Objective To determine whether dietary and other management factors were associated with development of colic in horses. Design Prospective matched case-control study. Population 2,060 horses examined by veterinarians in private practice in Texas for colic and noncolic emergencies. Procedure Each month for 12 months, participating veterinarians were sent forms to collect information on 1 horse with colic and 1 horse that received emergency treatment for a condition other than colic. Information collected included signalment, farm management and characteristics, diet, medical and preventive medical factors, transport, and activity or use. Case and control horses were compared by means of conditional logistic regression to identify factors associated with colic. Results Recent change in diet, recent change in type of hay, history of previous episode of colic, history of abdominal surgery for colic, recent change in weather conditions, recent change in housing, Arabian breed, administration of an anthelmintic during the 7-day period prior to examination, failure to receive regular deworming, age > 10 years, and regular exercise (vs pastured at all times) were associated with increased risk of colic. Conclusions and Clinical Relevance Results suggest that changes in diet (particularly in type of hay fed) contribute to increased risk of colic. A regular program for administration of anthelmintics may reduce the overall frequency at which colic develops, but recent administration of anthelmintics may predispose some horses to colic. Arabian horses may have an increased risk of colic, and horses at pasture may have a decreased risk of colic. (J Am Vet Med Assoc 1999;215:53-60)