paths leading from early weaning to Nutritional marasmus and from protracted breast feeding to kwashiorkor is schematically presented below: Protein Energy Malnutrition Marasmic Kwashiorkor Kwashiorkor Marasmus Fig . : Classification of PEM - - Proteins and lipids Nutritional Marasmus Marasmic Kwashiorkor Kwashiorkor Late gradual weaning Starchy family diet Acute Infection Breast feeding Early Abrupt Weaning Dilute dirty formula Repeated Infection Especially gastro enteritis Starvation therapy Fig . : Causes of PEM . .
Clinical signs and symptoms of PEM I. Kwashiorkor This disease was first reported to occur in children in Africa by Dr.Cicely Williams in . It is caused by deficiency of proteins in the diet. The important symptoms of the disease are: ) Growth failure ) Oedema of the face and lower limbs ) Muscle wasting ) Fatty liver ) Anorexia (loss of appetite) ) Diarrhoea ) Change in the colour, sparse, soft and thin hair.
) Change in the colour of the skin (hypo and hyperpigmentation) ) Anaemia ) Vitamin A deficiency ) Angular stomatitis (Cracks in the corners of mouth) ) Cheilosis (inflammation and cracks in lips) ) Moon face II. Marasmus This is caused by severe deficiency of proteins and calories in the diet. The important features are as follows: ) Severe wasting of muscles ) Loss of subcutaneous fat (Limbs appear as skin and bones) ) Skin is dry and atrophic ) Anaemia ) Eye lesions due to Vitamin A deficiency ) Irritability and fretfulness ) Diarrhoea - - Proteins and lipids III. Marasmic Kwashiorkor Children suffering from this disease show signs of both kwashiorkor and marasmus.
. . Differences between Kwashiorkor and Marasmus ) Dehydration ) Body temperature is sub-normal ) Failure to thrive ) Wrinkled skin - Old man’s face ) Grossly underweight Fig . : Kwashiorkor Fig .
: Marasmus Table . : Differences between Kwashiorkor and Marasmus Kwashiorkor Marasmus It develops in children whose diets are deficient of protein. It is due to deficiency of proteins and calories. It occurs in children between months and years of age.
It is common in infants under year of age. Subcutaneous