Protein energy malnutrition differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omodamola Aje B.Sc, M.D. [2]


Protein energy malnutrition must be differentiated from other diseases that cause failure to thrive, edema, wasting recurrent infections, skin and hair changes. It is important to also differentiate kwashiorkor from marasmus as the two diseases are caused by protein-energy malnutrition and share similar features such as, weight loss, muscle wasting, low blood glucose levels and growth retardation.

Differentiating Protein Energy Malnutrition From Other Diseases

Differentiating kwashiorkor from marasmus

Kwashiorkor must be differentiated from marasmus as the two diseases are caused by protein-energy malnutrition and share similar features such as, weight loss, muscle wasting, low blood glucose levels and growth retardation. The followwing table differentiates between the two:[1][2][3][4][5][6][7][8][9][10][11][12]

Distinguishing Features Kwashiorkor Marasmus
Cause Deficiency of protein in the diet of child Deficiency of protein as well as energy nutrients (that is carbohydrates and fats) in the diet
Age Occurs in children in the age group 1-5 years Typically occurs in children below the age of 1 year
Association More common in villages where there is small gap period between successive pregnancies More common in towns and cities where breast-feeding in discontinued quite early
Edema Presence of edema Absence of edema
Muscles Wasting of muscles Wasting of muscles is quite evident. The child is reduced to skin and bones
Skin changes Dermatitis and hyperpigmentation noticed Dry and atrophic skin but no changes in color
Serum cortisol Decreased/Normal Increased
Fasting blood glucose Decreased Decreased
Growth retardation Mildly retarded in growth Severely retarded in growth
Facial appearance Moon-like face Sunken eyes, maxillary prominence, loss of buccal fat pad
Abdomen Protuded Shrunken
Vitamin deficiency Present Present
Weight 60-80% of normal weight for age <60% of normal weight for age

Differential diagnosis of edema and wasting [13][14][15][16][17][18][19][20]

Disease Cause Age(years) Presentation Prevention Workup Prognosis Treatment
  • < 1
  • < 5
: :
Protein losing enteropathy
  • All age groups
Anasarca 1-4 Good prognosis if the underlying cause is identified and treated early
HIV wasting syndrome HIV infection
  • All age groups
Prognosis is good with the use of highly active anti-retroviral therapy (HAART)
Chronic pancreatitis
  • 30 to 40 years
Pediatric nephrotic syndrome <16years
Portal cirrhosis 5th - 6th decade of life Prognosis is poor

Table adapted from CDC Pinkbook.[21]


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  21. "Epidemiology and Prevention of Vaccine-Preventable Diseases".

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