Kwashiorkor and marasmus are types of protein-energy malnutrition (PEM) caused by inadequate food intake, poor food quality, or diseases that affect nutrient absorption. Kwashiorkor can occur quickly and manifests as a well-fed appearance, while marasmus is a gradual process and manifests as a hungry appearance. Diagnostic criteria and laboratory findings differ between the two types of PEM. Early identification and treatment are crucial.
Kwashiorkor and marasmus are two major types of PEU that are distinguished from each other based on clinical context, time of development, clinical features, and diagnostic criteria. In these types of malnutrition there is a lack of protein diet due to inadequate food intake, poor food quality or the presence of diseases that modify nutrient absorption and energy requirements. One major difference between kwashiorkor and marasmus is that kwashiorkor can occur quickly, whereas marasmus is usually the result of a gradual process. Kwashiorkor often manifests in an affected person as a well-fed appearance, but marasmus manifests as a hungry appearance. Malnutrition severely affects a person’s well-being and functioning, so these types of malnutrition need to be identified and treated early.
The clinical setting is a factor that helps distinguish kwashiorkor and marasmus from each other. In marasmus, there is a decrease in energy intake, often due to inadequate diet, over months to years. Long-term starvation, which often occurs in poor areas, is a major factor in the development of marasmus. In kwashiorkor, there is a decrease in protein intake within a state of stress, usually weeks. While there is a generalized decrease in calorie intake in marasmus, only the protein portion of the diet is decreased in kwashiorkor.
Kwashiorkor and marasmus differ in laboratory findings. In kwashiorkor, serum albumin is less than 2.8 grams per deciliter (g/dL), total iron binding capacity (TIBC) is less than 200 micrograms per deciliter (mcg/dL), and serum transfer is less than 150 milligrams per deciliter (mg/dl). Also, lymphocytes are less than 1500/µl and there is anergy or lack of immune response on skin antigen testing. In marasmus, the height index of creatinine is less than 60% of the standard, which means that when the 24-hour urinary excretion of creatinine is measured, its value is less than 60% of the normal according to the height. The low creatinine height index reflects the loss of muscle mass.
The clinical features of kwashiorkor and marasmus also differ. In kwashiorkor, the affected person often appears well nourished and has a protruding belly, edema or swelling, and easy hair pulling out. Lightening of the skin and hair is seen in those with dark hair and skin. This is due to reduced production of a hair and skin pigment called melanin, which is also a protein. Diagnostic criteria of kwashiorkor include reduction of serum albumin to less than 2.8 g/dL, as well as edema, easy hair pulling, poor wound healing, skin lesions, or pressure ulcers.
A marasmic person appears cachectic because there is a marked loss of subcutaneous fat and muscle mass. In adults, weight is less than 80% of the standard for height, but in children, weight is less than 60% of weight for age. Measurements of the triceps skinfold and middle arm circumference are important because these are the clinical criteria for the diagnosis of marasmus. A triceps skinfold less than 0.12 inches (3 mm) and a midarm muscle circumference less than 5.9 inches (15 cm) define the criteria for diagnosing a person as marasmic.
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