Discuss the three clinical forms of acute malnutrition.

Question

What will be an ideal response?

Answer 1

Acute malnutrition presents itself in three clinical forms: marasmus, kwashiorkor, and marasmus-kwashiorkor mix.
Kwashiorkor is a Ghanaian word that refers to the birth position of a child and is used to describe the illness a child develops when the next child is born. When a mother who has been nursing her first child bears a second child, she weans the first child and puts the second one on the breast. The first child, suddenly switched from nutrient-dense, protein-rich breast milk to a starchy, nutrient- poor cereal, soon begins to sicken and die. The child appears withdrawn or irritable and obviously ill. Loss of appetite interferes with any attempts to provide nourishment.
In kwashiorkor, some muscle wasting may occur, but it may not be apparent because the child’s face, limbs, and abdomen become swollen with edema—a distinguishing feature of kwashiorkor. Fluid balance shifts in response to decreased concentrations of the blood protein albumin. A fatty liver develops because of a lack of the protein carriers to transport lipids out of the liver. The fatty liver lacks enzymes to clear metabolic toxins from the body, so their harmful effects are prolonged. Inflammation in response to these toxins and to infections further contributes to the edema that accompanies kwashiorkor. Without sufficient tyrosine to make melanin, hair loses its color, and inadequate protein synthesis leaves the skin patchy and scaly, often with sores that fail to heal. The lack of proteins to carry or store iron leaves iron free. Free iron is common in kwashiorkor and may contribute to edema by increasing the secretion of ADH—the antidiuretic hormone responsible for water retention. In addition, iron may contribute to illness and death by promoting bacterial growth and free-radical damage.
Marasmus occurs most commonly in children in all the overpopulated and impoverished areas of the world. Children living in poverty simply do not have enough to eat. They subsist on diluted cereal drinks that supply scant energy and protein of low quality; such food can barely sustain life, much less support growth. The loose skin on the buttocks and thighs sags down and looks as if the child is wearing baggy pants. Sadly, children with marasmus are often described as just “skin and bones.”
Because the brain normally grows to almost its full adult size within the first 2 years of life, marasmus impairs brain development and learning ability. Reduced synthesis of key hormones slows metabolism and lowers body temperature. There is little or no fat under the skin to insulate against cold. Hospital workers find that children with marasmus need to be clothed, covered, and kept warm. Because these children often suffer delays in their mental and behavioral development, they also need loving care, a stimulating environment, and parental attention.
The starving child faces this threat to life by engaging in as little activity as possible—not even crying for food. The body musters all its forces to meet the crisis, so it cuts down on any expenditure of energy not needed for the functioning of the heart, lungs, and brain. Growth ceases; the child is no larger at age 4 than at age 2. Enzymes are in short supply, and the GI tract lining deteriorates. Consequently, what little food is eaten can’t be digested and absorbed.