Malnutrition marasmus

Degrees of protein-energy malnutrition (marasmus) are classified according to BMI. 

An isolated report describes an elderly woman treated with aminophylline by intravenous infusion who had a marked fall in her serum theophylline levels (from 16.3 to 6.3 mg/L) when the amino acid concentration of her parenteral nutrition regimen was increased from 4.25 to 7%. " A study in 7 patients with malnutrition (marasmus-kwashiorkor) found only a small, probably clinically irrelevant increase in the elimination of a single intravenous dose of theophylline when they were fed intravenously. ... 

Marasmus is a term used for severe protein-energy malnutrition in children where the patient s weight is compared with an age-matched reference weight Classifications vary but normal nutrition is 90-110% of reference wdght. Mild malnutrition is 75-90% and severe malnutrition (marasmus) is less than 60% of reference weight matched for age. 

Types of protein-energy malnutrition are marasmus (deficiency in total intake or nutrient utilization), kwashiorkor (relative protein deficiency), and mixed marasmus-kwashiorkor. 

A special form of undemutrition that particularly affects children is known as protein-energy malnutrition (PEM) which is a spectrum of syndromes from marasmus (lack of energy intake) to kwashiorkor (deficient protein intake). 

Patients with protein-calorie malnutrition, especially children with marasmus and chest infections, had very high levels of serum IgD (R7). Antigen binding activity of IgD to diphtheria-toxoid and to bovine y-globulins in some human sera have been reported (G4, H3). 

In countries where food Is In short supply or the diet is inadequate, protein-calorie malnutrition can take two extreme forms, kwashiorkor and marasmus. 

Vitamin A deficiency can result from insufficient dietary intake, from malabsorption and it has been recognized that also malfunction of RAR-receptors can lead to symptoms of vitamin A deficiency. These symptoms include skin lesions, night blindness, corneal ulcerations and conjunctivitis and poor bone remodeling. Vitamin A deficiency associated with malnutrition is wide spread in large parts of the world and may be fatal in infants and young children suffering from kwashiorkor or marasmus. 

The signs and symptoms of protein-energy malnutrition (PEM) depend on various factors, including the duration of the nutritional inadequacy, age at onset, and frequency/types of concomitant infections. Figure 24-1 shows children diagnosed with kwashiorkor and marasmus and outlines some of the diagnostic features discussed in this section (Scrimshaw and Behar, 1961). 

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite. It is seen in patients with cancer, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease and congestive heart failure. Underlying causes are poorly understood, but there is an involvement of inflammatory cytokines, such as TNF-a, IFN-y, IL-6 and tumour-secreted proteolysis-inducing factor. Related syndromes are kwashiorkor and marasmus, although these are most often symptomatic of severe malnutrition. 

There is a wide variation of deficiencies between energy and protein deficient diseases as in the cases described by marasmus and kwashiorkor. The term protein-energy malnutrition (PEM) is used to describe those differences. PEM is the result of poverty as well inadequate information on diet. In some countries there is the mistaken belief that the child should not be given high protein food, which is served to the father, while the child drinks the fluid the meat was cooked in. 

Severe protein-energy malnutrition often occurs after weaning, the transition frcim nursing to the consumption of foods from other sources (i.e.. Solid foods). The marasmus common in Latin America is caused by early weaning, followed by use of overdiluted commercial milk formulas. Kwashiorkor occurs in Africa, where babies arc fed starchy roots, such as cassava, that arc low in protein. It also occurs in the Caribbean, where babies are fed sugar cane. The major symptom of kwashiorkor is edema, mainly of the feet and legs. Edema is the condition produced when water normally held in the bloodstream by osmotic pressure leaks into (jther extracellular spaces. It can result from reduced osmotic pressure in the bloodstream caused by catabolism and depletion of serum albumin. 

Low copper and ceruloplasmin levels have been reported in marasmus of infants (protein and caloric malnutrition) from Chile (M28) and India (G9). 

One of the characteristics of critical illness is hypermetabolism. Trauma, burn injury, and sepsis are aU catalysts for the release of mediators that initiate and regulate the hypermetabohc response. The metabolic consequences of this response include altered carbohydrate metabolism, increased protein synthesis and degradation, and increased lipid oxidation, which ultimately result in loss of protein and lean body mass." In a previously well-nourished individual, critical illness can result in the onset of kwashiorkor-like malnutrition within 5 to 7 days. In a previously malnourished individual, critical illness can precipitate severe mixed marasmus-kwashiorkor in 3 to 5 days. In a prospective study of 129 patients admitted to the intensive care unit (ICU), 43% were malnourished." The malnourished patients had an increased length of stay in the ICU (a mean of 27 vs. 19 days) and a statistically significantly increased incidence of complications (55% vs. 40%) compared with well-nourished patients with a similar severity of illness. 

Marasmus Malnutrition resulting from inadequate intake of protein and calories. 

Malnutrition and its ultimate form starvation arise from many different causes and are present even in affluent societies. The case description reveals that the child lives in a third-world country, and the physical findings reveal that the child suflJ ers from protein-calorie-deficient starvation, or marasmus. 

An 8-month-old child presents with exhaustion, irritability, and malnutrition. The family history reveals poverty and inadequate nutrition in all members. The 8-month-old was fed diluted formula, and the tentative diagnosis of marasmus was made. 

Srikantia, S. G., Jacob, C. M., and Reddy, V., Serum enzyme levels in protein-calorie malnutrition. Studies in children with kwashiorkor and marasmus. Am. J. Dis. Child. 107, 256-259 (1964). 

Second, there was, of course, malnutrition. Agriculture provided quantity but not quality. Bones found from this period are stunted and show evidence of rickets. Pellagra, kwashiorkor, marasmus, scurvy, and the other deficiency diseases were probably rampant. 

The term kwashiorkor refers to a disease originally seen in African children suffering from a protein deficiency. It is characterized by marked hypoalbuminemia, anemia, edema, pot belly, loss of hair, and other signs of tissue injury. The term marasmus is used for prolonged protein-calorie malnutrition, particularly in young children. 

Mr. Veere s malnourished state was reflected in his admission laboratory profile. The results of hematologic studies were consistent with an iron deficiency anemia complicated by low levels of folic acid and vitamin Bi2, two vitamins that can affect the development of normal red blood cells. His low serum albumin level was caused by insufficient protein intake and a shortage of essential amino acids, which result in a reduced ability to synthesize body proteins. The psychiatrist requested a consultation with a hospital dietician to evaluate the extent of Mr. Veere s marasmus (malnutrition caused by a deficiency of both protein and total calories) as well as his vitamin and mineral deficiencies. 

If oedema is present, the malnutrition is termed kwashiorkor or marasmus-kwashiorkor if very severe. 

Protein deficiency see Protein-energy malnutrition, Kwashiorkor, Marasmus. 

Despite the extensive information on Kq in normal and S.G.A. neonates and infants, there is a lack of information in regard to sick infants. Also of importance are the reports of Kq infants suffering from Kwashiorkor or marasmus. Protein malnutrition results in a reduced Kq which has been related to the poor insulin response to glucose seen in this condition (Milner, 1971, and Godard and Zahnd, 1971) whereas such changes are not a feature of marasmus. Those involved in studies of parenteral nutrition will recog-... 

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