Kwashiorkor and marasmus are two major types of protein-energy malnutrition that are distinguished from each other based on clinical setting, time course to development, clinical features, and diagnostic criteria. In these types of malnutrition, there is protein diet deficiency because of inadequate food intake, poor quality of food, or the presence of diseases that modify nutrient absorption and energy requirements. One major difference between kwashiorkor and marasmus is that kwashiorkor can occur rapidly, while marasmus is usually the result of a gradual process. Kwashiorkor often manifests in an affected person as a well-nourished appearance, but marasmus manifests as a starved appearance. Malnutrition severely undermines a person’s well-being and functionality, so these types of malnutrition need to be detected and treated early.
Clinical setting is one factor that helps distinguish kwashiorkor and marasmus from each other. In marasmus, there is decreased energy intake, often due to an inadequate diet, within a span of months or years. Long-term starvation, which often occurs in poor areas, is a major factor in the development of marasmus. In kwashiorkor, there is decreased protein intake within a stress state, usually weeks. While there is a generalized decrease in the intake of calories in marasmus, only the protein part of the diet is diminished in kwashiorkor.
Kwashiorkor and marasmus differ in laboratory findings. In kwashiorkor, the serum albumin is less than 2.8 grams per deciliter (g/dL), the total iron-binding capacity (TIBC) is less than 200 micrograms per deciliter (mcg/dL), and serum transferring is less than 150 milligrams per deciliter (mg/dL). Additionally, the lymphocytes are less than 1500/microliter, and there is anergy, or lack of immune response to skin antigen testing. In marasmus, the creatinine height index is less than 60% of the standard, which means that when the 24-hour urinary excretion of creatinine is measured, its value is less than 60% that of normal based on height. The low creatinine height index reflects loss of muscle mass.
Clinical features of kwashiorkor and marasmus also differ. In kwashiorkor, the affected person often appears well nourished and has a protruding belly, edema or swelling, and easy hair pluckability. Lightening of the skin and hair is observed in those with dark hair and skin. This is due to the decreased production of a hair and skin pigment called melanin, which is also a protein. The diagnostic criteria of kwashiorkor include the reduction of serum albumin to less than 2.8 g/dL, as well as edema, easy hair pluckability, poor wound healing, skin breakdown, or pressure ulcers.
A marasmic person appears cachectic because there is notable loss of subcutaneous fat and muscle mass. In adults, the weight is less than 80% of the standard for height, but in children, the weight is less than 60% of the weight-for-age. Measurements of the triceps skinfold and mid-arm muscle circumference are important because these are the clinical criteria for diagnosing marasmus. A triceps skinfold of less than 0.12 inch (3 mm) and a mid-arm muscle circumference of less than 5.9 inches (15 cm) define the criteria for diagnosing a person as marasmic.