40, steamed = 46% of CP; p < 0.05). This could be a consequence of the heat damage and the associated increase in MRP. The content of furosine rose by 67% (native = 17.6, steamed = 29.4 mg/100 g DM; p < 0.05). The content of CML increased by 120% (native = 5.1, steamed = 11.3 mg/100 g DM; p < 0.05). We chose to analyse these two MRPs because they represent the reaction products with the limiting AA lysine. In contrast, the soluble fractions of CP declined, while PS as a percentage of CP decreased by 38% as a result of the treatment, and NDSCP was reduced by as much as 41% (p < 0.05). In line with this, the steaming process decreased the pcD of CP (native = 56%, steamed = 35%; p < 0.05) and pcdCP (native = 37.9, steamed = 22.5 g/kg DM; p < 0.05), respectively. The same effects were shown for selected AA; e.g., sulphuric AA pcd methionine plus pcd cysteine decreased by 45%, pcd threonine decreased by 41%, and the limited AA pcd lysine decreased by more than 50% (p < 0.05). In conclusion, the high temperatures generated during steaming lead to protein damage and consequently to a reduction in the pcD of CP and essential AA. Nevertheless, steaming successfully reduces viable microorganisms and binds dust particles. Therefore, steamed hay is still a proper and sometimes the only possible roughage for horses suffering from respiratory diseases such as equine asthma. Essentially, horse diets based on steamed hay should be balanced accordingly.

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.

"Feeding the Foot": Nutritional Influences on Equine Hoof Health

Nutrition plays an important role in equine health, including that of the foot. Deficiencies and excesses of dietary components can affect the growth and function of the foot and have been associated with important podiatric diseases. The recognition, prevention, and treatment of specific notable nutritional diseases of the foot are discussed, as well as information regarding specific ingredients included in supplements meant to improve equine hoof quality. Ensuring provision of a balanced diet, maintaining horses in appropriate body condition, and seeking guidance from an equine nutritionist when creating dietary recommendations will prevent most equine foot disease related to nutrition.

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.

Effect of Hay Soaking Duration on Metabolizable Energy, Total and Prececal Digestible Crude Protein and Amino Acids, Non-Starch Carbohydrates, Macronutrients and Trace Elements

Soaking hay before feeding has been documented to reduce airborn respirable particles and water-soluble carbohydrate (WSC) content which may have positive benefits for horses suffering from Equine Asthma (EA) or Equine Metabolic Syndrome (EMS). Prolonged soaking also leaches minerals, but to-date no measurement of the loss of small intestine digestible crude protein has been documented. One aim of this study was to investigate various soaking durations on nutrient contents of hay, WSC, macronutrients, and trace elements levels. Another objective was to determine the prececal digestible crude protein (pcd CP) and amino acid (pcd AA) fraction contents and prececal digestibility (pcD). Four different batches of meadow hay were soaked in water (20° C during preparation) for 0 minutes, 15 minutes, 30 minutes, 60 minutes, and 12 hours and drained for 20 minutes. A 15 minutes soaking duration significantly reduced the levels of nearly all investigated nutrients (e.g. for fructans, and WSC, macronutrients and trace elements). However, the crude fiber, acid detergent fiber (ADF), and acid detergent lignin content increased. Metabolizable energy (ME) contents decreased by 5-15 %, pcd CP and pcd AA fell by 35 %, and the pcD declined by up to 49 %. In contrast, the pcD was 56 % before soaking. Longer soaking durations did not enhance the wash-out effect. Horse owners should be aware that soaking hay, regardless of reason, may negatively alter the nutritional value. The wide range of wash-out effects may pose risks in calculating the correct dry matter portion to prevent weight loss and maintain ME, pcd CP and pcd AA requirements, especially for horses with EMS and EA.

The haybiome: Characterising the viable bacterial community profile of four different hays for horses following different pre-feeding regimens

Respirable dust in conserved forages can pose problems with equid respiratory health, thus soaking (W) and high temperature steaming (HTS) are employed to reduce the levels in hay. The aim of this study was to characterize the viable bacterial community profile of four hays from two different locations in UK following pre-feeding wetting regimens. Hypothesis: (1) Viable microbial community profile of hays will not differ between different pre-feeding regimens. (2) Hay type and location will not influence microbial community profile. Replicates of each of the four hays were subjected to dry (D), HTS conducted in a HG600, W by submergence in 45 L tap water, 16°C for 12 hours. From each post-treated hay, 100 g samples were chopped and half (n = 36) treated with Propidium monoazide dye, the remaining half untreated. Bacterial DNA were extracted for profiling the V4-V5 region of 16S rRNA gene from all 72 samples, then sequenced on the Illumina MiSeq platform. Bioinformatics were conducted using QIIME pipeline (v1.9.1). Linear discriminate analysis effect size (LEfSe) was used to identify differences in operational taxonomic units and predicted metabolic pathways between hays and regimens. HTS reduced proportions of microbiota compared to W and D hay (P < 0.001, df 3, F 13.91), viability was reduced within regimens (P = 0.017, df 1, F 5.73). Soaking reduced diversity within and between regimens. Core bacterial communities differed between hays and regimens, however pre-feeding regimen had the greatest effect on the bacterial community profile. W and HTS reduced viable bacteria (P< 0.05) known to cause respiratory disease, for HTS both respiratory and dental disease, with the greatest reductions overall from HTS without reducing bacterial diversity. Soaking increased Gram-negative bacteria and reduced bacterial diversity. Collectively these findings add to a body of evidence that suggest HTS is the most suitable pre-feeding regimen of hay for equid health.

Mapping the bacterial ecology on the phyllosphere of dry and post soaked grass hay for horses

Soaking hay fodder to reduce dust and soluble carbohydrate (WSC) contents prior to feeding is common practice among horse owners. Soaking can increase bacteria load in hay but no information exists on how this process alters the bacteria profile, which could pose a health risk or digestive challenge, to horses by introducing foreign bacteria into the gastrointestinal tract and so altering the normal profile. The current objectives were to map the bacterial profile of 3 different hays and determine how soaking alters this with the aim of improving best practice when feeding stabled horses. A Perennial Rye grass hay and two meadow s hays were soaked for 0, 1.5, 9 or 16 hours. Pre and post treatment, hays were analysed for WSC and total aerobic bacteria (CFU/g), and differences in bacteria family profiles were determined using ANOVA with significance set at P<0.05. Bacteria were identified via genomic DNA extraction and 16S library preparation (V3 and V4 variable region of 16S rRNA) according to the Illumina protocol. Differences in family operational taxonomic units (OTUs) between individual dry hays and different soaking times were identified via paired t-tests on the DESeq2 normalised data and false discovery rates accounted for using Padj (P<0.05). Mean % WSC losses and actual g/kg lost on DM basis (+/- SE) increased with soaking time being 18% = 30 (10.7), 38% = 72 (43.7), and 42% = 80 (38.8) for 1.5, 9 and 16 hours soak respectively. No relationship existed between WSC leaching and bacteria growth or profile. Grass type influenced bacterial profiles and their responses to soaking, but no differences were seen in richness or Shannon diversity indices. PCA analyses showed clustering of bacteria between meadow hays which differed from the perennial rye grass hay and this difference increased post soaking. Soaking hay pre-feeding causes inconsistent WSC leaching, bacteria growth and alterations in bacterial profiles which are unpredictable but may decrease the hygienic quality of the fodder.

Nutrient content changes from steaming or soaking timothy-alfalfa hay: effects on feed preferences and acute glycemic response in Standardbred racehorses1

Soaking hay and steaming hay are strategies that are used to reduce respirable dust particles for horses but may result in variable nutrient losses, including nonstructural carbohydrates (NSC) and minerals. Since these losses have not been quantified in Canadian hay yet, the first aim of this study was to identify nutrient losses from first-cut timothy-alfalfa hay grown in southern Ontario, Canada, after soaking for 30 min or steaming for 60 min. It is uncertain whether horses prefer hay when it is dry, soaked, or steamed. To address this, 13 Standardbred racehorses were offered 2 of these hays side by side for 30 min on 6 consecutive occasions until all possible combinations had been offered. Quantity of hay eaten was determined and horses were video recorded during feedings to assess time spent eating and investigating hay. Additionally, consumption of feeds with differing NSC levels has been observed to influence glycemic response in horses; however, this has not been measured in horses consuming steamed hay before and the results from soaked hay studies have been inconclusive. As such, the final aim of this study was to examine acute glycemic response in horses after being fed dry, soaked, and steamed hays. Blood glucose was measured every 30 min from 9 Standardbred racehorses for 6 h following a meal of 0.5% of their body weight of treatment hay on a dry matter basis (DMB). Soaked, but not steamed, hay had lower concentrations of soluble protein, NSC, and potassium in contrast to the same dry hay (P < 0.05). Peak glucose, average blood glucose, total area under the curve, and time to peak did not differ among treatments (P > 0.05). We conclude that acute glycemic response of racehorses was not influenced by soaking or steaming hay. Horses also consumed less soaked hay (DMB) than dry or steamed hay (P < 0.05) and spent less time eating soaked hay than dry or steamed hay (P < 0.05).

Equine metabolic syndrome: evolution of understanding over two decades: a personal perspective

There has been a marked increase in the incidence of equine obesity globally, especially in countries where there has been a shift away from the horse having an economically essential working role. This change in its core role, plus the increasing numbers of individual horse owners without access to traditional knowledge of animal and land management, have helped fuel this equine obesity ‘epidemic’. Other important potential contributory factors include increased availability of good grazing and/or forage, as well as supplementary feeds. Obesity now presents a major welfare issue for horses and ponies, not only because of the direct weight-associated effects, but also due to the increased risk it poses for certain clinical conditions, in particular laminitis. For many owners and veterinarians, obesity and the equine metabolic syndrome are synonymous, but this is not necessarily the case. Furthermore, as we understand more about this syndrome and the causes of endocrinopathic laminitis, the emphasis has shifted from tissue or peripheral insulin resistance to insulin dysregulation. The present paper outlines how our knowledge of equine metabolic syndrome arose and continues to develop, as well as the authors’ personal involvement in some of these advances.

Bambara groundnut (Vigna subterranea (L.) Verdc.) flour: A functional ingredient to favour the use of an unexploited sustainable protein source

Variability in dehulling efficiency, colour, chemical composition and selected functional properties of raw and pre-treated bambara groundnut (Vigna subterranea (L.) Verdc.) (BG) flour from red and black-eye varieties were studied. Functional properties were water and oil absorption, gelation, pasting, emulsification and foaming capacity. Pre-treatment of seeds (i.e. soaking, roasting and combined soaking and roasting) improved dehulling efficiency of BG varieties. Protein content of flour ranged from 15.6-19.6%, starch from 47.8-52.0% and sucrose from 1.9-5%. An improvement was observed for protein and ash content of pre-treated flour compared to raw flour. Heat treatments increased onset gelatinization temperature of flour. Black-eye BG flours that had higher starch content, also had better gelation capacity than red BG flours. All pre-treatment methods decreased flour emulsification capacity and stability. Dry-roasting caused a greater decline than other methods, whereas soaking had little effect on emulsion stability. Further, soaking increased foaming capacity, whilst a decline was observed in roasted flour. All pre-treatment methods increased oil absorption capacity of both BG flour varieties. Overall, soaked and combined soaked and roasted flour is recommended for BG flour to be incorporated in food products.

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.

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.

The effect of five different wetting treatments on the nutrient content and microbial concentration in hay for horses

Five different hays were used to determine the effect of 5 different soaking and steaming treatments on the water soluble carbohydrate and microbial (bacteria and mould) contents of UK hay. Hays were subjected to the following 5 treatments: 1. Dry; 2. Steamed for 50 minutes in the Haygain- 600 steamer; 3. Soaked in water at 16°C for 9 hours; 4. Steamed then soaked and 5. Soaked then steamed. Post treatment hays were tested for water soluble carbohydrates, bacteria and mould contents. Differences between means were determined using ANOVA and least significant difference with hay (5), bale (3) and treatment (5) as fixed factors, thus n = 75. Protein and ash proportions were unaltered in any of the treatments. Soaked, steamed then soaked and soaked then steamed treatments were all equally effective at reducing water soluble carbohydrates, with significantly (P<0.05) lower mean contents (79-83 g/kg DM) compared with 126 and 122 g/kg dry matter (DM) for dry and steamed respectively. Steamed and soaked then steamed had significantly (P<0.05) less bacteria (1.04×103 and 4.9×102 CFU/g DM) compared with soaked which increased CFU/g DM from 6.0×104 in dry hay up to 3.5×105. Mould contents CFU/g DM were significantly (P<0.05) reduced by steaming (2) and soaking then steaming (1.9) but no difference was seen between dry (1148), soaked (692) or steamed then soaked (501). Soaking for 9 hours followed by steaming for 50 minutes in the Haygain steamer was the most effective method for reducing water soluble carbohydrates and microbial contamination in hay. Soaking or steaming+soaking lowered water soluble carbohydrates but significantly reduced the hygienic quality of the hay which could potentially compromise the health of the horse.

Insulin dysregulation

Abnormalities of insulin metabolism include hyperinsulinaemia and insulin resistance, and these problems are collectively referred to as insulin dysregulation in this review. Insulin dysregulation is a key component of equine metabolic syndrome: a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses, ponies and donkeys. Insulin dysregulation can also accompany prematurity and systemic illness in foals. Causes of insulin resistance are discussed, including pathological conditions of obesity, systemic inflammation and pituitary pars intermedia dysfunction, as well as the physiological responses to stress and pregnancy. Most of the discussion of insulin dysregulation to date has focused on insulin resistance, but there is increasing interest in hyperinsulinaemia itself and insulin responses to feeding. An oral sugar test or in-feed oral glucose tolerance test can be performed to assess insulin responses to dietary carbohydrates, and these tests are now recommended for use in clinical practice. Incretin hormones are likely to play an important role in postprandial hyperinsulinaemia and are the subject of current research. Insulin resistance exacerbates hyperinsulinaemia, and insulin sensitivity can be measured by performing a combined glucose-insulin test or i.v. insulin tolerance test. In both of these tests, exogenous insulin is administered and the rate of glucose uptake into tissues measured. Diagnosis and management of hyperinsulinaemia is recommended to reduce the risk of laminitis. The term insulin dysregulation is introduced here to refer collectively to excessive insulin responses to sugars, fasting hyperinsulinaemia and insulin resistance, which are all components of equine metabolic syndrome.

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

Few studies have examined the effect of dietary restriction in horses with equine metabolic syndrome (EMS). This study aimed to determine improvements in insulin sensitivity following dietary restriction for 6 weeks, and to determine if the improvement would be greater in horses receiving short-chain fructo-oligosaccharides (sc-FOS). Dietary management involved feeding grass hay, restricted to 1.25% of body mass (BM) as daily dry matter intake and soaked in cold water prior to feeding, with the addition of a vitamin and mineral nutraceutical supplement with or without the addition of sc-FOS (10 g/100 kg). Soaking the hay resulted in a significant reduction in non-structural carbohydrates (38%, P = 0.01), digestible energy (6.78%, P = 0.01) and water soluble minerals. Following 6 weeks of dietary restriction with soaked grass hay and nutraceutical supplement, horses lost an average of 6.8% BM and showed reductions in body condition score (BCS) and belly circumference. Sensitivity to insulin improved overall, as determined by the total insulin response during the combined glucose insulin test. The magnitude of improvement in insulin sensitivity was associated with the degree of insulin resistance recorded at outset, and the extent of overall losses in BM and BCS, but was independent of the addition of sc-FOS. The nutraceutical supplement was highly palatable and no adverse effects were noted. From the findings of this study a strict dietary program in combination with a specifically designed vitamin and mineral nutraceutical supplement can be recommended to obtain rapid improvements in BM, BCS and insulin sensitivity of animals presenting with EMS.