Malnutrition is a pathologic state of varying severity: its clinical features are caused by a deficiency or by an imbalance of essential nutrients. The cause may be primary (insufficient quantity or quality of food) or secondary (increased requirements or inadequate utilization).
Development of marasmus occurs after severe deprivation primarily of calories, and it is characterized by growth retardation and wasting of muscle and subcutaneous fat. In kwashiorkor, the protein deficiency exceeds the calorie deficiency; edema accompanies muscle wasting that results from acute protein deprivation or loss of protein caused by stress or inadequate calorics. Indifference, apathy. and fatigue arc present in victims of both conditions, and psychologic alterations may be profound. Severe anorexia, apathy, and irritability make children with these conditions difficult to feed and manage. Many of the clin-
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