Marasmus

Abstract: The Eighth Joint Expert Committee on Nutrition of FAO and WHO1 emphasized the need for an accepted classification and definition of protein-calorie malnutrition. There are two pressing reasons for this. Bengoa* summarized the available information about the frequency of protein-calorie malnutrition in different countries. There are many gaps, partly because for some countries there are no data, and partly because data which do exist are not always comparable. It is important that studies of prevalence should be extended and that the same criteria should be used everywhere. Secondly, the prevailing pattern of malnutrition in any region may give some information about the nature of the dietary deficiency and so will have a bearing on the preventive measures which are most appropriate. There are two schools of thought about this. According to what might now be called the classical theory, kwashiorkor results from a deficiency of protein with a relatively adequate energy supply, whereas marasmus is caused by an overall deficiency of energy and protein. From this it follows that where the kwashiorkor syndrome prevails, protein rich supplements would be an appropriate method of prevention. On the other hand, Gopalan and his co-workers* produced evidence that there are no quantitative or qualitative differences in the diets of children who subsequendy develop kwashiorkor or marasmus. They therefore proposed that the difference in the clinical picture reflects not a difference in diet but a difference in the capacity of the child to adapt. Whichever of these theories is correct the fact remains that according to reports in the literature the prevailing pattern does differ from one country to another.4 If the differences are real there must be some reason for them, and the first step in finding the reason is to put the observations on a firm foundation with an agreed system of classification. The need for this is urgent because an alteration in the pattern of protein-calorie malnutrition and in its age of onset has important implications for the planning of preventive policies.

Abstract: Serum hepatic protein (albumin, transferrin, and prealbumin) levels have historically been linked in clinical practice to nutritional status. This paradigm can be traced to two conventional categories of malnutrition: kwashiorkor and marasmus. Explanations for both of these conditions evolved before knowledge of the inflammatory processes of acute and chronic illness were known. Substantial literature on the inflammatory process and its effects on hepatic protein metabolism has replaced previous reports suggesting that nutritional status and protein intake are the significant correlates with serum hepatic protein levels. Compelling evidence suggests that serum hepatic protein levels correlate with morbidity and mortality. Thus, serum hepatic protein levels are useful indicators of severity of illness. They help identify those who are the most likely to develop malnutrition, even if well nourished prior to trauma or the onset of illness. Furthermore, hepatic protein levels do not accurately measure nutritional repletion. Low serum levels indicate that a patient is very ill and probably requires aggressive and closely monitored medical nutrition therapy.