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]

Overview

As protein energy malnutrition manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Kwashiorkor must be differentiated from other diseases that cause failure to thrive, wasting, edema, skin and hair changes such as congenital heart diseases and micronutrient deficiency. In contrast, marasmus must be differentiated from other diseases that cause generalised wasting, such as vitamin A , iron, iodine, and zinc deficiencies.

Differentiating Protein energy malnutrition from other Diseases

Differentiating kwashiorkor from marasmus

Features	Kwashiorkor	Marasmus
Cause	Caused by the deficiency of protein in the diet of child.	Caused by 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.
Appearance	Wasting of muscles is not evident.	Wasting of muscles is quite evident. The child is reduced to skin and bones.
Skin changes	Skin changes color and become broken and scaly.	Skin does not change color and does not break.

Differentiating protein energy malnutrition from other micronutrient deficiency

Kwashiorkor
Marasmus
Vitamin A deficiency
Iron deficiency
Iodine deficiency