Marasmus

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Marasmus

• Anna Canard
• Jeff Farrah
• Heather Stabley
• Ginger Gantenbein

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Presentation Outline

• Definition of Marasmus
• Pathophysiology
• Metabolic Changes
• Who is Affected and its Prevalence
• Symptoms
• Treatment
• Really Gross Picture

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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)
• Kwashiorkar- protein deficiency

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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

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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

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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?

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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.

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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

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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.

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Prevalence

• 49 of the 10.4 million deaths occurring in
  children younger than five years of age from
  developing countries are associated with PEM

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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

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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

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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)

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TREATMENT CONT.

• Nutritional Rehabilitation
• Macronutrient Supplementation
• Micronutrient Supplementation

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TREATMENT CONT.

• Nutritional Rehabilitation
• Medication
• Nutritional and Sociocultural Education

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Sources

• Paper Media
• Krauses Food, Nutrition, and Diet Therapy
• Biochemistry Textbook
• Web
• http//www.emedicine.com/ped/topic164.htm
• http//www.eatright.org

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