Marasmus causes

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 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. 

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

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. 

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. 

The causes of peliosis hepatis are varied and include anabolic or androgenic steroids, oestrogens (52), azathio-prine, arsenic, vinyl chloride, tamoxifen and danazol as well as tuberculosis, histiocytosis, leishmaniasis, leprosy, carcinoma, sprue, liver abscess, cytomegalovirus infection, glycogenosis (type I) (14) and marasmus. (46) Congenital (angiomatous) abnormality of the vessels may also be a contributory factor. (5) The respective development of peliosis hepatis is still unclear. 

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. 

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. 

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. 

In developing countries, the causes of marasmus are either a chronic shortage of food or the more acute problem of famine, where there will be very little food available at all. All too frequently, famine comes on top of a long-term shortage of food, so its effects are all the more rapid and serious. 

A lack of food is unlikely to be a problem in developed countries, although the most socially and economically disadvantaged in the community are at risk of hunger and perhaps even protein-energy undernutrition in extreme cases. Two factors may cause marasmus in developed countries disorders of appetite and impairment of the absorption of nutrients. 

The underlying cause of kwashiorkor is an inadequate intake of food, as is the case for marasmus. Kwashiorkor traditionally affects children aged between of 3 and 5 years. In many societies a child continues to suckle until about this age, when the next child is born. As a result, the toddler is abruptly weaned, frequently onto very unsuitable food. In some societies, children are weaned onto a dilute gruel made from whatever is the local cereal in others the child may be fed on the water in which rice has been boiled - it may look like milk, but has little nutritional value. Sometimes the child is given little or no special treatment but has to compete with the rest of the family for its share from the stew-pot. A small child has little chance of getting an adequate meal under such conditions, especially if there is in any case not much food for the whole family. 

Marasmus is characterized by the loss of lean tissue and subcutaneous fat, causing characteristic wrinkling of the skin. It can be difficult to differentiate from dehydration. It is possible to present with a combination of the two, called marasmic kwashiorkor. 

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