Treatment of Marasmus: High-Protein Diet
The recommended diet for a patient with marasmus is a high-protein diet (Option A), which has been demonstrated to improve overall absorption of all macronutrients and restore lean body mass more effectively than other dietary approaches. 1
Rationale for High-Protein Approach
Metabolic Characteristics of Marasmus
- Marasmus represents a balanced deficiency of both protein and calories, resulting in severe depletion of lean body cell mass 2
- Unlike kwashiorkor, children with marasmus can maintain body protein breakdown rates similar to well-nourished children when chronically food-deprived 3
- The creatinine/height index serves as a valuable indicator of lean body cell mass depletion in marasmus 2
Evidence Supporting High-Protein Diet
A controlled study of 60 marasmic children compared three dietary interventions: high-protein (30% of total energy), high-fat (40% of total energy), and high-carbohydrate (70% of total energy) diets over 2 weeks. 1
Key findings:
- The high-protein diet resulted in improved absorption of all three macronutrients (protein, fat, and carbohydrate) 1
- High-fat diets improved only fat absorption with increased bile acids 1
- High-carbohydrate diets improved only xylose absorption 1
- The high-protein approach improves the overall intestinal environment and absorptive capacity as a whole, rather than targeting single nutrient pathways 1
Critical Refeeding Considerations
Avoiding Refeeding Complications
When initiating nutritional support in marasmus, careful attention must be paid to:
- Accurate energy requirement estimation using the Harris-Benedict equation or indirect calorimetry 4
- Minimizing fluid retention, which invariably complicates refeeding in marasmus 4
- Adequate daily repletion of phosphorus, potassium, and magnesium to prevent refeeding syndrome 4
- Accurate assessment of weight regain rate 4
Why Not Low-Protein, Low-Calorie (Option B)
Option B is contraindicated because:
- Marasmus already represents severe protein-calorie depletion 2
- Further restriction would worsen lean body mass loss and delay recovery 1
- Low-protein diets are associated with delayed water load responses and impaired metabolic function 5
Why Not High-Fat or High-Carbohydrate Alone (Options C & D)
- High-fat diets provide only targeted improvement in fat absorption without addressing protein deficiency 1
- High-carbohydrate diets similarly provide limited benefit to carbohydrate absorption only 1
- Neither approach addresses the fundamental need for protein repletion to restore lean body mass 2, 1
Clinical Implementation
The high-protein diet should provide approximately 30% of total energy from protein sources, with the remainder balanced between carbohydrates and fats. 1 This approach: