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Equine Nutrition in the United States: A Review of Perceptions and Practices of Horse Owners and Veterinarians
Accepted Manuscript Equine Nutrition in the USA: A review of perceptions and practices of horse owners and veterinarians Jayne Louise Roberts , MSc Jo-Anne Murray , PhD, PGDip, PGCERT PII:
S0737-0806(14)00157-9
DOI:
10.1016/j.jevs.2014.04.006
Reference:
YJEVS 1717
To appear in:
Journal of Equine Veterinary Science
Received Date: 24 November 2013 Revised Date:
6 April 2014
Accepted Date: 29 April 2014
Please cite this article as: Roberts JL, Murray JA, Equine Nutrition in the USA: A review of perceptions and practices of horse owners and veterinarians, Journal of Equine Veterinary Science (2014), doi: 10.1016/j.jevs.2014.04.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Manuscript Number: JEVS-D-13-00240R1 Title: Equine Nutrition in the USA: A review of perceptions and practices of horse owners and veterinarians Article Type: Review Article Keywords: nutrition, review, veterinary, education Corresponding Author: Mrs. Jayne Louise Roberts, MSc, 30 Summit Parade, Bahrs Scrub, 4207, Queensland, Australia. Corresponding Author's Institution: Equijay First Author: Jayne Louise Roberts, MSc Order of Authors: Jayne Louise Roberts, MSc; Jo-Anne Murray, PhD, PGDip, PGCERT Abstract: Nutrition plays a critical role in equine health. The horse owner/manager has a multitude of equine nutrition sources available to them, with preferences for how, and from whom, this information is delivered. Despite this, poor feeding practices continue to negatively affect the health, wellness, and welfare of equids, and have a detrimental impact on the environment. The veterinarian is the primary expected source of equine nutrition information, yet little is known about their recognition and acceptance of such a role. Doubt has arisen concerning the quality and provision of nutrition education within the veterinary curriculum, and subsequent continuing education. Moreover, the value equine nutrition education plays in the veterinarian's practice philosophy, and the resulting provision of such in clinical practice, remains under evaluated. This review examines the present state of equine nutrition and how horses are being fed in practice, in the USA. It considers feeding horses from the horse owner's perspective, and the expected role the veterinarian plays in such. Lastly, it goes on to evaluate this expected role from the veterinarian's perspective, examining how current nutrition education and practices may be falling short, and offering recommendations for future research.
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1. Introduction Nutrition is an essential component to equine health, welfare and performance. Nutritional imbalances impact physiological homeostasis, reproduction and growth [1]; compromise welfare [2]; contribute to various disease conditions such as colic, musculoskeletal problems and obesity [3]; have adverse effects on the environment [4], and have implications on maximum athletic performance [5,6,7,8]. Despite the increasing body of research that implicates poor nutritional practices in the escalating prevalence of disorders such as obesity, insulin resistance, and Equine Metabolic Syndrome, widespread inappropriate feeding regimes remain in place [1,3,5,6,7,8].
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Nutrition management is of particular concern. While veterinarians are the expected major source of nutrition information [1,3,9,10,11], little is known if such expectations are emulated by veterinary professionals, and there continues to be a call for increased involvement by the veterinarian [3] in equine nutrition advice.
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This review aims to examine the current state of equine nutrition in the USA, investigate the role of the veterinarian in such, from both a horse owner and veterinarian viewpoint, and examine whether veterinary education is meeting the current demands in equine nutrition. 2. Current equine nutrition practices – How are we doing? While the role diet plays in the health and wellbeing of the equine has been well researched [12,13], it is only in the last decade or so that studies have begun to reveal how horses are being fed in practice, and the role the veterinarian plays in this [1,3,5,6,9].
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A preliminary study by Honore and Uhlinger [1] aimed to assess the ability of horse owners to choose and deliver balanced rations for their horses, and identify common trends and mistakes in the feeding of adult pleasure horses. They found the majority of animals in the study were being fed unbalanced rations in four or more nutrient categories, with some cases being severe. Excessive intake of digestible energy (DE), crude protein (CP) and/or dry matter (DM) was a common problem, even though most owners recognized their horses were overweight. Moreover, the authors suggested the overfeeding of DE might have been more severe than the results indicated, as horse owners have a tendency to overestimate workload. In concurrence with later studies [3,9,10,11), Honore and Uhlinger [1] found that horse owners were interested in equine nutrition and they acquired their information from varying sources. However, there appeared to be disunity between knowledge and practice when formulating and delivering appropriate rations. The authors noted “considerable disparity” between the amounts owners thought they were feeding, and the amount they actually offered to their horses. The authors called for the equine veterinarian to be the primary provider of nutritional advice by becoming more familiar with optimal ration formulation. In 2009, Hoffman et al.[3] investigated feeding practices and knowledge of horse owners in New England, USA. Looking further than ration formulation and diet supplementation, they also evaluated owner knowledge of horse nutrition to try to identify areas where veterinarian-client communication could be improved. Using a survey administered to horse owners visiting the large Animal Hospital at Tufts Cummings School of Veterinary
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Medicine, they identified a number of inadequate feeding practices that were potential contributors to the very reason why the majority of horses were presented for treatment e.g. orthopedic problems, weight loss, gastric ulcers, metabolic/endocrine disease. In addition, 84% of owners reported giving at least one dietary supplement to their horses, with the median number being three. Although reporting only a 20% response rate, this study provided a much more varied population of horse owners (i.e. different breeds and usage of horses) than had previously been reported [1], and further demonstrated the need for increased involvement by the veterinarian, particularly in designing supplement protocols.
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Despite nutrition being an essential component for optimal athletic performance, a number of studies have demonstrated shortfalls in feeding and nutritional management practices of competition horses [5,6,7,8]. These horses spend considerable time in transit and competition and, as a result, spend a substantial amount of time under stressful conditions. At this level, optimal nutrient balance is crucial to prevent illness and keep the horse competing at the top of his game.
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A survey of common feeding practices of international, elite performance horses competing in The Winter Equestrian Festival (WEF), USA, reported nutrient deficiencies in all disciplines. Data was collected on 181 horses and ponies competing in varied disciplines including showjumping, show hunters, pony hunters, dressage and polo [7]. Of particular note, 17 of the 55 polo ponies experienced significant nutrient deficiencies, with calcium, magnesium, sodium, chloride, potassium, iodine and copper being fed below recommended daily amounts, and also receiving a suboptimal level of forage.
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Burk and Williams [8] looked at nutrition and feeding management practices of top-level three-day event horses prior to and during high level competition. Riders in CCI** and CCI*** completed a survey regarding the nutritional management of their competition horse(s). Information gathered included ongoing performance problems, distance travelled to the event, as well as feeding times, type of, and hours spent at, pasture, type and amount of hay, concentrate and supplements, and feeding associated specifically with transport and cross-country. In contrast to earlier studies by Martin [7], Burk and Williams [8] reported a small percentage of horses being fed above NRC recommendations for forage and concentrate (21% CCI** and 3% CCI***). In addition, 25% (CCI**) and 16% (CCI***) of horses were being fed more than recommended amount of concentrate per meal. The majority of feeding management practices in this small sample population followed research-driven recommendations, others did not. Although the majority of horses were likely being fed to meet their nutritional requirements, the relatively high average supplement use of four supplements, raised the question of likely over-supplementation, by the authors. A study by Leahy et al. [6] looked at nutrition related problems in elite level, three-day event horses. Using members from the United States Eventing Association, 81 surveys were mailed to riders in the USA & Canada. Twenty-nine (35.7%) riders responded, representing 45 horses being ridden in top-level 3-day events. All of the horses (100%) in the study experienced at least one nutritional-related problem; top ranking were gastric ulcers, joint problems, decreased appetite and weight loss; results similar to that reported by Hoffman et al. [3]. While this study was observational in nature, it provided further 2
ACCEPTED MANUSCRIPT evidence for the significance of nutritional-associated problems in top-level performance horses, and highlighted the need for in-depth evaluation of diets and how they affect performance.
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Inappropriate feeding regimes not only impact the health, welfare, and performance of the horse, they may also negatively impact the environment. A recent study investigating dietary and manure management practices on equine farms in 2 New Jersey watersheds implicated overfeeding as “one of the main causes of environmental loss of nutrients” in addition to “over conditioning and health and digestive or nutritional imbalances” [4]. Surveying 700 equine property owners, the authors found that the majority made equine nutritional decisions with no assistance, with 45% balancing diets on their own and the remaining 15% having no dietary plan at all. Professional assistance was sought by a quarter of respondents with 20.5% taking veterinarian advice, 3% consulting a nutritionist, and 2% using Extension advice. The remainder (14.5%) based their feeding decisions on advice from the feed store. Overall the study reported that most equine producers did not have a consistent feeding management plan, and concluded that diet management programs need to focus on outreach to professionals who work with equine farmers. While they did not evaluate actual dietary practices, the research further highlighted the need for increased professional interaction with regard to dietary advice. It appears current nutritional practices are still falling short of the latest dietary recommendations, for both pleasure and performance horses. Moreover, there appears to be an increasing incidence of problems created by improper dietary formulation and feeding mismanagement [1,2,3,6,7,] and the veterinarian is expected to play a greater role in information dissemination and nutrition monitoring.
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3. The Role of the Veterinarian in Equine Nutrition 3.1 The Horse Owner’s Perspective Numerous studies have reported the expected role of the veterinarian in relation to the provision of equine nutrition information, from an equine owner/operator perspective. In the USDA’s 1998 report [9], equine owners/operators considered the veterinarian to be the principal source of equine nutrition/diet information with 83% considering the veterinarian to be a “very important” or “somewhat important” source of equine nutrition/diet information.
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In 2006, researchers [10] at the University of Minnesota conducted a state-wide survey of horse owners characterizing their preferences for education on equine topics; nutrition was an area of particular interest. The majority of horse owners reported themselves to be “somewhat knowledgeable” in equine nutrition, and ranked the veterinarian highest in importance for developing and presenting educational programs. Despite this, the majority of respondents were currently obtaining information from equine magazines and other horse owners, perhaps indicating a need to further research any potential shortfalls in client-veterinarian communication, and/or the need for better accessibility to such sources. Hoffman et al. [3] surveying a subpopulation of horse owners in New England, again identified the veterinarian as the most utilized source of equine nutrition information, followed by the trainer, and feed store. They reiterated the need for proper communication 3
ACCEPTED MANUSCRIPT between the horse owner and veterinarian with a particular emphasis on the importance of the veterinarian being prepared to discuss optimal nutritional practices with horse owners, and becoming familiar with the available dietary supplements on the market.
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Recent reports by American Horse Publications (AHP) have provided the most up-to-date, nationwide insight into the horse owner’s perception of the role the veterinarian plays in horse health [11,14] and nutrition decisions [11]. The first report [14] produced statistics on owner demographics, horse ownership, costs of horse keeping, issues facing the industry, and horse health care. Building on this, the 2012 study incorporated a specific focus on equine nutrition [11]. Of the 11,320 respondents, who either owned or managed horses, 81% made their own feed buying decisions. As with previous studies, the veterinarian was again identified as having the most influence over respondents’ feed and supplement buying decisions. However, the significance of the equine nutritionist/consultant had risen significantly from that reported in previous studies [3.9], perhaps reflecting increased availability of such professionals, and a continued demand for informed equine nutrition information from the horse owner.
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While the veterinarian remains the primary reported source of equine nutrition information from the horse owner/manager perspective, horse owners have a number of ways they prefer to receive such information. Martinson et al. [10] reported that horse owners preferred short publications, the internet, and evening seminars. Less desirable options were Saturday morning programs, online courses and all day Saturday programs. When asked how likely they would be to attend programs on various subjects, in their area, 87% of respondents reported they would be likely to attend a program on equine nutrition.
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Similar results were reported in the 2010 AHP study [14], with the majority of respondents indicating they preferred to receive horse health information either in person or live online, followed by short articles either online or in print, and lectures. Moreover, AHP’s later study [11] reported face-to face interaction and reading short articles online, and reading research reports online were preferred ways to receive nutritional information.
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Although Martinson et al.’s study [10] was limited to Minnesota, it reported a 67% response rate and reflected results later reported by the AHP’s nationwide studies [11,14]. The studies gave a much needed insight into the educational needs of horse owner education and their preferences for the delivery of such resources. This should be considered of great value to the veterinarian, or indeed any educational provider, for future effective methods of communication and information dissemination for horse owners.
3.2 The Veterinarian’s Perspective While there is a reported consensus among horse owners that the veterinarian is an important source of nutritional information [1,2,3,9,10,11,14,] , there is little published data to determine if this viewpoint is emulated by the veterinarian, or incorporated into their practice philosophy. A recent study by Roberts and Murray [15] provided the first insight into the perceptions and practices of equine clinicians, towards equine nutrition in their practice. They 4
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surveyed 391 veterinarians in the state of Georgia, listed as having some equine species contact time in the AVMA online database. In concurrence with previous studies in horse owners [3,9,11,14], respondents were asked to rate the importance of several sources of equine nutritional information. All of the respondents (100%) considered veterinarians and equine nutritionists to be a ‘very’ or ‘somewhat’ important source of equine nutrition information for horse owners. The majority of respondents (80%) placed strong emphasis on the importance of the equine nutritionist as a source of information. However, 78% of respondents reported not having access to such a service, and would be likely to recommend it if it were available (91%). Of those that reported having access, the majority (82%) used it ‘sometimes’ and the remainder ‘never’ used it. One respondent reported that they did not know such a service existed. While the results of this study suggest a demand for a referral nutrition service for veterinarians, this remains under investigated and further research in this area is warranted.
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Roberts and Murray [15] further identified that the majority of respondents (78%) provided nutrition counselling, offering it as an integral part of routine veterinary health checks. While the majority of respondents considered equine nutrition it to be a ‘very important’ or ‘somewhat important’ part of their practice philosophy, almost 3% reported that they did not think it was important at all. Moreover, the authors found no correlation between the importance placed on equine nutrition and the actual provision of it in clinical practice. For those that did not provide nutritional counselling, most (56%) reported it was due to their clients not being interested/did not listen, just over one third (38%) reported that they did not feel sufficiently knowledgeable to provide such nutritional assistance, and the remainder did not feel there was enough time.
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Given the emphasis that is placed on the veterinarian as such an important source of nutritional information, this again raises the question as to whether this critical role is being fulfilled by the veterinary profession. As Roberts and Murray proposed [15], it may be time to start shifting the expected responsibility away from the veterinarian by utilizing other well-informed professional sources of nutritional advice, such as equine nutritionists/scientists, extension agencies and universities, as valuable sources of support for the veterinary profession.
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Reflecting the multi-source approach to equine nutrition information exchange reported by horse owners [9,10,11] Roberts and Murray [15] also reported several methods of communication used by respondents to provide nutrition counselling to their clients. Similarly, one-on-one consults were the most popular method. Other preferred methods of horse owner communication remained under-utilized (newsletters, internet, magazines, seminars) and represent a significant opportunity for improvement in communication between veterinarians and horse owners. The authors concluded that the veterinarian must be better prepared to evaluate client’s needs and tailor lines of communication accordingly. While there is little doubt concerning the primary role the veterinarian is expected to play in equine nutrition education, published data suggest that the veterinarian may not fully embrace this responsibility. The study by Roberts and Murray [15], although only statewide, provided the first published insight into the knowledge and confidence levels, and practices and perceptions of equine veterinarians regarding equine nutrition. This should 5
ACCEPTED MANUSCRIPT lay the foundation for further studies of this nature to provide a more comprehensive account of the state of veterinarian equine nutrition knowledge, practices and perceptions.
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4. Is Veterinary Education Meeting Demand? Veterinarians play a critical role in the equine industry. Market research conducted by the American Veterinary Medical Association (AVMA) revealed approximately 13% (8069) of currently employed veterinarians (equine and mixed animal) provide healthcare for the nation’s equids [16], with $2.3 billion being spent on veterinary care and services annually [17]. Lifelong learning is a necessity in veterinary medicine [18]. While some veterinarians may have a nutritional background, many do not, and some may find it difficult to keep abreast of current guidelines due to busy schedules [19], and the demands of multi-species practices.
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A report published by the Pew National Veterinary Education Program in 1988 [20], examined the social, technological and economic environment in which veterinary medicine, and related educational institutions, functioned in the U.S. The results of the study gave rise to a 13-point summary of recommendations for the future direction of veterinary medicine. Of particular note was the call to strengthen general veterinarian education, reorient clinical studies education to a more single-species focus, and improve the quality of veterinary services delivered to meet the escalating expectations of the public, with specific reference to the health care of their animals. The report widely criticized the veterinary industry for not “adapting rapidly enough to changing needs”, and noted veterinary medical educational institutions were unaware of how “out-of-step” veterinary education had become [20].
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In response to the 1988 Pew report, the American College of Veterinary Nutrition (ACVN) established a curriculum committee to develop strategies to promote veterinary nutrition education within the profession. One of the preliminary steps was to determine the actual status of the quality and effectiveness of veterinary nutrition education. Buffington and LaFlamme [18] conducted a survey of 4,016 American Veterinary Medical Association (AVMA) members (of which 333 were equine). Assessments were made regarding the appropriateness of the amount and quality of nutrition education received during their undergraduate degree, and after graduating. In addition, the Perceived Self-Efficacy (PSE) of veterinarians to engage in nutrition-related activities was assessed. All U.S. veterinary colleges were represented in the sample with a response rate of 36% (1,465). Approximately half of the responses came from equine veterinarians (87), mixed animal veterinarians (274) and large animal veterinarians (214); with the remainder being small animal veterinarians (785). Although the response group was determined to be sufficiently representative of the veterinarian population, there was a notably high representation of first year graduates due to the fact that 100% of new graduates receive complimentary AVMA membership in their first year in practice. Interestingly, journals and textbooks took precedence over nutrition courses as sources of nutrition information for veterinarians. In general, respondents indicated that time dedicated to nutrition education in the curriculum was “inadequate”, and approximately half of participants indicated the quality of the nutrition course was “inferior”. Moreover, continuing education for a quarter of respondents was considered to be “inferior” (although there was no further questioning to determine the reasons for this) and over half of respondents reported insufficient hours 6
ACCEPTED MANUSCRIPT were available to undertake continuing education. This is of particular relevance as continuing education is not only essential in veterinary medicine, it is also a pre-requisite for continued licensure as a legally practicing veterinarian in the US. The authors reported PSE’s to be ‘moderate’ in all nutritional activities, indicating room for improvement.
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The inferiority in both veterinary curricula and professional continuing education noted previously [18], was more recently reported by Roberts and Murray [15]. Respondents were asked to rate their current level of equine nutrition knowledge, and their level upon graduation. On a scale of one to five, with one being ‘poor’ and five being ‘excellent’, respondents reported a lower ranking level of equine nutrition knowledge (median = 2) upon graduation from their veterinary degree. Although respondents reported a higher ranking level of current equine nutrition knowledge (median = 4), the authors reported that was correlated to the increased percentage of equine species contact, and the number of horses seen, rather than any recent CE in this area. Respondents also reported a low ranking level of confidence in giving nutritional advice for several prevalent equine disorders. Again, using a scale of one to five, with one being ‘not at all confident’ and five being ‘very confident’, ranks four and five were considered to be an acceptable level of confidence, whilst ranks three and below represented an unacceptable level of confidence. Colic ranked highest in confidence level with 84% of respondents rating it four or above, followed by geriatrics (64%), laminitis (62%) and obesity (59%). The least confidence was expressed in hyperkalaemic periodic paralysis (77%), developmental orthopaedic disease (72%), equine polysaccharide storage myopathy (70%) and equine pituitary pars intermedia dysfunction (68%), with respondents ranking their confidence level as three or below
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Going further than previous research [18], Roberts and Murray [15] identified the majority of respondents (88%) had not attended equine nutrition CE within the previous year. The main reason given for this was a lack of available courses; however, the majority of respondents expressed an interest in taking CE, with a higher percentage more likely to engage if the courses were offered online.
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Although this study [15] was limited to the state of Georgia, it provided a more in-depth insight into equine nutrition education from an equine veterinarian perspective, than had been previously reported [18], and it highlighted several areas of concern that would benefit from further research on a nationwide scale. Whether the education system supporting veterinarians is meeting the needs of the industry remains under-evaluated and requires further research to establish current standards, provision, and accountability.
5. Conclusion A review of the published research to date provides an important insight into the equine nutrition practices of horse owners and operators in the USA, as well as the role the equine veterinarian plays in this. It appears that current nutritional practices appear to be falling short of recommendations, in both pleasure and performance horses. While many of the studies have been state specific, provided demographic-only related information, have addressed only the horse owner/operator viewpoint, or have only surveyed commercial farms instead of the industry as a whole, they provide substantial justification for the need
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The contribution of equine nutrition to horse health and welfare, as well as the environment is indisputable. As the equid population continues to grow and horse ownership continues to rise, there is little doubt to the role the equine veterinarian plays in the future of the equine industry, particularly with reference to educating horse owners. However, there seems to be some disinclination on the part of the veterinarian to fully embrace this responsibility. Given the serious implications of this, further research is warranted in this area, and additional sources of professional nutrition support investigated.
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References [1] Honore, E.K. and Uhlinger, C.A. (1994). Equine Feeding Practices in Central North Carolina: A Preliminary Survey. Journal of Equine Veterinary Science. 14 (8) 424-429
Horses. Netherlands: Kluwer Academic Publishers. 45-76.
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[2] Davidson, N. and Harris, P. (2002). Nutrition and Welfare. In: Waran, N. The Welfare of
[3] Hoffman, C.J., Costa, L.R. and Freeman, L.M. (2009). Survey of feeding practices,
supplement use, and knowledge of equine nutrition among a subpopulation of horse owners in
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New England. Journal Equine Veterinary Science. 29 (10) 719-724
[4] Westendorf, M.L., Puduri, V., Williams, C.A., Joshua, T., Govindasamy, R. (2013). Dietary
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and Manure Management Practices on Equine Farms in Two New Jersey Watersheds. Journal
[5] Owens, E. (2005). Sport horse nutrition - An Australian perspective. In: Pagan, JD Advances in Equine Nutrition, Vol III. Nottingham: Nottingham University Press. 185-192. [6] Leahy, E.R., Burk, A.O., Greene, E.A. and Williams, C.A. (2010). Nutrition-associated
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problems facing elite level three-day eventing horses. Equine Veterinary Journal. 42 (Suppl. 38), 370-374.
[7] Martin, O. (2010). Feeding Horses at the Winter Equestrian Festival: A Review of Common
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Practices, Proceedings of the 17th Kentucky Equine Research Nutrition Conference: Feeding and Veterinary Management of the Sport Horse, Kentucky Equine Research, Lexington,
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Kentucky, USA, 127-130
[8] Burk, A.O., Williams, C.A.. (2008). Feeding management practices and supplement use in top-level event horses. Comparative Exercise Physiology. 5 (2), 85-93. [9] United States Department of Agriculture, USDA (1998). National Animal Health Monitoring System Baseline Reference of 1998 Equine Health and Management. Fort Collins, CO: United States Department of Agriculture, 79-91
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[10] Martinson, K., Hathaway, M., Wilson, J.H., Gilkerson, B., Peterson, P.R. and del Vecchio, R. (2006). University of Minnesota Horse Owner Survey: Building an Equine Extension Program. Journal of Extension. 44 (6), 1.
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[11] American Horse Publications, AHP (2012) Results from the 2012 AHP Equine Industry Survey http://www.americanhorsepubs.org/resources/. Last accessed 24th November 2103
[12] Hintz, H.F. (1985). Equine nutrition: Changes and challenges. Cornell Veterinarian. 75, 191-200.
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[13] Hintz, H.F. (2000). Equine nutrition update. Proceedings of the American Association of
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Equine Practitioners Annual Convention. San Antonio, Texas, USA, 62-79 [14] American Horse Publications, AHP (2010) Results from the 2009-2010 AHP Equine Industry Survey. Available at: http://www.americanhorsepubs.org/resources/AHP-EquineSurvey-Final.pdf. Last accessed 19th Mar 2011.
[15] Roberts, J.L., Murray, J. (2013). Survey of Equine Nutrition: Perceptions and Practices of
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Veterinarians in Georgia, USA. Journal of Equine Veterinary Science. 33, 454-459. [16] American Veterinary Medical Association (AVMA) (2011c). Market research statistics: U.S. veterinarians — 2010. Available: http://www.avma.org/reference/marketstats/usvets.asp. Last accessed 11th Mar 2011.
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[17] American Horse Council, AHC (2005). The Economic Impact of the Horse Industry on the United States. Wilton, CT: Deloitte. 8-22.
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[18] Buffington, CA, LaFlemme DP. (1996). A survey of veterinarians’ knowledge and attitudes about nutrition. Journal of the American Veterinary Medical Association. 208 (5), 674-675. [19] Nielsen, B.D. (2007). “Evaluating Equine Research”, Proceedings of the 2nd Equine Nutrition Conference, Vienna, AUSTRIA. 35-47 [20] Pritchard, W.R. (1988). Future directions for veterinary medicine. Durham, NC: Pew National Veterinary Education Program.
S0737-0806(14)00157-9
DOI:
10.1016/j.jevs.2014.04.006
Reference:
YJEVS 1717
To appear in:
Journal of Equine Veterinary Science
Received Date: 24 November 2013 Revised Date:
6 April 2014
Accepted Date: 29 April 2014
Please cite this article as: Roberts JL, Murray JA, Equine Nutrition in the USA: A review of perceptions and practices of horse owners and veterinarians, Journal of Equine Veterinary Science (2014), doi: 10.1016/j.jevs.2014.04.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Manuscript Number: JEVS-D-13-00240R1 Title: Equine Nutrition in the USA: A review of perceptions and practices of horse owners and veterinarians Article Type: Review Article Keywords: nutrition, review, veterinary, education Corresponding Author: Mrs. Jayne Louise Roberts, MSc, 30 Summit Parade, Bahrs Scrub, 4207, Queensland, Australia. Corresponding Author's Institution: Equijay First Author: Jayne Louise Roberts, MSc Order of Authors: Jayne Louise Roberts, MSc; Jo-Anne Murray, PhD, PGDip, PGCERT Abstract: Nutrition plays a critical role in equine health. The horse owner/manager has a multitude of equine nutrition sources available to them, with preferences for how, and from whom, this information is delivered. Despite this, poor feeding practices continue to negatively affect the health, wellness, and welfare of equids, and have a detrimental impact on the environment. The veterinarian is the primary expected source of equine nutrition information, yet little is known about their recognition and acceptance of such a role. Doubt has arisen concerning the quality and provision of nutrition education within the veterinary curriculum, and subsequent continuing education. Moreover, the value equine nutrition education plays in the veterinarian's practice philosophy, and the resulting provision of such in clinical practice, remains under evaluated. This review examines the present state of equine nutrition and how horses are being fed in practice, in the USA. It considers feeding horses from the horse owner's perspective, and the expected role the veterinarian plays in such. Lastly, it goes on to evaluate this expected role from the veterinarian's perspective, examining how current nutrition education and practices may be falling short, and offering recommendations for future research.
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1. Introduction Nutrition is an essential component to equine health, welfare and performance. Nutritional imbalances impact physiological homeostasis, reproduction and growth [1]; compromise welfare [2]; contribute to various disease conditions such as colic, musculoskeletal problems and obesity [3]; have adverse effects on the environment [4], and have implications on maximum athletic performance [5,6,7,8]. Despite the increasing body of research that implicates poor nutritional practices in the escalating prevalence of disorders such as obesity, insulin resistance, and Equine Metabolic Syndrome, widespread inappropriate feeding regimes remain in place [1,3,5,6,7,8].
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Nutrition management is of particular concern. While veterinarians are the expected major source of nutrition information [1,3,9,10,11], little is known if such expectations are emulated by veterinary professionals, and there continues to be a call for increased involvement by the veterinarian [3] in equine nutrition advice.
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This review aims to examine the current state of equine nutrition in the USA, investigate the role of the veterinarian in such, from both a horse owner and veterinarian viewpoint, and examine whether veterinary education is meeting the current demands in equine nutrition. 2. Current equine nutrition practices – How are we doing? While the role diet plays in the health and wellbeing of the equine has been well researched [12,13], it is only in the last decade or so that studies have begun to reveal how horses are being fed in practice, and the role the veterinarian plays in this [1,3,5,6,9].
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A preliminary study by Honore and Uhlinger [1] aimed to assess the ability of horse owners to choose and deliver balanced rations for their horses, and identify common trends and mistakes in the feeding of adult pleasure horses. They found the majority of animals in the study were being fed unbalanced rations in four or more nutrient categories, with some cases being severe. Excessive intake of digestible energy (DE), crude protein (CP) and/or dry matter (DM) was a common problem, even though most owners recognized their horses were overweight. Moreover, the authors suggested the overfeeding of DE might have been more severe than the results indicated, as horse owners have a tendency to overestimate workload. In concurrence with later studies [3,9,10,11), Honore and Uhlinger [1] found that horse owners were interested in equine nutrition and they acquired their information from varying sources. However, there appeared to be disunity between knowledge and practice when formulating and delivering appropriate rations. The authors noted “considerable disparity” between the amounts owners thought they were feeding, and the amount they actually offered to their horses. The authors called for the equine veterinarian to be the primary provider of nutritional advice by becoming more familiar with optimal ration formulation. In 2009, Hoffman et al.[3] investigated feeding practices and knowledge of horse owners in New England, USA. Looking further than ration formulation and diet supplementation, they also evaluated owner knowledge of horse nutrition to try to identify areas where veterinarian-client communication could be improved. Using a survey administered to horse owners visiting the large Animal Hospital at Tufts Cummings School of Veterinary
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Medicine, they identified a number of inadequate feeding practices that were potential contributors to the very reason why the majority of horses were presented for treatment e.g. orthopedic problems, weight loss, gastric ulcers, metabolic/endocrine disease. In addition, 84% of owners reported giving at least one dietary supplement to their horses, with the median number being three. Although reporting only a 20% response rate, this study provided a much more varied population of horse owners (i.e. different breeds and usage of horses) than had previously been reported [1], and further demonstrated the need for increased involvement by the veterinarian, particularly in designing supplement protocols.
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Despite nutrition being an essential component for optimal athletic performance, a number of studies have demonstrated shortfalls in feeding and nutritional management practices of competition horses [5,6,7,8]. These horses spend considerable time in transit and competition and, as a result, spend a substantial amount of time under stressful conditions. At this level, optimal nutrient balance is crucial to prevent illness and keep the horse competing at the top of his game.
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A survey of common feeding practices of international, elite performance horses competing in The Winter Equestrian Festival (WEF), USA, reported nutrient deficiencies in all disciplines. Data was collected on 181 horses and ponies competing in varied disciplines including showjumping, show hunters, pony hunters, dressage and polo [7]. Of particular note, 17 of the 55 polo ponies experienced significant nutrient deficiencies, with calcium, magnesium, sodium, chloride, potassium, iodine and copper being fed below recommended daily amounts, and also receiving a suboptimal level of forage.
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Burk and Williams [8] looked at nutrition and feeding management practices of top-level three-day event horses prior to and during high level competition. Riders in CCI** and CCI*** completed a survey regarding the nutritional management of their competition horse(s). Information gathered included ongoing performance problems, distance travelled to the event, as well as feeding times, type of, and hours spent at, pasture, type and amount of hay, concentrate and supplements, and feeding associated specifically with transport and cross-country. In contrast to earlier studies by Martin [7], Burk and Williams [8] reported a small percentage of horses being fed above NRC recommendations for forage and concentrate (21% CCI** and 3% CCI***). In addition, 25% (CCI**) and 16% (CCI***) of horses were being fed more than recommended amount of concentrate per meal. The majority of feeding management practices in this small sample population followed research-driven recommendations, others did not. Although the majority of horses were likely being fed to meet their nutritional requirements, the relatively high average supplement use of four supplements, raised the question of likely over-supplementation, by the authors. A study by Leahy et al. [6] looked at nutrition related problems in elite level, three-day event horses. Using members from the United States Eventing Association, 81 surveys were mailed to riders in the USA & Canada. Twenty-nine (35.7%) riders responded, representing 45 horses being ridden in top-level 3-day events. All of the horses (100%) in the study experienced at least one nutritional-related problem; top ranking were gastric ulcers, joint problems, decreased appetite and weight loss; results similar to that reported by Hoffman et al. [3]. While this study was observational in nature, it provided further 2
ACCEPTED MANUSCRIPT evidence for the significance of nutritional-associated problems in top-level performance horses, and highlighted the need for in-depth evaluation of diets and how they affect performance.
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Inappropriate feeding regimes not only impact the health, welfare, and performance of the horse, they may also negatively impact the environment. A recent study investigating dietary and manure management practices on equine farms in 2 New Jersey watersheds implicated overfeeding as “one of the main causes of environmental loss of nutrients” in addition to “over conditioning and health and digestive or nutritional imbalances” [4]. Surveying 700 equine property owners, the authors found that the majority made equine nutritional decisions with no assistance, with 45% balancing diets on their own and the remaining 15% having no dietary plan at all. Professional assistance was sought by a quarter of respondents with 20.5% taking veterinarian advice, 3% consulting a nutritionist, and 2% using Extension advice. The remainder (14.5%) based their feeding decisions on advice from the feed store. Overall the study reported that most equine producers did not have a consistent feeding management plan, and concluded that diet management programs need to focus on outreach to professionals who work with equine farmers. While they did not evaluate actual dietary practices, the research further highlighted the need for increased professional interaction with regard to dietary advice. It appears current nutritional practices are still falling short of the latest dietary recommendations, for both pleasure and performance horses. Moreover, there appears to be an increasing incidence of problems created by improper dietary formulation and feeding mismanagement [1,2,3,6,7,] and the veterinarian is expected to play a greater role in information dissemination and nutrition monitoring.
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3. The Role of the Veterinarian in Equine Nutrition 3.1 The Horse Owner’s Perspective Numerous studies have reported the expected role of the veterinarian in relation to the provision of equine nutrition information, from an equine owner/operator perspective. In the USDA’s 1998 report [9], equine owners/operators considered the veterinarian to be the principal source of equine nutrition/diet information with 83% considering the veterinarian to be a “very important” or “somewhat important” source of equine nutrition/diet information.
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In 2006, researchers [10] at the University of Minnesota conducted a state-wide survey of horse owners characterizing their preferences for education on equine topics; nutrition was an area of particular interest. The majority of horse owners reported themselves to be “somewhat knowledgeable” in equine nutrition, and ranked the veterinarian highest in importance for developing and presenting educational programs. Despite this, the majority of respondents were currently obtaining information from equine magazines and other horse owners, perhaps indicating a need to further research any potential shortfalls in client-veterinarian communication, and/or the need for better accessibility to such sources. Hoffman et al. [3] surveying a subpopulation of horse owners in New England, again identified the veterinarian as the most utilized source of equine nutrition information, followed by the trainer, and feed store. They reiterated the need for proper communication 3
ACCEPTED MANUSCRIPT between the horse owner and veterinarian with a particular emphasis on the importance of the veterinarian being prepared to discuss optimal nutritional practices with horse owners, and becoming familiar with the available dietary supplements on the market.
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Recent reports by American Horse Publications (AHP) have provided the most up-to-date, nationwide insight into the horse owner’s perception of the role the veterinarian plays in horse health [11,14] and nutrition decisions [11]. The first report [14] produced statistics on owner demographics, horse ownership, costs of horse keeping, issues facing the industry, and horse health care. Building on this, the 2012 study incorporated a specific focus on equine nutrition [11]. Of the 11,320 respondents, who either owned or managed horses, 81% made their own feed buying decisions. As with previous studies, the veterinarian was again identified as having the most influence over respondents’ feed and supplement buying decisions. However, the significance of the equine nutritionist/consultant had risen significantly from that reported in previous studies [3.9], perhaps reflecting increased availability of such professionals, and a continued demand for informed equine nutrition information from the horse owner.
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While the veterinarian remains the primary reported source of equine nutrition information from the horse owner/manager perspective, horse owners have a number of ways they prefer to receive such information. Martinson et al. [10] reported that horse owners preferred short publications, the internet, and evening seminars. Less desirable options were Saturday morning programs, online courses and all day Saturday programs. When asked how likely they would be to attend programs on various subjects, in their area, 87% of respondents reported they would be likely to attend a program on equine nutrition.
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Similar results were reported in the 2010 AHP study [14], with the majority of respondents indicating they preferred to receive horse health information either in person or live online, followed by short articles either online or in print, and lectures. Moreover, AHP’s later study [11] reported face-to face interaction and reading short articles online, and reading research reports online were preferred ways to receive nutritional information.
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Although Martinson et al.’s study [10] was limited to Minnesota, it reported a 67% response rate and reflected results later reported by the AHP’s nationwide studies [11,14]. The studies gave a much needed insight into the educational needs of horse owner education and their preferences for the delivery of such resources. This should be considered of great value to the veterinarian, or indeed any educational provider, for future effective methods of communication and information dissemination for horse owners.
3.2 The Veterinarian’s Perspective While there is a reported consensus among horse owners that the veterinarian is an important source of nutritional information [1,2,3,9,10,11,14,] , there is little published data to determine if this viewpoint is emulated by the veterinarian, or incorporated into their practice philosophy. A recent study by Roberts and Murray [15] provided the first insight into the perceptions and practices of equine clinicians, towards equine nutrition in their practice. They 4
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surveyed 391 veterinarians in the state of Georgia, listed as having some equine species contact time in the AVMA online database. In concurrence with previous studies in horse owners [3,9,11,14], respondents were asked to rate the importance of several sources of equine nutritional information. All of the respondents (100%) considered veterinarians and equine nutritionists to be a ‘very’ or ‘somewhat’ important source of equine nutrition information for horse owners. The majority of respondents (80%) placed strong emphasis on the importance of the equine nutritionist as a source of information. However, 78% of respondents reported not having access to such a service, and would be likely to recommend it if it were available (91%). Of those that reported having access, the majority (82%) used it ‘sometimes’ and the remainder ‘never’ used it. One respondent reported that they did not know such a service existed. While the results of this study suggest a demand for a referral nutrition service for veterinarians, this remains under investigated and further research in this area is warranted.
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Roberts and Murray [15] further identified that the majority of respondents (78%) provided nutrition counselling, offering it as an integral part of routine veterinary health checks. While the majority of respondents considered equine nutrition it to be a ‘very important’ or ‘somewhat important’ part of their practice philosophy, almost 3% reported that they did not think it was important at all. Moreover, the authors found no correlation between the importance placed on equine nutrition and the actual provision of it in clinical practice. For those that did not provide nutritional counselling, most (56%) reported it was due to their clients not being interested/did not listen, just over one third (38%) reported that they did not feel sufficiently knowledgeable to provide such nutritional assistance, and the remainder did not feel there was enough time.
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Given the emphasis that is placed on the veterinarian as such an important source of nutritional information, this again raises the question as to whether this critical role is being fulfilled by the veterinary profession. As Roberts and Murray proposed [15], it may be time to start shifting the expected responsibility away from the veterinarian by utilizing other well-informed professional sources of nutritional advice, such as equine nutritionists/scientists, extension agencies and universities, as valuable sources of support for the veterinary profession.
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Reflecting the multi-source approach to equine nutrition information exchange reported by horse owners [9,10,11] Roberts and Murray [15] also reported several methods of communication used by respondents to provide nutrition counselling to their clients. Similarly, one-on-one consults were the most popular method. Other preferred methods of horse owner communication remained under-utilized (newsletters, internet, magazines, seminars) and represent a significant opportunity for improvement in communication between veterinarians and horse owners. The authors concluded that the veterinarian must be better prepared to evaluate client’s needs and tailor lines of communication accordingly. While there is little doubt concerning the primary role the veterinarian is expected to play in equine nutrition education, published data suggest that the veterinarian may not fully embrace this responsibility. The study by Roberts and Murray [15], although only statewide, provided the first published insight into the knowledge and confidence levels, and practices and perceptions of equine veterinarians regarding equine nutrition. This should 5
ACCEPTED MANUSCRIPT lay the foundation for further studies of this nature to provide a more comprehensive account of the state of veterinarian equine nutrition knowledge, practices and perceptions.
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4. Is Veterinary Education Meeting Demand? Veterinarians play a critical role in the equine industry. Market research conducted by the American Veterinary Medical Association (AVMA) revealed approximately 13% (8069) of currently employed veterinarians (equine and mixed animal) provide healthcare for the nation’s equids [16], with $2.3 billion being spent on veterinary care and services annually [17]. Lifelong learning is a necessity in veterinary medicine [18]. While some veterinarians may have a nutritional background, many do not, and some may find it difficult to keep abreast of current guidelines due to busy schedules [19], and the demands of multi-species practices.
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A report published by the Pew National Veterinary Education Program in 1988 [20], examined the social, technological and economic environment in which veterinary medicine, and related educational institutions, functioned in the U.S. The results of the study gave rise to a 13-point summary of recommendations for the future direction of veterinary medicine. Of particular note was the call to strengthen general veterinarian education, reorient clinical studies education to a more single-species focus, and improve the quality of veterinary services delivered to meet the escalating expectations of the public, with specific reference to the health care of their animals. The report widely criticized the veterinary industry for not “adapting rapidly enough to changing needs”, and noted veterinary medical educational institutions were unaware of how “out-of-step” veterinary education had become [20].
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In response to the 1988 Pew report, the American College of Veterinary Nutrition (ACVN) established a curriculum committee to develop strategies to promote veterinary nutrition education within the profession. One of the preliminary steps was to determine the actual status of the quality and effectiveness of veterinary nutrition education. Buffington and LaFlamme [18] conducted a survey of 4,016 American Veterinary Medical Association (AVMA) members (of which 333 were equine). Assessments were made regarding the appropriateness of the amount and quality of nutrition education received during their undergraduate degree, and after graduating. In addition, the Perceived Self-Efficacy (PSE) of veterinarians to engage in nutrition-related activities was assessed. All U.S. veterinary colleges were represented in the sample with a response rate of 36% (1,465). Approximately half of the responses came from equine veterinarians (87), mixed animal veterinarians (274) and large animal veterinarians (214); with the remainder being small animal veterinarians (785). Although the response group was determined to be sufficiently representative of the veterinarian population, there was a notably high representation of first year graduates due to the fact that 100% of new graduates receive complimentary AVMA membership in their first year in practice. Interestingly, journals and textbooks took precedence over nutrition courses as sources of nutrition information for veterinarians. In general, respondents indicated that time dedicated to nutrition education in the curriculum was “inadequate”, and approximately half of participants indicated the quality of the nutrition course was “inferior”. Moreover, continuing education for a quarter of respondents was considered to be “inferior” (although there was no further questioning to determine the reasons for this) and over half of respondents reported insufficient hours 6
ACCEPTED MANUSCRIPT were available to undertake continuing education. This is of particular relevance as continuing education is not only essential in veterinary medicine, it is also a pre-requisite for continued licensure as a legally practicing veterinarian in the US. The authors reported PSE’s to be ‘moderate’ in all nutritional activities, indicating room for improvement.
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The inferiority in both veterinary curricula and professional continuing education noted previously [18], was more recently reported by Roberts and Murray [15]. Respondents were asked to rate their current level of equine nutrition knowledge, and their level upon graduation. On a scale of one to five, with one being ‘poor’ and five being ‘excellent’, respondents reported a lower ranking level of equine nutrition knowledge (median = 2) upon graduation from their veterinary degree. Although respondents reported a higher ranking level of current equine nutrition knowledge (median = 4), the authors reported that was correlated to the increased percentage of equine species contact, and the number of horses seen, rather than any recent CE in this area. Respondents also reported a low ranking level of confidence in giving nutritional advice for several prevalent equine disorders. Again, using a scale of one to five, with one being ‘not at all confident’ and five being ‘very confident’, ranks four and five were considered to be an acceptable level of confidence, whilst ranks three and below represented an unacceptable level of confidence. Colic ranked highest in confidence level with 84% of respondents rating it four or above, followed by geriatrics (64%), laminitis (62%) and obesity (59%). The least confidence was expressed in hyperkalaemic periodic paralysis (77%), developmental orthopaedic disease (72%), equine polysaccharide storage myopathy (70%) and equine pituitary pars intermedia dysfunction (68%), with respondents ranking their confidence level as three or below
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Going further than previous research [18], Roberts and Murray [15] identified the majority of respondents (88%) had not attended equine nutrition CE within the previous year. The main reason given for this was a lack of available courses; however, the majority of respondents expressed an interest in taking CE, with a higher percentage more likely to engage if the courses were offered online.
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Although this study [15] was limited to the state of Georgia, it provided a more in-depth insight into equine nutrition education from an equine veterinarian perspective, than had been previously reported [18], and it highlighted several areas of concern that would benefit from further research on a nationwide scale. Whether the education system supporting veterinarians is meeting the needs of the industry remains under-evaluated and requires further research to establish current standards, provision, and accountability.
5. Conclusion A review of the published research to date provides an important insight into the equine nutrition practices of horse owners and operators in the USA, as well as the role the equine veterinarian plays in this. It appears that current nutritional practices appear to be falling short of recommendations, in both pleasure and performance horses. While many of the studies have been state specific, provided demographic-only related information, have addressed only the horse owner/operator viewpoint, or have only surveyed commercial farms instead of the industry as a whole, they provide substantial justification for the need
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The contribution of equine nutrition to horse health and welfare, as well as the environment is indisputable. As the equid population continues to grow and horse ownership continues to rise, there is little doubt to the role the equine veterinarian plays in the future of the equine industry, particularly with reference to educating horse owners. However, there seems to be some disinclination on the part of the veterinarian to fully embrace this responsibility. Given the serious implications of this, further research is warranted in this area, and additional sources of professional nutrition support investigated.
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[10] Martinson, K., Hathaway, M., Wilson, J.H., Gilkerson, B., Peterson, P.R. and del Vecchio, R. (2006). University of Minnesota Horse Owner Survey: Building an Equine Extension Program. Journal of Extension. 44 (6), 1.
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[11] American Horse Publications, AHP (2012) Results from the 2012 AHP Equine Industry Survey http://www.americanhorsepubs.org/resources/. Last accessed 24th November 2103
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Equine Practitioners Annual Convention. San Antonio, Texas, USA, 62-79 [14] American Horse Publications, AHP (2010) Results from the 2009-2010 AHP Equine Industry Survey. Available at: http://www.americanhorsepubs.org/resources/AHP-EquineSurvey-Final.pdf. Last accessed 19th Mar 2011.
[15] Roberts, J.L., Murray, J. (2013). Survey of Equine Nutrition: Perceptions and Practices of
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Veterinarians in Georgia, USA. Journal of Equine Veterinary Science. 33, 454-459. [16] American Veterinary Medical Association (AVMA) (2011c). Market research statistics: U.S. veterinarians — 2010. Available: http://www.avma.org/reference/marketstats/usvets.asp. Last accessed 11th Mar 2011.
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[17] American Horse Council, AHC (2005). The Economic Impact of the Horse Industry on the United States. Wilton, CT: Deloitte. 8-22.
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[18] Buffington, CA, LaFlemme DP. (1996). A survey of veterinarians’ knowledge and attitudes about nutrition. Journal of the American Veterinary Medical Association. 208 (5), 674-675. [19] Nielsen, B.D. (2007). “Evaluating Equine Research”, Proceedings of the 2nd Equine Nutrition Conference, Vienna, AUSTRIA. 35-47 [20] Pritchard, W.R. (1988). Future directions for veterinary medicine. Durham, NC: Pew National Veterinary Education Program.