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Chapter 072. Malnutrition and Nutritional Assessment (Part 2)

Marasmus The end stage of cachexia, marasmus is a state in which virtually all available body fat stores have been exhausted due to starvation. Conditions that produce marasmus in developed countries tend to be chronic and indolent, such as cancer, chronic pulmonary disease, and anorexia nervosa. Marasmus is easy to detect because of the patient's starved appearance. The diagnosis is based on severe fat and muscle wastage resulting from prolonged calorie deficiency. Diminished skin-fold thickness reflects the loss of fat reserves; reduced arm muscle circumference with temporal and interosseous muscle wasting reflects the catabolism of protein throughout the body, including vital organs. | Chapter 072. Malnutrition and Nutritional Assessment Part 2 Marasmus The end stage of cachexia marasmus is a state in which virtually all available body fat stores have been exhausted due to starvation. Conditions that produce marasmus in developed countries tend to be chronic and indolent such as cancer chronic pulmonary disease and anorexia nervosa. Marasmus is easy to detect because of the patient s starved appearance. The diagnosis is based on severe fat and muscle wastage resulting from prolonged calorie deficiency. Diminished skin-fold thickness reflects the loss of fat reserves reduced arm muscle circumference with temporal and interosseous muscle wasting reflects the catabolism of protein throughout the body including vital organs such as the heart liver and kidneys. The laboratory findings in marasmus are relatively unremarkable. The creatinine-height index the 24-h urinary creatinine excretion compared with normal values based on height is low reflecting the loss of muscle mass. Occasionally the serum albumin level is reduced but it stays above 2.8 g dL in uncomplicated cases. Despite a morbid appearance immunocompetence wound healing and the ability to handle short-term stress are reasonably well preserved in most patients with marasmus. Marasmus is a chronic fairly well-adapted form of starvation rather than an acute illness it should be treated cautiously in an attempt to reverse the downward trend gradually. Although nutritional support is necessary overly aggressive repletion can result in severe even life-threatening metabolic imbalances such as hypophosphatemia and cardiorespiratory failure. When possible oral or enteral nutritional support is preferred treatment started slowly allows readaptation of metabolic and intestinal functions Chap. 73 . Kwashiorkor In contrast to marasmus kwashiorkor in developed countries occurs mainly in connection with acute life-threatening illnesses such as trauma and sepsis and chronic illnesses that involve .