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Slacker
Forum Senior Topics: 29 Posts: 137 |
Dr. Goljan says Marasmus is caused by dietary deficiency of both protein and calories. Since protein intake is decreased shouldn't a person with marasmus also should have pitting edema??? Can someone plz help me out here? thanks in advance!!! 
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doc179
| Forum Guru Topics: 67 Posts: 1213
Marasmus is one of the three forms of serious protein-energy malnutrition (PEM). The other two are kwashiorkor (KW) and marasmic KW. These forms of serious PEM represent a group of pathologic conditions associated with a nutritional and energy deficit occurring mainly in young children from developing countries at the time of weaning. They are frequently associated with infections, mainly gastrointestinal infections. The reasons for a progression of nutritional deficit into marasmus rather than KW are unclear and cannot be solely explained by the composition of the deficient diet (ie, a diet deficient in energy for marasmus and a diet deficient in protein for KW). The study of these phenomena is considerably limited by the lack of an appropriate animal model. Marasmus is a serious worldwide problem. According to the World Health Organization (WHO), 49% of the 10.4 million deaths occurring in children younger than 5 years in developing countries are associated with PEM. Malnutrition has been a permanent priority of the WHO for decades. Although PEM occurs more frequently in low-income countries, numerous children from higher-income countries are also affected, including children from large urban areas and of low socioeconomic status, children with chronic disease, and children who are institutionalized. Hospitalized children are also at risk for PEM when they experience complex conditions, such as oncologic disease, genetic disease, or neurological disease, requiring prolonged and complicated hospital care. In these conditions, the challenging nutritional management is often overlooked and insufficient, resulting in an impairment of the chances for recovery and the worsening of an already precarious neurodevelopmental situation. According to the WHO, 150 million children aged 5 years or younger have PEM, resulting not only in mortality but also in morbidity and suboptimal neurological development. The social and economic implications of PEM and its complications are incalculable. This review is limited to marasmus resulting from an insufficient nutritional intake as observed under impaired socioeconomic conditions, such as those present in developing countries. This condition is most frequently associated with acute conditions (eg, gastroenteritis) or chronic conditions (eg, tuberculosis, HIV infection). Pathophysiology: Various extensive reviews of the pathophysiological processes resulting in marasmus exist. Unlike KW, marasmus can be considered as an adaptation to an insufficient energy intake. Marasmus results from a negative energy balance. This imbalance can result from a decreased energy intake, increased energy expenditure, or both, such as that observed in acute or chronic disease. Children adapt to an energy deficit with a decrease in physical activity, lethargy, a decrease in basal energy metabolism, slowing of growth, and finally weight loss. Pathophysiological changes associated with nutritional and energy deficits can be described as (1) body composition changes, (2) metabolic changes, and (3) anatomic changes. Body composition Body mass: Body mass is significantly decreased in a heterogeneous way. Fat mass: Fat stores can decrease to as low as 5% of the total body weight and be macroscopically undetectable. The remaining fat is usually stored in the liver, as is often observed in KW but also to a lesser extent in marasmus. Total body water: The proportion of water content in the body increases with the increased seriousness of PEM (marasmus or KW) and is associated with the loss of fat mass, which is poor in water. The proportion of extracellular water also increases, often resulting in edema. Edema is significant in KW but can also be present in marasmus or in the frequently encountered mixed forms of PEM. The increase in extracellular water is proportional to the increase in the total body water. During the first days of therapy, part of the extracellular water shifts to the intracellular compartment and part of it is lost in the urine, resulting in the observed initial weight loss with treatment. Protein mass: Mainly represented by muscle and some organs (eg, heart), protein mass can decrease up to 30% in the most serious forms. The muscle fibers are thin with loss of striation. Muscle cells are atrophic, and muscle tissue is infiltrated with fat and fibrous tissue. Total recovery is long, but it seems possible. Other organ mass: The brain, skeleton, and kidney are preserved, whereas the liver, heart, pancreas, and digestive tract are first affected. Pediatric and adult physiologic change: Finally, physiologic changes are different in infants and children when compared to adults. For example, marasmic infants have an increased tendency to hypothermia and hypoglycemia, requiring the frequent administration of small meals. This can be explained by the body composition imbalance of marasmic children in favor of high–energy-consuming organs, such as brain and kidney, as compared to energy storage organs, such as muscle and fat. Assessment of fat and muscle mass: As described below, assessment of the fat and muscle mass loss can be performed clinically by measuring arm circumference (see Image 1) or skinfold thickness, such as triceps skinfold. The diagram illustrates the validity of this assessment method. Because arm circumference is relatively constant in healthy children aged 1-5 years, it roughly represents a general assessment of nutritional status.
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mjl1717
| Forum Junior  Topics: 964 Posts: 5442
this is what Im going with: kwashiorkor-protein def.,edema, protruberant abdomen, fatty liver, diarrhea, normal muscle mass. (may not want to eat)' marasmus-total malnutrition, loss of muscle mass, subcutaneous fat, alertness, broomstick extremities. (wants to eat)
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Slacker
| Forum Senior Topics: 29 Posts: 137
But i don't get it tho. if marasmus is total malnutrition(including protein), won't that person have ascites and edema too?
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mjl1717
| Forum Junior Topics: 964 Posts: 5442
dont know
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Obecalp
| Forum Junior  Topics: 13 Posts: 293
Bump. I'm pondering the same problem; If inadequate protein intake (KW) produces hypoalbuminemia and thus ascites, shouldn't total calorie deficiency (Marasmus) produce ascites because of hypoalbuminemia???
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Ariella13
| Forum Newbie  Topics: 1 Posts: 23
Im pretty sure it has to do with the muscle mass. Since in kwashiorkor theres normal muscle mass which means that the protein present its causing the water to move into an area of high concentration whereas in Marasmus there is a loss of muscle mass which means that theres in no difference in oncotic pressure so the water is able to leave the body freely.
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