Difference between Kwashiorkor and Marasmus

Protein-energy malnutrition (PEM) is a crucial health condition prevailing in the country. A primary deficiency in diet may result in a reduced quantity of adipose tissue and body mass. This condition gives rise to protein-energy malnutrition. PEM is specifically more observed in developing countries like Asia, South America and Africa. The three manifestations of PEM are: Kwashiorkor, marasmus and marasmic kwashiorkor.

Marasmus is generally more common to affect the children as compared to kwashiorkor which is less common in terms of prevalence.

Kwashiorkor and Marasmus: Differences

Based on- Prevalence (as per age) 

Children lying in the age group of 1-4 years usually are affected by kwashiorkor whereas marasmus generally affects infants under 1 year of age, children but can also happen in adults.

Based on- Etiological factor

1. The underlying reason for Kwashiorkor is severe protein deficiency in the diet and significantly low amounts of calories than required. Diets based solely on maize or rice are also associated with the kwashiorkor. Other factors associated with it include a recent history of infection (measles specifically), poor living conditions, abrupt weaning off etc.
2. The etiological reason for marasmus is the inadequacy of total calorie intake. The reason for children in poverty and poor living conditions. In adults, usually, anorexia is the potent cause contributing to the development of marasmus. The decreased food intake with age affects the nutritional efficacy of the diet. Depression also contributes to developing anorexic conditions.

Malabsorption i.e. reduced absorption of the food in the body also is one of the underlying factors.

Based on – Pathophysiology of the condition

Insufficient intake of amino acids causes depriving visceral organs of adequate protein stores. The striking feature in children suffering from kwashiorkor is peripheral oedema. The nutritional oedema is a result of an increased level of antidiuretic hormone (ADH) in response to declining albumin protein levels in plasma.

The role of albumin in the plasma is to maintain fluid levels in the vasculature, whereas the antidiuretic hormone levels increase in the blood in response to hypovolemia i.e. decreased volume of fluid in the blood.

Marasmus is a result of unfulfilled metabolic demands posed by the body because of the lack of calorie intake by the individual. The decreased energy levels are matched by energy expenditure by the muscle and adipose tissue of the body. 

Based on – Clinical presentation 

• Kwashiorkor

1. Pitting oedema can be observed. It begins in the leg and feet gradually spreading in an advanced stage of the condition i.e. to the face and upper extremity.
2. A child may give an appearance of a fatty and healthy child, creating a false image of a ‘well fed’ child. Also referred to as ‘sugar baby’ resemblance.
3. Changes in skin appearance can be observed as ‘Enamel spots’, as a result of increased pigmentation of the skin. They resemble ‘flaky paint’. 
4. Hair loses lustre and shine, easy to pluck it off from the root. Changes include depigmentation usually.
5. The child shows absent hunger signs, making it hard to feed them.
6. The presence of wasting of muscles is evident in a child suffering from kwashiorkor. The child usually has low muscle tone, is weak and finds standing and walking a difficult form of activity.

• Marasmus

1. No sign of oedema is present unlike in kwashiorkor with pitting type of oedema.
2. The child is very lean and weak. The appearance is like ‘skin and bones.
3. The loose hanging skin folds at the region of the buttocks give a ‘baggy pants appearance’.
4. In spite of the clinical presentation, the child appears alert.
5. The face gives the resemblance to ‘monkey facies’ owing to the visibility of wrinkles due to the loss of the buccal pad of the fat tissue.
6. The child shows a severe level of muscle wasting. A large amount of fat is lost due to a lot of energy expenditure done by it.

Based on – Morphological Features 

1. Fat tissue is absent in children suffering from marasmus whereas in kwashiorkor the child appears as well fed. The subcutaneous fat is preserved in kwashiorkor.
2. In the case of kwashiorkor enlarged fatty liver is observed whereas a child with marasmus has no fatty liver (absent hepatic enlargement).
3. Muscle and organs get atrophied in both marasmus and kwashiorkor but with variability in the amount of subcutaneous fat deposition.

Based on – Mortality and Recovery rate

1. A child in the early stage of being affected with kwashiorkor has a high mortality rate as compared to marasmus. 
2. A child with marasmus recovers in quite less time whereas the recovery phase is longer in kwashiorkor.

Management and Treatment

• Kwashiorkor

1. Routinely doses of Vitamin A, D, B-complex and iron.
2. Easy to digest and palatable food rich in protein, minerals and extra calories is a must.
3. Additional fats are also to be given.
4. Skincare to be taken. Proper cleaning and protection are important to avoid chances of dermatosis.

• Marasmus

1. Correction of fluid and electrolyte imbalance.
2. Antibiotic therapy if infections prevail.
3. Refeeding is essential owing to severe muscle wasting.
4. Administration of a protein-rich diet.

Conclusion

Marasmus and Kwashiorkor fall under the category of malnutrition with an acute presentation. Out of three manifestations of protein-energy malnutrition (PEM), kwashiorkor and marasmus are deficiency disorders that are caused due to starvation and insufficient total calorie intake respectively. The clinical presentation is variable depending on the severity level and the stage of the deficiency disorder. The fulfilment of the unmet needs of a child in the context of adequate nutrition supply, diet and proper care could reverse the advancement of the disease, decrease the mortality rate and better the prognosis.

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