Malnutrition
              Protein / Energy
     Definitions of Malnutrition
     Kwashiorkor: protein deficiency
     Marasmus: energy deficiency
     Marasmic/ Kwashiorkor: combination of 
       chronic energy deficiency and chronic or 
       acute protein deficiency
     Failure to thrive:  marasmus in U. S. children 
       under 3.
     Definitions of Malnutrition
     PEM
     Primary: inadequate food intake
     Secondary: result of disease
     FTT
     In-organic: inadequate food intake
     Organic: result of disease
                  MARASMUS
      Marasmus is the term used for severe PEM and wasting (low 
       wt/ht). 
      Many secondary forms of marasmic PEM are associatedw ith 
       chronic diseases( cysricf  ibrosis, tuberculosis,cancer, acquired 
       immunodeficiency virus, celiac disease).
      The principal clinical manifestarion in a child wirh severe 
       malnutririon is emaciation with a body weight less than 50%o f 
       the median (50th percentile) for age or less than70%o f the 
       ideal weight For height and depleted body fat stores
      Loss of muscle mass and subcutaneous fat stores are 
       confirmed by inspection or palpation and quantified by 
       anthropometric measurements. 
      the head may appearlarge but generally is proportional to the 
       body length. 
      Edema usually is absent. 
      The skin is dry and thin, and the hair may be thin, sparse, and 
       easily pulled out. 
      Marasmic children may be apathetic and weak