Cardiometabolic risk in marasmus and kwashiorkor survivors

Abstract

Infants with marasmus have lower mortality rates than infants with kwashiorkor during the acute phase of severe acute malnutrition. The intermediary metabolism of marasmic infants during this acute phase is more "thrifty" than kwashiorkor infants, and thus they appear better adapted to survive starvation/ famine. The lower birth weight of marasmus infants also suggests that they previously experienced intrauterine growth restriction, which may account for their altered metabolism. While this provides a survival effect during severe acute malnutrition, it becomes maladaptive if they are in more obesogenic environments. Adult marasmus survivors are smaller, more stunted, more likely to have beta-cell dysfunction and glucose intolerance, and more liver fat than kwashiorkor survivors. Both adult survivors of marasmus and kwashiorkor are at increased risk of hypertension and other cardiac outcomes. Preliminary epigenetic studies have highlighted differentially methylated genes that can explain the observed phenotypes in the marasmus survivors. These data indicate that survivors of severe acute malnutrition, especially marasmus survivors, are at high cardiometabolic risk in later life. There is a lack of data on effective interventions in these individuals.