English
Predictors of laminitis development in a cohort of nonlaminitic ponies.
Abstract: Quantifying risk factors for laminitis development requires improvement. Objective: To identify the most useful physical examination, metabolic and management factors to predict laminitis development in client-owned, nonlaminitic ponies. Methods: Prospective cohort study. Methods: Physical examination, metabolic and management data were collected from a pony cohort 6 monthly for up to 4 years. Ponies were monitored for the development of laminitis. Metabolic data included basal plasma concentrations of ACTH ([ACTH]), adiponectin ([adiponectin]), triglycerides and glucose. Serum insulin concentrations ([insulin]) were measured in the unfasted basal state ([insulin]T0) and 60 minutes ([insulin]T60) after administration of corn syrup (0.3ml/kg). Separate multivariable Cox proportional-hazards models were developed for physical, management/signalment and metabolic data and later combined into two final models. Low-, medium- and high-laminitis risk categories were defined based on basal or T60 [insulin]. Results: Overall, 374 ponies (age 5-32 years) and 891 pony-years were included in the main analysis. Laminitis incidence (95% confidence interval (CI)) was 4.8 (3.5-6.5) cases/100 pony-years. Laminitis development was associated with numerous univariable factors. Significant (P < .05) factors retained in the final multivariable models included [insulin]T0, [insulin]T60, [adiponectin] and divergent hoof growth. [ACTH] was not independently associated with laminitis. Based on [Insulin]T0, low- (45.2 µIU/ml) categories encompassed 70, 20 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 6 (2-9)%, 22 (10-33)% and 69 (48-82)% respectively. Based on [Insulin]T60 the low- (<53.4 µIU/ml), medium- (53.4-153 µIU/ml) and high-risk (≥153 µIU/ml) categories comprised 60, 30 and 10% of the population and had estimated 4-year laminitis incidences (95%CI) of 3 (0-6)%, 20 (10-29)% and 73 (52-84)% respectively. Conclusions: Results may not apply to different insulin assays, geographical regions, breeds or management types. Conclusions: [Insulin]T0 or [insulin]T60 best quantify the risk of future laminitis development in nonlaminitic ponies. Unassigned: A quantificação dos fatores de risco para o desenvolvimento de laminite requere mais estudos. Objective: Identificar os fatores de exame físico, níveis metabólicos e de manejo mais úteis para predizer o desenvolvimento de laminite em pôneis não laminíticos de proprietários privados. Unassigned: Coorte prospectivo. Methods: Exame físico e dados metabólicos e de manejo foram coletados de um coorte de pôneis a cada seis meses por um máximo de quatro anos. Os pôneis foram monitorados para o desenvolvimento de laminite. Dados metabólicos incluíram: concentração basal de ACTH ([ACTH]), adiponectina ([adiponectina]), triglicérides e glicose. A concentração sérica de insulina ([insulina]) foi mensurada no estado basal sem jejum ([insulina]T0) e 60 minutos ([insulina]T60) após a administração de xarope de milho (0.3ml/kg). Modelos separados de riscos proporcionais de Cox multivariável foram desenvolvidos para dados de exame físico, manejo/identificação dos animais e metabólicos, que depois foram combinados em dois modelos finais. As categorias para o risco de desenvolvimento de laminite foram classificadas como baixa, média e alta, levando em consideração o nível basal ou T60 de insulina. Results: 374 pôneis (idades entre 5 e 32 anos) e um total de 891 anos acumulados foram incluídos na análise. A incidência de laminite (95% de intervalo de confiança (IC)) foi 4.8 (3.5-6.5) casos/100 anos. O desenvolvimento de laminite foi associado com inúmeros fatores invariáveis. Os fatores significantes (p<0.05) retidos no modelo de análise multivariável final foram: [insulina] T0, [insulina] T60, [adiponectina], e crescimento de casco divergente. [ACTH] não foi independentemente associado com laminite. Baseado nas categorias de [insulina] T0, as categorias de baixo (45.2 µIU/ml) risco foram compostas por 70, 20 e 10% da população e tiveram uma estimativa de 4 anos de incidência de laminite (95% CI) de 6 (2-9)%, 22 (10-33)% e 69 (48-82%), respectivamente. Baseado na [insulina] T60, as categorias de risco baixa (<53.4 µIU/ml), média (53.4-153 µIU/ml) e alta (≥153 µIU/ml) foram compostas por 60, 30 e 10% da população e tiveram uma estimativa de 4 anos de incidência (95% CI) de 3 (0-6)%, 20 (10-29)% e 73 (52-84)%, respectivamente. PRINCIPAIS LIMITAÇÕES: Esses resultados podem não ser aplicáveis com outras metodologias de mensuração de insulina, e outras regiões geográficas, raças ou tipos de manejo. CONCLUSÕES: [Insulina] T0 ou [insulina] T60 são os fatores que melhor quantificam o risco de futuro desenvolvimento de laminite em pôneis não laminíticos.
© 2022 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Publication Date: 2022-04-01
PubMed ID: 35263471PubMed Central: PMC10084125DOI: 10.1111/evj.13572Google Scholar: Lookup
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- Journal Article
Summary
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This research investigates factors that could predict the development of laminitis, a disease affecting the feet of hooved animals, in nonlaminitic ponies. The study uses physical examination, metabolic markers and management considerations alongside a specific procedure involving insulin testing.
Objective and Methodology
- The primary objective of this study was to determine key physical, metabolic, and management indicators that can predict the onset of laminitis in nonlaminitic, client-owned ponies.
- The researchers conducted a prospective cohort study where they collected physical examination and metabolic data from the ponies every 6 months over a span of 4 years.
- The ponies were supervised for the development of laminitis. Metabolic data collected included basal plasma concentrations of ACTH (Adrenocorticotropic Hormone), adiponectin, triglycerides, and glucose.
- Insulin concentration was also measured in two states: in the non-fasting basal state and 60 minutes after corn syrup administration, denoted as [insulin]T0 and [insulin]T60 respectively.
- Potential risk factors were evaluated using multiple Cox proportional-hazards models, and eventual results were generated by combining two final models.
Results and Findings
- The study involved a total of 374 ponies, aged between 5 to 32 years, over 891 pony-years.
- The occurrence of laminitis was found to be around 4.8 cases per 100 pony-years, showing a strong association with multiple univariable factors.
- The most significant factors contributing to laminitis were found to be [insulin]T0, [insulin]T60, adiponectin, and irregular hoof growth. The study revealed that ACTH was not independently related to laminitis.
- Based on the initial measurements of insulin concentration, the ponies were categorized into low-, medium- and high-risk groups. The groups constituted 70%, 20%, and 10% of the population respectively.
- The predicted 4-year laminitis occurrence rates for the three risk groups were 6%, 22%, and 69%, respectively.
Conclusions and Limitations
- The study concludes that the measurements of [Insulin]T0 or [Insulin]T60 are the most reliable indicators of the risk of future development of laminitis in nonlaminitic ponies.
- However, the researchers acknowledge that their findings may not be applicable to different methodologies of insulin measurement, geographical regions, breeds, or management styles.
Cite This Article
APA
Knowles EJ, Elliott J, Harris PA, Chang YM, Menzies-Gow NJ.
(2022).
Predictors of laminitis development in a cohort of nonlaminitic ponies.
Equine Vet J, 55(1), 12-23.
https://doi.org/10.1111/evj.13572
Publication
Researcher Affiliations
- The Royal Veterinary College, Hatfield, UK.
- Bell Equine Veterinary Clinic, Mereworth, UK.
- The Royal Veterinary College, Hatfield, UK.
- WALTHAM Centre for Pet Nutrition, Waltham on the Wolds, UK.
- The Royal Veterinary College, Hatfield, UK.
- The Royal Veterinary College, Hatfield, UK.
MeSH Terms
- Horses
- Animals
- Foot Diseases / epidemiology
- Foot Diseases / veterinary
- Foot Diseases / etiology
- Horse Diseases / chemically induced
- Horse Diseases / epidemiology
- Adiponectin
- Prospective Studies
- Insulin
- Adrenocorticotropic Hormone
Grant Funding
- MARS Petcare
- The Royal Veterinary College from the Mellon Trust
Conflict of Interest Statement
EJ Knowles is employed by CVS Ltd and provides diagnostic laboratory services through Axiom Veterinary Laboratories. He has received fees for speaking/CPD material from Boehringer Ingelheim. PA Harris is employed by MARS Petcare UK.
References
This article includes 35 references
- Patterson-Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis.. Vet J 2018 Jan;231:33-40.
- Karikoski NP, Horn I, McGowan TW, McGowan CM. The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital.. Domest Anim Endocrinol 2011 Oct;41(3):111-7.
- Pollard D, Wylie CE, Verheyen KLP, Newton JR. Identification of modifiable factors associated with owner-reported equine laminitis in Britain using a web-based cohort study approach.. BMC Vet Res 2019 Feb 12;15(1):59.
- Wylie CE, Collins SN, Verheyen KL, Newton JR. Risk factors for equine laminitis: a systematic review with quality appraisal of published evidence.. Vet J 2012 Jul;193(1):58-66.
- Menzies-Gow NJ, Harris PA, Elliott J. Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the United Kingdom.. Equine Vet J 2017 May;49(3):300-306.
- Knowles EJ, Moreton-Clack MC, Shaw S, Harris PA, Elliott J, Menzies-Gow NJ. Plasma adrenocorticotropic hormone (ACTH) concentrations in ponies measured by two different assays suggests seasonal cross-reactivity or interference.. Equine Vet J 2018 Sep;50(5):672-677.
- Henneke DR, Potter GD, Kreider JL, Yeates BF. Relationship between condition score, physical measurements and body fat percentage in mares.. Equine Vet J 1983 Oct;15(4):371-2.
- Carter RA, Geor RJ, Burton Staniar W, Cubitt TA, Harris PA. Apparent adiposity assessed by standardised scoring systems and morphometric measurements in horses and ponies.. Vet J 2009 Feb;179(2):204-10.
- Beech J, Boston RC, McFarlane D, Lindborg S. Evaluation of plasma ACTH, alpha-melanocyte-stimulating hormone, and insulin concentrations during various photoperiods in clinically normal horses and ponies and those with pituitary pars intermedia dysfunction.. J Am Vet Med Assoc 2009 Sep 15;235(6):715-22.
- The Equine Endocrinology Group Recommendations for the Diagnosis and Treatment of Pituitary Pars Intermedia Dysfunction (PPID) 2019. https://sites.tufts.edu/equineendogroup/files/2019/12/2019u2010PPID_EEGbooklet.pdfn
- Johnson DR, Creech JC. Ordinal measures in multiple indicator models: a simulation study of categorization error. Am Sociol Rev. 1983;48:398u2013407.
- Moore DF. Time dependent covariates. In: Moore D editor. Applied survival analysis using R. Cham, Switzerland: Springer Nature. 2016; p. 101u201312.
- Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression.. Am J Epidemiol 2007 Mar 15;165(6):710-8.
- Steyerberg EW editor. Overfitting and optimism in prediction models. In: Clinical Prediction Models, 2nd edn. Cham, 2019; p. 95u2013111.
- Heinze G, Dunkler D. Five myths about variable selection.. Transpl Int 2017 Jan;30(1):6-10.
- Grant SW, Hickey GL, Head SJ. Statistical primer: multivariable regression considerations and pitfalls.. Eur J Cardiothorac Surg 2019 Feb 1;55(2):179-185.
- Royston P. Explained variation for survival models. Stata J. 2006;6:83u201396.
- Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.. Stat Med 1996 Feb 28;15(4):361-87.
- Simon R, Makuch RW. A non-parametric graphical representation of the relationship between survival and the occurrence of an event: application to responder versus non-responder bias.. Stat Med 1984 Jan-Mar;3(1):35-44.
- Pollard D, Wylie CE, Verheyen KLP, Newton JR. Assessment of horse owners' ability to recognise equine laminitis: A cross-sectional study of 93 veterinary diagnosed cases in Great Britain.. Equine Vet J 2017 Nov;49(6):759-766.
- Menzies-Gow NJ, Katz LM, Barker KJ, Elliott J, De Brauwere MN, Jarvis N, Marr CM, Pfeiffer DU. Epidemiological study of pasture-associated laminitis and concurrent risk factors in the South of England.. Vet Rec 2010 Oct 30;167(18):690-4.
- USDA. Lameness & Laminitis in US Horses. 2000 [Accessed 2020 Oct 7]. Available from: https://www.aphis.usda.gov/animal_health/nahms/equine/downloads/equine98/Equine98_dr_Lameness.pdf.
- Luthersson N, Mannfalk M, Parkin TDH, Harris P. Laminitis: risk factors and outcome in a group of Danish horses. J. Equine Vet. Sci. 2017;53:68u201373.
- Pollard D, Wylie CE, Newton JR, Verheyen KLP. Incidence and clinical signs of owner-reported equine laminitis in a cohort of horses and ponies in Great Britain.. Equine Vet J 2019 Sep;51(5):587-594.
- Wylie CE, Collins SN, Verheyen KL, Newton JR. Risk factors for equine laminitis: a case-control study conducted in veterinary-registered horses and ponies in Great Britain between 2009 and 2011.. Vet J 2013 Oct;198(1):57-69.
- Longland AC, Byrd BM. Pasture nonstructural carbohydrates and equine laminitis.. J Nutr 2006 Jul;136(7 Suppl):2099S-2102S.
- Bailey SR, Habershon-Butcher JL, Ransom KJ, Elliott J, Menzies-Gow NJ. Hypertension and insulin resistance in a mixed-breed population of ponies predisposed to laminitis.. Am J Vet Res 2008 Jan;69(1):122-9.
- Treiber KH, Kronfeld DS, Hess TM, Byrd BM, Splan RK, Staniar WB. Evaluation of genetic and metabolic predispositions and nutritional risk factors for pasture-associated laminitis in ponies.. J Am Vet Med Assoc 2006 May 15;228(10):1538-45.
- Carter RA, Treiber KH, Geor RJ, Douglass L, Harris PA. Prediction of incipient pasture-associated laminitis from hyperinsulinaemia, hyperleptinaemia and generalised and localised obesity in a cohort of ponies.. Equine Vet J 2009 Feb;41(2):171-8.
- Knowles EJ, Harris PA, Elliott J, Menziesu2010Gow NJ. Oral sugar test responses with or without prior fasting helps differentiate previously laminitic from nonlaminitic ponies. In: Proceedings of the British Equine Veterinary Association Congress. 2016; p. 202.
- Jocelyn NA, Harris PA, Menzies-Gow NJ. Effect of varying the dose of corn syrup on the insulin and glucose response to the oral sugar test.. Equine Vet J 2018 Nov;50(6):836-841.
- Tu00f3th F, Frank N, Martin-Jimu00e9nez T, Elliott SB, Geor RJ, Boston RC. Measurement of C-peptide concentrations and responses to somatostatin, glucose infusion, and insulin resistance in horses.. Equine Vet J 2010 Mar;42(2):149-55.
- Bamford NJ, Potter SJ, Baskerville CL, Harris PA, Bailey SR. Influence of dietary restriction and low-intensity exercise on weight loss and insulin sensitivity in obese equids.. J Vet Intern Med 2019 Jan;33(1):280-286.
- Jacob SI, Geor RJ, Weber PSD, Harris PA, McCue ME. Effect of age and dietary carbohydrate profiles on glucose and insulin dynamics in horses.. Equine Vet J 2018 Mar;50(2):249-254.
- Karikoski NP, Box JR, Mykku00e4nen AK, Kotiranta VV, Raekallio MR. Variation in insulin response to oral sugar test in a cohort of horses throughout the year and evaluation of risk factors for insulin dysregulation.. Equine Vet J 2022 Sep;54(5):905-913.
Citations
This article has been cited 4 times.- Delarocque J, Feige K, Carslake HB, Durham AE, Fey K, Warnken T. Development of a Web App to Convert Blood Insulin Concentrations among Various Immunoassays Used in Horses.. Animals (Basel) 2023 Aug 24;13(17).
- Lykkjen S, Stenbakk LK, Holmu00f8y IH. Prevalence and risk factors for laminitis within the Norwegian pony breed Nordlandshest/Lyngshest.. Acta Vet Scand 2023 Jun 16;65(1):22.
- Kellon EM, Gustafson KM. Hypertriglyceridemia in equines with refractory hyperinsulinemia treated with SGLT2 inhibitors.. Open Vet J 2023 Mar;13(3):365-375.
- de Tonnerre DJ, Medina Torres CE, Stefanovski D, Robinson MA, Kemp KL, Bertin FR, van Eps AW. Effect of sirolimus on insulin dynamics in horses.. J Vet Intern Med 2023 Mar;37(2):703-712.
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