From the Guidelines
Chronic Malnutrition Syndromes
Chronic malnutrition syndromes, including marasmus and kwashiorkor, are conditions that require prompt nutritional intervention to prevent long-term complications 1.
Characteristics and Causes
These syndromes are characterized by:
- Malabsorption: Reduced ability to absorb nutrients from food, often due to gastrointestinal diseases such as inflammatory bowel disease (IBD) 1.
- Increased energy and protein requirements: Conditions like IBD can increase the body's demand for nutrients, leading to malnutrition if not met 1.
- Inflammation: Chronic inflammation, as seen in IBD, can lead to malnutrition by causing anorexia, nausea, and increased catabolism 1.
Diagnosis and Screening
Diagnosing malnutrition involves assessing for:
- Clinically significant weight loss
- Reduced energy intake
- Loss of lean mass
- Loss of subcutaneous fat mass
- Fluid accumulation
- Diminished functional status 1. Tools like the Global Leadership Initiative on Malnutrition criteria and the ESPEN criteria can be used for screening 1.
Treatment and Management
Treatment typically involves:
- Oral rehydration therapy with electrolyte-rich solutions
- Gradual introduction of high-calorie, high-protein diets
- Micronutrient supplementation with vitamins and minerals like vitamin D, iron, and zinc, especially in patients with IBD 1.
- Co-management with a registered dietitian for patients with complicated IBD or those requiring complex nutrition therapies 1.
Importance of Early Intervention
Early nutritional intervention is crucial to prevent long-term complications such as increased hospitalizations, disease flares, need for surgery, and postoperative complications in patients with IBD 1.
From the Research
Chronic Malnutrition Syndromes
The chronic malnutrition syndromes are characterized by two main forms:
- Kwashiorkor: a condition marked by edema, often accompanied by a swollen abdomen, and can be associated with an enlarged liver with fatty infiltrates 2.
- Marasmus: a condition characterized by severe wasting and emaciation, without edema 2.
Key Features of Kwashiorkor and Marasmus
Some key features of these conditions include:
- Depletion of antioxidants, vitamins, and minerals, which is more severe in kwashiorkor than in marasmus 2.
- Liver mitochondrial and peroxisomal dysfunction, which can be secondary to toxic microbial compounds produced in the gut 2.
- Gut-liver axis alteration, characterized by edema and a fatty and enlarged liver, associated with a dramatic depletion of methionine and glutathione, an excessive level of free circulating iron, and frequent lethal bacteraemia by enteric pathogens 2.
Diagnosis and Management
Diagnosis of these conditions can be made using anthropometric parameters, clinical signs, and biochemical indicators of malnutrition 3. Management of severe acute malnutrition, including kwashiorkor and marasmus, can be effective using WHO guidelines, which include the use of ready-to-use therapeutic food and other nutritional interventions 4, 3. The use of antibiotics may also be beneficial in the treatment of kwashiorkor, particularly in cases with suspected bacterial infections 2.
Risk Factors and Prevention
Prenatal factors, such as birth weight, may contribute to the emergence of kwashiorkor or marasmus in severe undernutrition, with higher birth weight associated with an increased risk of kwashiorkor 5. Understanding the risk factors and preventive measures for these conditions is crucial for reducing morbidity and mortality associated with severe acute malnutrition 4, 6.