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PROTEIN ENERGY MALNUTRITION

•Kwashiorkor
• Marasmus
DEFINITION
It refers to a range of clinical
manifestations that result from
inadequate intake of proteins
and calories required to meet the
daily needs of the body
Pathogenesis
• From physiological point of view, proteins of the
body can be considered to exist in two different
compartments within the body
– Somatic compartment – in skeletal muscles
– Visceral compartment – proteins present in visceral
organs.
• Two poles of PEM are
– Kwashiorkor
– Marasmus
• In marasmus, somatic compartment is depleted
more
• In kwashiorkor, predominantly the visceral
compartment gets affected.
Kwashiorkor Vs Marasmus
Both diseases tend to occur more commonly in children

Marasmus Kwashiorkor
• If the child is malnourished with • When protein
equitable deficiency of both proteins deficiency is relatively
and calories, he is likely to develop greater than total
marasmus. caloric intake,
kwashiorkor is the
• Somatic protein compartment is more likely
depleted more, with preservation of manifestation.
the more vital visceral protein
compartment. Hence the disease is • There is severe
less serious as compared to depletion of visceral
kwashiorkor. protein compartment.

• Since visceral protein compartment is • Consequently, serum


preserved, serum protein and albumin protein and albumin
levels are normal. concentrations are
low.
• Edema is absent. • Hypoalbuminemia results in
dependent or generalized
• Body weight is less than edema.
60% of normal for age and • Due to fluid retention, fall in
sex of the child. body weight is not as marked
as in marasmus.
• Along with proteins, • Subcutaneous fat is mobilized
subcutaneous fat is less.
consumed as a energy
• Hair changes are seen
source. Hence the child commonly.
appears thin and
• Fatty liver, apathy, loss of
emaciated. Head appears appetite and defective
larger in proportion to the immunity is more common.
body (Broomstick
• Mucosal atrophy in small
extremities). intestine seen commonly that
results in malabsorption
syndrome.
Other Changes
 Bone Marrow- Hypoplastic resulting in
microcytic hypochromic or dimorphic anemia.

 Brain – cerebral atrophy, neuronal deficiency


and impaired myelinization of white matter may
be seen.

 Lymphoreticular system: thymic hypoplasia


and lymphoid atrophy.

 Opportunistic infections.

 Other nutritional deficiencies including iodine


deficiency may result in severe mental
retardation.
Kwashiorkor