Difference between kwashiokor and marasmus (5M)
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Here is a comprehensive 5-mark comparison between Kwashiorkor and Marasmus:
Kwashiorkor vs. Marasmus
Both are forms of Severe Acute Malnutrition (SAM) — two ends of a spectrum resulting from inadequate dietary protein and calories.
| Feature | Kwashiorkor | Marasmus |
|---|---|---|
| Definition/Cause | Protein deprivation relatively greater than caloric deficit | Severe deficiency of both calories AND protein |
| Protein compartment | Visceral compartment severely depleted | Somatic (skeletal muscle) compartment severely depleted |
| Serum albumin | Markedly reduced (hypoalbuminemia) | Normal or slightly reduced |
| Edema | Present — generalized/dependent edema due to hypoalbuminemia | Absent |
| Subcutaneous fat | Relatively spared (masked by edema) | Markedly lost |
| Muscle wasting | Mild/relative sparing | Severe — marked emaciation |
| Body weight | 60–80% of normal (true loss masked by edema) | Falls to <60% of normal |
| Appearance | Puffy, edematous ("moon face"), distended abdomen | "Skin and bones" — head appears too large for emaciated body |
| Liver | Enlarged & fatty (reduced lipoprotein synthesis) | Normal (no fatty change) |
| Skin changes | "Flaky paint" dermatosis — alternating hyper/hypopigmentation and desquamation | Dry, loose, wrinkled skin; no specific dermatosis |
| Hair changes | Loss of pigment, straightening, "flag sign" (alternating pale/dark bands), easily plucked | Hair thinning but less characteristic |
| Behavior/mood | Apathy, listlessness, anorexia | Relatively alert and hungry |
| GI changes | Small bowel mucosal atrophy, loss of villi, disaccharidase deficiency → lactose intolerance | Less prominent GI changes |
| Thymic/lymphoid atrophy | More marked | Present but less severe |
| Bone marrow | Hypoplastic (both conditions); anemia present | Hypoplastic; anemia present |
| Brain (if early onset) | Cerebral atrophy, reduced neurons, impaired myelination | Similar neurological risk |
| Typical context | Protein-poor diet (e.g., weaning child fed starchy/carb-rich diet); also chronic diarrhea, protein-losing enteropathies | Absolute food scarcity; severe global famine |
Key Distinguishing Mnemonic
Kwashiorkor = Killed by protein lack → Kidney leaks albumin analogy → Keeps fluid (edema), Kill liver (fatty), Krazy skin/hair
Pathophysiology Summary
- In marasmus: the body adapts by catabolizing somatic proteins (muscle) for energy — visceral protein is protected → albumin stays near normal → no edema. Leptin falls → cortisol rises → lipolysis → fat lost.
- In kwashiorkor: the visceral protein compartment is not spared → hypoalbuminemia → decreased oncotic pressure → edema. Reduced synthesis of apolipoprotein B causes fat accumulation in the liver (fatty liver). Reduced lipolysis means subcutaneous fat is relatively preserved.
"Marasmus and kwashiorkor represent two ends of a spectrum, and considerable overlap exists." — Robbins, Cotran & Kumar Pathologic Basis of Disease; Robbins & Kumar Basic Pathology
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