Overall inadequate nutritional intake results in two similar but distinct diseases, marasmus and kwashiorkor.
Marasmus is defined as chronic deprivation of energy needed to maintain body weight. Its extreme form is characterized by severe weight loss and wasting. Marasmus is further characterized by low body temperature, decreased pulse and metabolic rate, loss of skin quality, constipation, and diarrhea consisting of frequent, small, mucus-containing stools.
Kwashiorkor is a somewhat more complex disease. It is characterized by massive swelling of the hands and feet, skin rash, irritability, hair loss or discoloration, loss of muscle tone, and anemia. Kwashiorkor was initially thought to result from a diet high in calories (mainly carbohydrates) but deficient in protein; it is now hypothesized that infection may also play a role.
In both these disorders, several types of blood abnormalities and electrolyte disturbances can occur, which may be life-threatening.
These conditions are most commonly seen in areas that are both impoverished and affected by human immunodeficiency virus (HIV) infection, such as sub-Saharan Africa. Evidence indicates that HIV-infected children in Africa have more than twice the incidence of marasmus, compared with uninfected children.
Protein-calorie malnutrition is also found in developed countries under unusual circumstances, including in patients with anorexia nervosa and cancer. The condition has also been found in infants placed on severely restricted diets and in patients who have had "stomach stapling" surgery to control obesity.
Both marasmus and kwashiorkor can lead to impaired function of the immune system, which results is greater susceptibility to infectious diseases. Immune function can be normalized by refeeding. However, extensive physical and mental retardation may be irreversible.
Protein-Calorie Malnutrition: Treatment
Treatment consists of two phases: stabilization and rehabilitation.
The initial (stabilization) phase lasts for one week. It consists of:
- Treatment and prevention of low blood sugar, low body temperature, dehydration, and infection
- Correction of electrolyte imbalances and micronutrient (vitamin and mineral) deficiencies
- A cautious feeding regimen devised by physicians and dieticians
A rehabilitation phase proceeds from weeks two through six. It consists of:
- Further refeeding
- Emotional support
- Preparation for follow-up after recovery
- Treatment of anemia and associated conditions
Individuals treated for protein-energy malnutrition are at risk for refeeding syndrome, in which severe electrolyte disturbances may lead to abnormal functioning of the heart, lungs, brain, intestines, blood, bones, muscles, and hormones. Medical guidelines have been developed to help prevent these complications and to establish a transition to normalcy.