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Psychosocial factors & the progression to either marasmus or kwashiorkor

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Bill Kinsey

University of Leiden

Normal user

11 Nov 2015, 18:54

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?

Blanche Mattern

Normal user

13 Nov 2015, 10:21

Hi,
I am sorry that I cannot give you any answers but I would be very interesting to know more details about your study and findings.

Paul

Frequent user

13 Nov 2015, 12:30

Try this reference

Am J Clin Nutr. 2009 Feb;89(2):592-600. doi: 10.3945/ajcn.2008.27092. Epub 2008 Dec 30.
Reduced production of sulfated glycosaminoglycans occurs in Zambian children with kwashiorkor but not marasmus.
Amadi B1, Fagbemi AO, Kelly P, Mwiya M, Torrente F, Salvestrini C, Day R, Golden MH, Eklund EA, Freeze HH, Murch SH.

André BRIEND

Frequent user

13 Nov 2015, 13:52

Dear Bill,

A lot has been written on the psychologic aspects of kwashiorkor. See these 2 refs:

Guedeney A. Kwashiorkor, depression, and attachment disorders. Lancet. 1995 Nov 11;346(8985):1293.

Guedeney A. Les aspects psychosomatiques des malnutritions protéino-caloriques de la première enfance en milieu tropical, faits et hypothèse. Psychiatr Enfant. 1986;29(1):155-89.

In this last article, you have a discussion on the role of maternal depression as a possible starting point and an extensive bibliography on this, arguably a lot in French and not easily accessible.

I hope this helps,

Bill Kinsey

University of Leiden

Normal user

13 Nov 2015, 19:40

Thanks, Paul and Andre. I'll have a look at the references, none of which I had managed to locate before. Blanche, when I have finished revising the paper, I'll post a link to it.
Cheers Bill

Blanche Mattern

Normal user

16 Nov 2015, 10:56

Ok great, thanks.

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