Journal of veterinary internal medicine2019; 33(2); 335-349; doi: 10.1111/jvim.15423

ECEIM consensus statement on equine metabolic syndrome.

Abstract: 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.
Publication Date: 2019-02-06 PubMed ID: 30724412PubMed Central: PMC6430910DOI: 10.1111/jvim.15423Google Scholar: Lookup
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This article focuses on the Equine Metabolic Syndrome (EMS), a condition in horses marked by risk factors like insulin dysregulation that can lead to laminitis. The research advices practical methods for recognizing, diagnosing, and controlling this condition in order to promote the animal’s overall health.

Introduction to Equine Metabolic Syndrome (EMS)

  • Equine Metabolic Syndrome (EMS) is a common health disorder among horses that brings together multiple risk factors for a disease known as endocrinopathic laminitis.
  • Endocrinopathic laminitis is a painful and debilitating disorder affecting a horse’s feet.
  • The principal risk factor for EMS is the disruption of insulin regulation, often known as Insulin Dysregulation (ID).

Importance of Identifying Risk Factors

  • The article emphasizes the importance of accurately identifying these risk factors to mitigate and control the likelihood of a horse suffering from a laminitis attack.
  • Both clinicians and horse handlers have the responsibility to notice these risk factors, including signs of insulin dysregulation and obesity, among others.

Diagnosis of EMS

  • The process for diagnosing EMS is two-fold, comprised of both a review of the horse’s medical history and a clinical examination, as well as laboratory testing.
  • Diverse testing mechanisms exist, each illuminating different aspects of insulin dysregulation and other closely linked metabolic disruptions.

EMS Management

  • The management of EMS mainly revolves around adjusting the horse’s diet and instituting a proper exercise program. These alterations aim to amend insulin regulation and cut down obesity where it exists.
  • In certain situations, the use of pharmacological aids could be beneficial. However, this is a secondary strategy and is used only if the primary methods don’t yield results.

The Need for Long-Term Care

  • The proper handling of an EMS case is a long-term strategy that requires a high degree of diligence and discipline from the horse’s carer.
  • The carer should work closely with their veterinarians to ensure that the horse receives consistent support and guidance.

Cite This Article

Durham AE, Frank N, McGowan CM, Menzies-Gow NJ, Roelfsema E, Vervuert I, Feige K, Fey K. (2019). ECEIM consensus statement on equine metabolic syndrome. J Vet Intern Med, 33(2), 335-349.


ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 33
Issue: 2
Pages: 335-349

Researcher Affiliations

Durham, Andy E
  • Liphook Equine Hospital, Liphook, United Kingdom.
Frank, Nicholas
  • Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts.
McGowan, Cathy M
  • Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom.
Menzies-Gow, Nicola J
  • Department of clinical sciences and services, Royal Veterinary College, Herts, United Kingdom.
Roelfsema, Ellen
  • Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands.
Vervuert, Ingrid
  • Faculty of Veterinary Medicine, University of Leipzig, Institute of Animal Nutrition, Nutrition Diseases and Dietetics, Leipzig, Germany.
Feige, Karsten
  • Clinic for Horses, University of Veterinary Medicine Hannover, Germany.
Fey, Kerstin
  • Equine Clinic, Internal Medicine, Faculty of Veterinary Medicine, Justus-Liebig-University of Giessen, Giessen, Germany.

MeSH Terms

  • Animals
  • Consensus
  • Endocrine System Diseases / complications
  • Foot Diseases / veterinary
  • Hoof and Claw / pathology
  • Horse Diseases / metabolism
  • Horses
  • Insulin / metabolism
  • Metabolic Syndrome / veterinary
  • Obesity / veterinary
  • Societies, Veterinary

Conflict of Interest Statement

The authors provide the following declarations: A.E. Durham is employed by the Liphook Equine Hospital that offers a commercial diagnostic service including endocrine testing of horses and has received travel expenses from Boehringer Ingelheim Vetmedica for meetings related to Equine Metabolic Syndrome. N. Frank has received financial compensation for consultation on study design for Boehringer‐Ingelheim Vetmedica, Inc. and Kindred Biosciences, Inc. Boehringer‐Ingelheim Vetmedica, Inc. has also supported travel and accommodation expenses for Equine Endocrinology Group meetings. C.M. McGowan is employed by the University of Liverpool which has received funding for research projects and consultancy related to Equine Metabolic Syndrome from Boehringer Ingelheim Vetmedica. K. Feige is employed by the University of Veterinary Medicine, Hannover which has received funding for research grants related to Equine Metabolic Syndrome from Boehringer Ingelheim Vetmedica. K. Fey is employed by the Justus‐Liebig‐University in Giessen/Germany and has received fees for consultancy, presentations as well as travel expenses from Boehringer Ingelheim Vetmedica for subjects related to equine endocrine diseases.


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