Protein energy malnutrition has been identified as a major health and nutrition problem in the developing countries which is manifested as marasmus or kwashiorkor. The two terms do differ with respect to their definition, clinical symptoms, sings, biochemical changes seen and the management.
Marasmus
Severe protein energy malnutrition in children usually leads to marasmus, with a weight less than 60% of the mean for the age, and a wasted, wizened appearance without edema.
In marasmus, muscle wasting is obvious with severe loss of subcutaneous fat. Generalized edema is not seen, and weight for the height is very low. These children are sometimes quiet and apathetic. Appetite is usually good, and the dermatological manifestations are not usually seen. Hair changes are rare with no hepatomegaly. In these patients, serum albumin is usually normal or slightly low with normal plasma non essential/ essential amino acid ratio.
Kwashiorkor
In this condition, body weight is 60-80% of the expected and generalized edema is present.
In kwashiorkor, muscle wasting is sometime hidden by edema, and fat often retained but not firm. Edema is usually seen in the lower legs, face and the extremities of the upper arms. Usually, they are irritable, moaning, and apathetic. Appetite is poor. Dermatological manifestations are common with a flaky-paint skin rash with hyperkeratosis and desquamation. Distended abdomen with enlarged liver is commonly seen. Hair is spare and depigmented. Serum albumin is low with elevated plasma non essential/ essential amino acid ratio.
What is the difference between Marasmus and Kwashiorkor?
• In marasmus weight is less than 60% of the mean for the age while in kwashiorkor body weight is 60-80% of the expected weight.
• Edema is usually seen in kwashiorkor but not common with marasmus.
• In marasmus, muscle wasting is obvious with severe loss of subcutaneous fat, but in kwashiorkor, muscle wasting is sometime hidden by edema.
• Enlarged liver is seen in kwashiorkor due to fat infiltration, but not in marasmus.
• Dermatological manifestations like flaky-paint dermatitis with hyperkeratosis and desquamation are seen in kwashiorkor but not in marasmus.
• Hair changes are uncommon in marasmus, but in kwashiorkor, hair is spare and depigmented.
• Biochemical changes are different in the two conditions.