Starvation kwashiorkor

Marasmus results from deficiency of protein and energy intake, as in starvation, and results in generalized wasting (atrophy of muscles and subcutaneous tissues, emaciation, loss of adipose tissue) Edema occurs in kwashiorkor but not in marasmus however, the distinction between these disorders is not always clear. The treatment of marasmus requires supplementation of protein and energy intake. 

As indicated above, cholinesterase levels rise with the amount of body fat. On the other hand, there is always a reduction of esterase levels under conditions of starvation (E5, S34), as for instance in kwashiorkor (B4, S35). Since in starvation there is a general tendency for the blood volume to shrink before there are major changes in the concentrations of blood constituents, the possibility must be considered that the reduction in the actual amount of cholinesterase protein is much greater than may be suggested by the reduction of cholinesterase activity per unit volume of plasma. 

In kwashiorkor there is less breakdown of protein and release of amino acids from muscle than in marasmus since provision of adequate energy in the diet reduces the adrenal cortical response to starvation and, consequently, the flow of amino acids from muscle to viscera. The release of amino acids from muscle is, therefore, not sufficient to meet the needs of the internal organs. 

Kwashiorkor—Infants fed low-protein, starchy foods such as bananas, yams, and cassava after weaning may develop kwashiorkor. This imbalanced diet, which has a subnormal protein-to-calorie ratio for infants, prevents some of the adaptive mechanisms of the body from operating the way that they do in the case of starvation or marasmus—a wasting condition due to lack of food. 

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