Tips for Refeeding Malnourished Horses
Since 2007, the number of horses arriving at humane shelters in low body condition (scores of 1 to 3 on the 9-point body condition scale) due to starvation has risen, said Rebecca Remillard, DVM, PhD, Dipl. ACVN. Yet for the organizations and individuals that take on the task of rehabilitating these malnourished horses, there’s no collective refeeding plan to guide them.

Remillard, of Veterinary Nutritional Consultations Inc., in Hollister, North Carolina, described how to refeed starved, malnourished horses at the 2016 American Association of Equine Practitioners Convention, held Dec. 3-7 in Orlando, Florida.

How Does it Happen?

The most common cause of malnutrition is neglect or lack of owner finances or knowledge, Remillard said, not criminal abuse. At worst, an adult horse loses about 40% of body weight (BW) due to a complete lack of feed for 60 to 90 days. At this point, the horse can no longer physically support its own body weight becomes recumbent (unable to rise), and has a poor prognosis for survival. Most horses with low body condition score (BCS) receive a poor-quality, inadequate diet for more than three or four months before becoming recumbent.

Starting Point

When managing a malnourished horse, start by having the veterinarian conduct a physical exam. He or she will measure body weight, BCS, and blood parameters, and assess appetite.

Disease status can profoundly impact the horse’s gastrointestinal (GI) system. Without food, physical changes in the small and large intestines compromise a horse’s ability to digest nutrients. The hindgut’s microbiome (its microbial flora) is particularly sensitive to diet, yet our understanding of it is limited. Remillard suggested housing malnourished horses with other horses in an environment with dirt and manure. The theory is that this might help reestablish the microbiome naturally, similar to how foals develop a microbiome.

Key Points for Refeeding

When beginning to refeed a starved horse, base his digestible energy (DE) intake on his current weight, not optimal weight. To estimate DE, use the equation:


DE Mcal/day = Body weight in kg x 0.03
(Mcal = megacalorie, 1 Mcal = 1.000 kcal)


Take several days to work up to feeding the calculated amount. Consider the “forage first” plan, said Remillard, because forage helps regenerate the GI track physically, functionally, and nutritionally. Resist the urge to feed more or to feed high-starch or simple-sugar feeds, which put the horse at risk for digestive disturbances and laminitis or, worse, refeeding syndrome. Refeeding syndrome occurs when too many calories and nutrients are consumed by a starving animal, resulting in electrolyte imbalance, multi-organ failure, and possibly death.

Remillard described how much weight a properly fed horse should gain back per day, given its BCS:

  • BCS 1: Aim for weight gain of 0-1 pounds per day;
  • BCS 2: Aim for weight gain of 1-2 pounds per day;
  • BCS 3: Aim for weight gain of 2 pounds per day.

Take-Home Message

Recumbent horses and horses that lack appetite tend to have a poor prognosis for survival, said Remillard. Still, the potential for successful rehabilitation depends on each horse and the care and resources available. Veterinary and nutritionist guidance is key for helping ensure the horse returns to health. Full rehabilitation can take weeks. A horse with a BCS of 1 can take nearly a year to reach his ideal weight. Time, patience, and care are critical.