GI - Marasmus

Question 1

Definition

Answer 1

Severe form of malnutrition characterised by overall energy deficiency
- typically occurs in infants and young children who experience a severe lack of calories and nutrients over an extended period of time.
- esp protein and carbohydrates

Question 2

Epidemiology

Answer 2

6 - 18 months

Question 3

Cause

Answer 3

Unknown

Question 4

Pathophysiology

Answer 4

Inadequate calorie intake leads to negative energy balance = body isn’t receiving enough energy to meet metabolic needs.
Marasmus = considered form of protein-energy malnutrition. Inadequate intake of protein = deficiency of essential amino acids = impaired protein synthesis = severe muscle wasting and depletion of visceral proteins including albumin and other circulating proteins.
Malnutrition alters the secretion and regulation of several hormones. Insulin levels are decreased, which contributes to impaired glucose utilization and increased gluconeogenesis. Growth hormone and insulin-like growth factor-1 (IGF-1) levels are reduced, leading to growth retardation and impaired tissue repair.
Malnutrition can disrupt electrolyte balance in the body. Deficiencies in essential minerals and electrolytes, such as potassium, sodium, magnesium, and phosphorus, can occur.

Question 5

Adaptations of the body to counteract energy deficit

Answer 5

Decreased in basal metabolic rate (BMR)
Shift in substrate utilisation
The body tries to conserve energy by reducing energy expenditure and utilising alternative energy sources such as ketones bodies derived from fat breakdown.

Question 6

Symptoms

Answer 6

● Severe weight loss- appear emaciated
● Muscle wasting
● Fat depletion
● Growth retardation
● Weakness and lethargy
● Impaired cognitive functions

Question 7

Investigations

Answer 7

FIRST LINE = Clinical assessment and evaluation of the child’s nutritional status
Other =
- growth charts
- FBC
- U + Es
- LFTa
- Stool and urine tests

Question 8

Differential Diagnosis

Answer 8

Kwashiorkor’s

Question 9

Management

Answer 9

Nutritional rehabilitation
- Therapeutic feeding: specialized therapeutic feeds
that are rich in calories, protein, and essential nutrients in the form of ready-to-use therapeutic foods (RUTFs) or fortified milk formulas. The quantity and composition of feeds are determined by the child’s age, weight, nutritional needs, and
response to treatment.
- Breastfeeding promotion: For infants, promoting exclusive breastfeeding and providing support to lactating mothers is crucial. Breast milk is an optimal source of nutrition and provides essential antibodies to help protect against infections.

Question 10

Risk factors

Answer 10

Inadequate calorie intake,
Protein deficiency,
Insufficient carbohydrate intake,
Poor feeding practices,
Poverty,
Socioeconomic factors