2. Whats the etiology Of Protein Energy Malnutrition?

Marasmus
Etiology : Primary causes : Marasmus may be dietary in origin. This is the most common cause
observed in children in the the developing countries of the world. It stems from an inadequate
diet, both qualitivatevky and quantitevely. Most infants who suffer from marasmus are fed
artificially with over diluted formulae. They suffer from infections such as gastro-enteritis. They
belong to poor socio-economic groups and parents lack of education is often a contiributory
factor.
Secondary causes : the following factors can contribute to this condition, the last two in the list
below being far less important than the first five.
1) Age : marasmus is much more common infants than in older children. This is particularly
true of premature babies. A premature infant or an infant with a low birth weight may
take time to catch up with healthier infants and may appear marasmic in the meanwhile.
This could be due to the high energy requirements of infants and also to the rapid wasting
that can occur in a short period of time due to dietary deficiency. Older children may take
longer to develop a marasmic state because of their lasser caloric requirements.
Howevwer, it has been shown than evem adults can evelop PEM if the essential causative
factors operate.
2) Chronic vomiting from any cause can lead marked wasting. The vomiting may be due to
congenital hypertonic pyloric stenosis. Unless treated promptly and energetically, this can
and does leas to undernutrition and marasmus in the first few months of llife. Other less
frequent causes of chronic vomiting, such as chalasia of the cardia, i.e relax ed cardiac
sphincter, diagpharmagmatic hernia, etc can result in marked wasting. Rumination is rare
but can lead to marked underweight in older infants
3) Repeated episodes of chronic dirrhoea lead to loss of weight and marasmus because the
baby is kept too long a low-calorie diet like arrowroot fruel. Besides, the digestion and
absorption of nutrients is impaired during and after diarrhoe, especially when there are
reperated bouts.
4) Chronic infections, e.g. congenital syphilis, chronic empyema thorachis, tuberculosis,
upper respiratory infection, etc can cause wasting. Besides, the marasmic infants is
readily probe to infection (of the aer, lungs, skin, bowels, etc) and reacts poorly to them.
The wasting than becomes aggrevated.
5) Congenital disease limit the intake and digestion of food, e..g, cleft oalate, micrognathia
hydrocephalus, congenital renal disorders, Hirschsprungs disease, etc.
6) Serious organic disorders of heart, brain and kidney can causes a failure og growth.
Coeliac disease and mucoviscodiosis, both rare in the tropics, lead to wasting because of
the failure of digestion.

7) Certain metabolic disorders produce a disturbance in nutrition. Marasmus may be present

in infantile renal acidosis. Diabetes rarely occurs in infants. Galactosemia may lead to
nutritional failure often associated with vomiting.
Kwashiorkor
1) The non availability of suirtable protein-rich foods for feeding infants and children
because of socio-economic and agronomical factors seems to be the main cuase. Animalprotein foods like milk, meat, eggs and fish are rarely consumed by children of the poorer
classes because of the high cost. For example, a supply of 10 g of animal protein would
cost about a rupee, while vegetable sources like roasted groundnut or Bengak gram would
cost about fifty paise. Several surveys of wearning food habits in South India among the
poorer classes have rrevelated that in most instances, the amount of cos or buffalos milk
consumed by children is below four oz/day, and that hardly any meat is included in the
diet. Poverty is an overwhelmingly predisposing factor to malnutrition. The poverty
index ( espreed in terms of deficient caloric intake ) indictes that as much as 70 percent of
Indians exist below the poverty line
2) Faulty feeding habits arise from ignorance, prejudices and superstions. The late instution
of supplementary feeding is common in many communities. Even the choice of
supplementary food is often limited to a portion of the adult cereal diet, hardly any pulses
and no animal foods.
3) Prolonged breast feeding : in India and Africa, prolonged breast feeding of infants even
up to the third year is quite common. No doubt such milk supplies some protein and may
well protect the child against protein and may well protect the child against protein
malnutrition. But the quantity of milk supplies some protein and may well protect the
child against protein malnutrition. But the quantity of milk is inadequate and prolonged
sucking at the breast tends to encourage the child to take very small amounts of solid
food or even to refuse it. Prolonged breast feeding actually leads to breast and diction
and aggravates malnutrition.
4) Infections and infestations : poverty, ignorance, poor sanitation and oevercrowding in
slums owing to increasing urbanization are responsiavle for precipitating infections and
infestations. In an already undernutrition. This lowers the resistance, which in turn
aggravates the risk of infection.
5) A sudden loss of protein or a sudden demand for an increased amount of protein are
important precipitating causes in kwashiorkor. Prolonged breast feeding without
nutritional supplements leads to malnutrition. When breast feeding is suddenly withdrawn
because of another pregnancy, the child does not get eve the minimal quantity of good
quality animal protein which he has being. This sudden loss of protein supply, in addition
to emotional deprivation, precipitates kwashiorkor. As the fetus utero idislaces this child,
this condition is known as the deposed child or dispaced child syndrome. Similarly, in

an already undernourished child, a sudden illness, like the onset of measles, responds
favourably only tto extra protein, and when this is not available kwashiorkor result
6) Seasonal incidences : in India, the peak incidence of kwashiorkor corresponds to the
months when the largest number of infective diarrhoeal cases occur. Diarrhea and a
decrease in the intake and digestion of food precipitates kwashiorkor.
7) Size of family : this has a direct relationahip to the nutritional status of children. In
families where there are more than four or five children, the incidence is 2-3 times more.

Marasmic Kwashiorkor
Cause marasmic - kwashiorkor can be divided into two causes are malnutrition primary and
secondary malnutrition.
1)

The primary malnutrition is malnutrition caused by the intake of protein and energy is
inadequate. This is because of poverty, the composition of improper diet, alcoholism,
drug addiction, food allergies, do not eat, idiosyncrasy (abstain from eating certain
foods), fad diet (unhealthy food), and others that can make the intake is inadequate.

2) Secondary malnutrition is malnutrition that Occurs because of the Increased need,

reduced absorption and / or an increase in loss of protein and energy of the body.
Reference:
J.Viswanathan. Achars Textbook Of Pediatrics. 3rd Edition. Orient Longman.