Aging metabolic horses need more individualized nutrition plans

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A new The Horse report is putting fresh attention on a familiar but increasingly complex patient: the aging horse with metabolic disease. In “Aging Metabolic Horses—What Do They Need?,” Stacey Oke, DVM, MSc, pulls together expert guidance on how to feed and manage older horses with insulin dysregulation, pituitary pars intermedia dysfunction, or both, with an emphasis on nutrition, exercise, medication choices, osteoarthritis, and end-of-life considerations. (thehorse.com)

The timing matters because these cases rarely fit neatly into one diagnosis. Older horses with PPID may also have insulin dysregulation, and both conditions raise laminitis risk. At the same time, age-related problems such as dental disease, declining topline, reduced mobility, and chronic pain can make textbook metabolic management harder to apply in the field. The Equine Endocrinology Group’s current recommendations continue to position pergolide as standard therapy for PPID, while broader endocrine guidance still frames diet, exercise, and restoration of insulin sensitivity as the foundation of care for insulin-dysregulated horses. (equineendocrinologygroup.org)

In the nutrition section, the article underscores a shift from using only percentage NSC cutoffs toward intake-based targets per meal. Macon says many clinicians still work from the longstanding under-12% NSC benchmark for hay and concentrates, but she notes that nutritionists increasingly recommend limiting hyperinsulinemic horses to about 0.1 to 0.15 grams of NSC per kilogram of body weight per meal. The article also recommends forage as the dietary base, generally around 2% of body weight for horses in good condition, with restriction only as needed for weight loss and not below 1.5% of body weight because of hindgut-health concerns. Smaller, more frequent meals and hay analysis remain central tools. (thehorse.com)

What makes the piece especially useful for veterinarians is its focus on friction points in real-world senior care. Exercise is still part of metabolic management, but osteoarthritis may limit what’s feasible. The article cites a recent U.S. survey finding veterinarian-diagnosed osteoarthritis in 30% of horses, then reviews medication tradeoffs for horses that are both arthritic and metabolically fragile. Oke reports that phenylbutazone did not increase insulin secretion in insulin-dysregulated horses in recent work, but corticosteroids remain more concerning. A 2025 Journal of Equine Veterinary Science study found that intra-articular betamethasone had systemic effects, including suppression of ACTH and cortisol, in both normal and insulin-dysregulated horses, supporting continued caution in laminitis-prone patients. (thehorse.com)

The second source, on feeding horses with EOTRH, adds an important layer to that discussion. EOTRH is primarily a disease of older horses and can directly interfere with forage intake and body condition. The Horse’s earlier coverage notes that reported risk factors have included periodontal disease, PPID, and equine metabolic syndrome. That overlap means some senior horses may need diets that are both low in sugar and starch and physically easier to chew or prehend, particularly around extractions or advanced dental pain. Follow-up data cited by The Horse suggest many horses return to normal eating after incisor extraction and may even improve in body condition, but the interim nutritional management can be intensive. (thehorse.com)

Industry and expert commentary in the article is measured rather than dramatic, which fits the subject. Sundra emphasizes that horses can have different insulin responses to the same diet, likely reflecting factors such as genetics and the microbiome, while Macon stresses that hay testing and meal design still matter even when a horse is not overweight. The AAEP’s continuing education programming has also reflected growing interest in disease-specific equine nutrition, including practical feeding strategies for PPID, insulin dysregulation, and laminitis. (thehorse.com)

Why it matters: For veterinary professionals, this is less about a new rule than a clearer model for case management. Aging metabolic horses often need a three-way balancing act: endocrine control, safe caloric support, and accommodation for pain or dental dysfunction. That can mean resisting oversimplified advice like “just feed low NSC,” and instead building individualized plans around actual hay values, meal size, body condition, insulin status, mobility, and oral function. It also reinforces the need to revisit common therapies, especially when treating concurrent osteoarthritis in horses with a history of laminitis or hyperinsulinemia. (thehorse.com)

What to watch: The next step is likely more refinement, not less: updated endocrine recommendations, more outcome data on off-label SGLT-2 inhibitor use, and stronger evidence on how to manage arthritis and dental disease without destabilizing metabolic horses. For practitioners, the near-term trend is clear: senior equine nutrition is becoming more personalized, more test-driven, and more tightly integrated with whole-horse medical management. (equineendocrinologygroup.org)