What is the Difference Between Marasmus and Kwashiorkor

Protein-energy malnutrition has been identified as a major health and nutrition problem in developing countries. This condition often manifests as marasmus or kwashiorkor. The two terms do differ with respect to their definition, clinical symptoms, signs, biochemical changes seen, and management.

The key difference between Marasmus and Kwashiorkor is their symptoms. Marasmus is characterized by severe wasting and loss of body tissue due to overall malnutrition, while Kwashiorkor is characterized by edema, skin lesions, and changes in hair. 

CONTENTS

1. Overview and Key Difference
2. What is Marasmus  
3. What is Kwashiorkor
4. Similarities – Marasmus and Kwashiorkor
5. Marasmus vs Kwashiorkor in Tabular Form
6. Summary – Marasmus and Kwashiorkor
7. FAQ – Marasmus and Kwashiorkor

What is 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 the marasmus, muscle wasting is obvious, as well as severe loss of subcutaneous fat. Generalized edema is not seen, and the weight for the height is very low. These children are sometimes quiet and apathetic. Their 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 a normal plasma nonessential/ essential amino acid ratio.

What is Kwashiorkor?

In Kwashiorkor, body weight is 60-80% of the expected, and generalized edema is present. In this condition, muscle wasting is sometimes hidden by edema, and fat is 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, such as a flaky-paint skin rash with hyperkeratosis and desquamation. A distended abdomen with an enlarged liver is commonly seen. Hair is spare and depigmented. Serum albumin is low, with an elevated plasma nonessential/ essential amino acid ratio.

Similarities Between Marasmus and Kwashiorkor

1. Marasmus and Kwashiorkor are both severe forms of malnutrition resulting from inadequate intake of essential nutrients, particularly protein and calories.
2. Both conditions are commonly found in areas with high levels of poverty.
3. Both conditions predominantly affect children.

Difference Between Marasmus and Kwashiorkor

Definition

1. Marasmus is a severe form of malnutrition characterized by extreme wasting of body tissues, including muscle and fat, resulting from inadequate intake of protein and calories over a prolonged period.
2. Kwashiorkor is a severe form of malnutrition primarily caused by inadequate protein intake, characterized by edema (swelling due to fluid retention), skin lesions, hair discoloration, and other symptoms resulting from protein deficiency despite sufficient calorie intake.

Body Weight

1. In marasmus, weight is less than 60% of the mean for the age.
2. In kwashiorkor, the body weight is 60-80% of the expected weight.

Edema

1. Edema is usually seen in kwashiorkor
2. Edema is not common with marasmus.

Muscle Wasting

1. In kwashiorkor, muscle wasting is sometimes hidden by edema.
2. In marasmus, muscle wasting is obvious, as well as a severe loss of subcutaneous fat.

Enlarged Liver

1. An enlarged liver is seen in Kwashiorkor due to fat infiltration
2. An enlarged liver is not a symptom of marasmus.

Dermatological Manifestations

1. Dermatological manifestations like flaky-paint dermatitis with hyperkeratosis and desquamation are seen in kwashiorkor.
2. Dermatological manifestations are not seen in marasmus.

Hair Changes

1. Hair changes are uncommon in marasmus.
2. In Kwashiorkor, hair is spare and depigmented.

Summary – Marasmus vs Kwashiorkor

Marasmus and Kwashiorkor are severe malnutrition conditions with distinct differences. Marasmus results from overall nutritional deficiency, causing extreme wasting and stunted growth due to insufficient protein and calorie intake. In contrast, Kwashiorkor stems from severe protein deficiency despite adequate calorie intake, leading to edema and characteristic symptoms like skin lesions and compromised immunity. Marasmus typically affects infants under one year old, while Kwashiorkor becomes more prevalent after 18 months of age. Both highlight the critical need for proper nutrition, especially during early childhood, to prevent severe health complications.

FAQ: Marasmus and Kwashiorkor

1. What is the age difference between Kwashiorkor and Marasmus?

• Marasmus typically affects infants under one year old, while Kwashiorkor becomes more common after 18 months of age, primarily affecting children between 1 and 3 years old.

2. What is Marasmus and Kwashiorkor together?

• Marasmus and Kwashiorkor can indeed occur together in some cases. This combined condition, known as marasmic kwashiorkor, happens when a child experiences severe malnutrition over an extended period, leading to both wasting and edema.

3. Why is Kwashiorkor worse than Marasmus?

• Kwashiorkor is often considered worse than Marasmus due to its higher mortality rate and more severe immediate complications. This is primarily because Kwashiorkor involves severe protein deficiency despite sufficient calorie intake, leading to symptoms like edema, skin lesions, and compromised immune function, which can rapidly deteriorate without proper treatment.

4. What is the pathophysiology of Marasmus and Kwashiorkor?

• The pathophysiology of Marasmus involves severe deficiency of both protein and calories, leading to extreme wasting and loss of body tissue, while Kwashiorkor is primarily caused by severe deficiency of dietary protein despite sufficient calorie intake, resulting in edema and characteristic symptoms associated with protein deficiency.

Reference:

1. “Marasmus.” Wikipedia. Wikipedia Foundation.

2. “Kwashiorkor.” Wikipedia. Wikipedia Foundation.

Image Courtesy:

1. “Starved girl” By Dr. Lyle Conrad – Centers for Disease Control and Prevention, Atlanta, Georgia, USAPublic Health Image Library (PHIL); ID: 6901http://phil.cdc.gov/ (Public Domain) via Commons Wikimedia