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Post a reply: Psychosocial factors & the progression to either marasmus or kwashiorkor

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Once so common, the diagnoses 'marasmus' & 'kwashiorkor' almost seem to have vanished from the literature. Both states start from the same condition--undernutrition. But why do some children progress to kwashiorkor--with its very poor prognosis--and others to marasmus--with more positive prognosis and speedy recovery with proper diet. My colleagues and I have administered interviews to assess psychosocial conditions for children admitted to hospital with both diagnosed marasmus & kwashiorkor. The results point to psychosocial trigger mechanisms (alcoholism, spousal abuse, domestic violence, etc) as underlying the two different nutritional trajectories. Undernourished children also experiencing domestic stress seem to have very different outcomes from those from normal homes.
But we are having trouble finding recent evidence in the literature of the same phenomenon elsewhere. Can anyone point to good references or to experience elsewhere that might provide comparisons? And references to the emotional-physiological connections?

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