Comparison of changes in serum proteins during early treatment in kwashiorkor and marasmus.

Kwashiorkor and marasmus are the two commonest forms of infant malnutrition found in tropical countries and the fundamental aetiological difference between them appears to be in the proportion of carbohydrate in the diet. The diet leading to marasmus seems to be reasonably balanced though insufficient in quantity and therefore in calories as well as protein, whereas the diet leading to kwashiorkor is imbalanced in that there is a protein deficiency but a relative excess of carbohydrates which can lead to an adequate calorie intake. The clinical picture in these two types of malnutrition is strikingly different. Though protein deficiency in the aetiology of kwashiorkor has been emphasized, and without doubt is present in these infants, perhaps insufficient attention has been paid to the carbohydrate metabolism in kwashiorkor. Before going so far as to suggest that the clinical signs ofkwashiorkor are related to a relative excess of carbohydrate, and that it is this excess which gives rise to the oedema, skin and hair changes and fatty liver, either directly or indirectly, seen in kwashiorkor and not in marasmus, it was thought that a comparison of the protein metabolism in the two states might show whether in fact protein metabolism differed in the two conditions. If a difference is present, then one can, with more justification, designate kwashiorkor as protein malnutrition; if there is no difference, apart from that of degree, then it is possible that kwashiorkor is no more nor less dependent on protein malnutrition than is marasmus and the emphasis in aetiology should perhaps be shifted to carbohydrate. A simple approach to this problem lies in the study of the serum proteins, and especially in the first few days of treatment when the body is faced