Marasmus and Kwashiorkor

Diet rich in caibohydrates and low in protein quality and micronutrients 

Protein Malnntrition or Kwashiorkor Micronntrient Deficiencies Vitamins and Minerals 

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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. 

A protein-deficient child will grow more slowly than one receiving an adequate intake of protein — this is stunting of growth. As discussed in section 8.2, the protein-energy deficiency diseases, marasmus and kwashiorkor, result from a general lack of food (and hence metabolic fuels), not a specific deficiency of protein. 

Marasmic Kwashiorkor. This condition is found in many situations where children are fed diluted gruels after weaning. It is characterized by a combination of disorders which accompany both marasmus and kwashiorkor. Today, the tendency is to use the generalized term, protein-energy malnutrition, to describe this condition. 

Marasmic kwashiorkor—Patients who show features of both marasmus and kwashiorkor are usually given the general diagnosis of protein-energy malnutrition. 

What are main differences between marasmus and kwashiorkor How many people are affected by these deficiencies What are the classic symptoms of an infant severely affected by kwashiorkor ... 

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). 

Figure 8.5 Stunting of growth in kwashiorkor, marasmus and marasmic kwashiorkor.

PEM results from a diet inadequate in protein and energy. It manifests as growth failure, marasmus or kwashiorkor. 

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. 

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. 

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... 

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. 

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. 

Figure 24-1. Typical features found in children with kwashiorkor and marasmus. Photographs reprinted with permission from Scrimshaw and Behar (1961). 1961, AAAS.

Both forms of PEM are associated with hy-percortisolemia.The level of cortisol in kwashiorkor is lower, however, than in marasmus, likely due to decreased adrenocortical function caused by low protein intake (and not adrenal failure). If a sufficiently high level of cortisol is not maintained, then adequate muscle protein is not mobilized to sustain hepatic protein synthesis. Indeed, hypoproteinemia, evident by the decreased serum albumin and transferrin levels, is more acute in kwashiorkor than marasmus. 

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