Marasmus

DR NOWSHAD
 Presentation Outline
Definition of Marasmus
Pathophysiology
Metabolic Changes
Who is Affected and its Prevalence
Symptoms
Treatment
Really Gross Picture
 DEFINITION
Marasmus is a state of malnutrition
characterized by gradual wasting of somatic
fat and muscle stores and preservation of
visceral proteins
It is one of the three forms of serious protein-
energy malnutrition (PEM)
 Kwashiorkor- protein deficiency
 PATHOPHYSIOLOGY
Adaptive Starvation
 Evolutionary - allows primates to undergo
feast and famine
 Negative Energy Balance- expending more
energy than taking in
 Results in Protein Energy Malnutrition
METABOLIC CHANGES
Energy Metabolism
during Starvation
 Glycogen levels become
depleted.
 Gluconeogenesis occurs
by synthesizing glucose
from protein
compounds/muscle
breakdown.
 Fat is used to make ATP
and is used as an energy
source
METABOLIC CHANGES
Protein Metabolism during Starvation
 Adaptation to starvation depends on ketone
production.
 Reduced muscle catabolism:
 Needs for gluconeogenesis decline b/c brain and
nervous system are using alternative fuel for energy
(ketones)
 Ammonia levels received by the liver are reduced
 *This decreases the need for what metabolic cycle?
 KETONE BODIES
Protein losses are minimized and lean
body mass spared b/c gluconeogenesis
declines.
Fat provides fuel for the muscle and
brain in the form of ketones.
When fat stores are exhausted, the
protein is used and patient dies.
WHO GETS MARASMUS
Marasmus is associated with a
nutritional and energy deficit occurring
mainly in young children in developing
countries at time of weaning.
Mainly affects children of low-income
countries, but can also affect children
from higher-income countries
 WHO IT MAINLY
AFFECTS
Children that have a
low socio-economic
status, children with
chronic disease and
children that are
institutionalized are
at a higher risk of
developing
marasmus.
 Prevalence
49% of the 10.4 million deaths occurring in
children younger than five years of age from
developing countries are associated with
PEM
 SYMPTOMS OF
MARASMUS
Pronounced weight loss with loss of muscle
formation, particularly on the shoulders and
buttocks
Absence of fat under the skin
Thin, papery skin with hanging folds
Darker skin, as if the child has a sunburn
Hair loss
 SYMPTOMS CONT.
Alternate diarrhea and constipation
Child is cross and depressed
Infants appear apathetic and lie still for
long periods without moving or crying
Ravenous while emaciated
Frequent colicky pain
Edema
 TREATMENT
Establishing severity – outpatient vs.
inpatient
Step 1: Re-hydration
Correct Fluid and Electrolyte Imbalances
 What are the two sources of fluid intake that
would be affected by marasmus?
 Drinking Water = (1200mL/day)
 ______ ? = (1000mL/day)
 ______ ? = ( 300mL/day)
 TREATMENT CONT.
Nutritional Rehabilitation
 Macronutrient Supplementation

 Micronutrient Supplementation
 TREATMENT CONT.
Nutritional Rehabilitation
 Medication

 Nutritional and Sociocultural Education

 Sources

Paper Media:
Krause’s Food, Nutrition, and Diet
Therapy
Biochemistry Textbook
Web:
http://www.emedicine.com/ped/topic164
.htm
http://www.eatright.org
 Warning!!!!

The following picture is graphic!!!!!!!