Marasmus

1. Marasmus Anna Canard Jeff Farrah Heather Stabley Ginger Gantenbein

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

3. 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

4. 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

5. 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

6. 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?

7. 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.

8. 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

9. 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.

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

11. 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

12. 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

13. 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)

14. TREATMENT CONT. • Nutritional Rehabilitation • Macronutrient Supplementation • Micronutrient Supplementation

15. TREATMENT CONT. • Nutritional Rehabilitation • Medication • Nutritional and Sociocultural Education

16. Sources • Paper Media: • Krause’s Food, Nutrition, and Diet Therapy • Biochemistry Textbook • Web: • http://www.emedicine.com/ped/topic164.htm • http://www.eatright.org

17. Warning!!!! The following picture is graphic!!!!!!!