Marasmus

Protein-energy malnutrition in children can therefore be classified by both the deficit in weight compared with what would be expected for age and also the presence or absence of oedema, as shown in Table 8.2. The most severely affected group, and therefore the priority group for intervention, are those suffering from marasmic kwashiorkor - they are both severely undernourished and also oedematous. 

Marasmus is a state of extreme emaciation the name is derived from the Greek papaopoo for wasting. It is the predictable outcome of prolonged negative energy balance with severe depletion of all energy reserves in the body. 

60-80% of expected weight for age 60% of expected weight for age Underweight Marasmus Kwashiorkor Marasmic kwashiorkor 

Not only have the body s fat reserves been exhausted, but there is wastage of muscle as well, and as the condition progresses there is loss of protein from the heart, liver and kidneys, although as far as possible essential tissue proteins are protected. As discussed in section 9.2.3.3, protein synthesis is energy expensive, and in marasmus there is a considerable reduction in the rate of protein synthesis, although catabolism continues at the normal rate (section 9.1.1). The amino acids released by the catalysis of tissue proteins are used as a source of metabolic fuel and as substrates for gluconeogenesis to maintain a supply of glucose for the brain and red blood cells (section 5.7). 

As a result of the reduced synthesis of proteins, there is a considerable impairment of the immune response, so that undernourished people are more at risk from infections that those who are adequately nourished. Diseases that are minor childhood illnesses in developed countries can often prove fatal to undernourished children in developing countries. Measles is commonly cited as the cause of death among children in developing countries, although it would invariably be more correct to give the true cause of death as malnutrition - infection is simply the last straw. 

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All 20 of the amino acids present in proteins are essential for health. While comparatively rare in the Western world, amino acid deficiency states are endemic in certain regions of West Africa where the diet relies heavily on grains that are poor sources of amino acids such as tryptophan and lysine. These disorders include kwashiorkor, which results when a child is weaned onto a starchy diet poor in protein and marasmus, in which both caloric intake and specific amino acids are deficient. 

Marasmus can occur in both adults and children and occurs in vulnerable groups of all populations. Kwash-... 

In addition to the wasting of muscle tissue, loss of intestinal mucosa, and impaired immune responses seen in marasmus, children with kwashiorkor show a number of characteristic feamres. The defining characteristic is edema, associated with a decreased concentration of plasma proteins. In addition, there is enlargement of... 

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). 

Malnourished children can have two very different appearances. In marasmus, the limbs are wasted and the whole of the body assumes a shrunken skin and bone appearance, as muscle is sacrificed to support more vital tissues. The shranken cheeks are caused by a loss of the Bidet fat depots, hi kwashiorkor, children have pot-bellies partially explained by generalised oedema and hepatomegaly. Both have brittle, bleached hair, skin lesions and a deeply apathetic demeanour. Although the two conditions intergrade they show some geographical separation with kwashiorkor being restricted to tropical and subtropical regions while marasmus can occur anywhere. 

Marasmus is considered to be due to inadequate food intake. It is not usually the quantity but the quality of the food that is deficient, e.g. low nutritional value of bulky vegetables. Kwashiorkor is considered to be caused, more specifically, by a low-protein diet. This condition frequently develops at the time of weaning when protein-rich milk is replaced by protein-deficient solid food. It did not appear in the medical literature until 1934 when it was reported by Cicely Williams who studied the condition while she was working among tribes of Western Africa. She gave it the name kwashiorkor, which was used by the Ga tribe to describe the condition that develops when the baby is taken away from mother s breast, usually because another baby has been bom. It has generally been held that the oedema is a consequence of a low plasma albumin concentration and a reduction in the colloid osmotic pressure which reduces the movement of water from tissue fluid back into capillaries. The low albumin level results from a decreased rate of synthesis of albumin by the liver. However, if marasmus is due entirely to lack of energy... 

The serum protein concentrations, especially of albumin, are low in kwashiorkor but normal in marasmus. 

The ratio of essential to non-essential amino acids is high in kwashiorkor but normal in marasmus. The cause of this may be low activities of the enzymes for metabolising the essential amino acids. These are required for any protein synthesis that must take place even in kwashiorkor. 

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). 

Results from two different groups of children reveal that the serum immunoglobulin levels in children with marasmus are not significantly different from those with kwashiorkor. Sixteen marasmic infants free from all signs of apparent kwashiorkor but all having gastrointestinal disturbances or respiratory infections had immunoglobulin levels as fol-... 

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

Marasmus occurs as a result of deprivation of calories relative to protein, eg, a diet mainly of milk. 

The absence of edema or reduction in albumin distinguishes marasmus from kwashiorkor. 

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. 

Aletris formosuna (Hayata) Sasaki A. spicata French Fei Jin Cao (Chinese stargrass) (root) Stigmasterol, beta-sitosterol, diosgenin.54 Antitussive, vermifugal, for ascariasis, marasmus, cough. 

Marasmus Marasmus occurs when calorie deprivation is rela tively greater than the reduction in protein. Marasmus usually occurs in children younger than one year of age when the mother s breast milk is supplemented with thin watery gruels of native cereals, which are usually deficient in protein and calories. Typical symptoms include arrested growth, extreme muscle wast ing (emaciation), weakness, and anemia. Victims of marasmus do not show the edema or changes in plasma proteins observed in kwashiorkor. 

Kwashiorkor is caused by inadequate intake of protein. Marasmus Marasmus occurs when calorie deprivation is relatively greater than the reduction in protein. 

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