CASE FILES: BIOCHEMISTRY
A N SW E R S TO C A SE 36: STARVATION
An 8-month-old girl presents with exhaustion and excessive starva-
tion secondary to deficient intake of calories and protein.
Physical findings of kwashiorkor and not marasmus: Subcutaneous
fat, distended abdomen, hepatomegaly, and fatty liver
C L IN IC A L C O R R E L A T IO N
Protein-energy malnutrition is caused by inadequate food intake or diseases
that interfere with food absorption or digestion. The two major types of mal-
nutrition are marasmus and kwashiorkor. In marasmus, a child usually
between the ages of 1 to 3 years has inadequate caloric intake leading to loss
of subcutaneous fat, loose wrinkled skin, and either flat or distended abdomen
resulting from atropic abdominal wall muscles. Often, children are susceptible
as they go from breast milk to solid food. The affected child usually has the
appearance of an “old person’s face.” In kwashiorkor, the main issue is lack of
protein, leading to edema, sparse hair, enlarged liver, and a distended
abdomen. The edema of the face and legs is different from that of marasmus.
The therapy for both of these diseases is caloric replacement.
A PPR O A C H TO STARVATION R E L A T E D D ISE A SE S
Understand the metabolic changes in starvation.
Be familiar with the formation of ketone bodies in starvation.
Know about the oxidation of fatty acids.
Be familiar with the metabolic change in fasting states as compared to
Marasmus: Malnutrition resulting from inadequate intake of protein and
Kwashiorkor: Malnutrition resulting from inadequate intake of protein
though the intake of total calories is adequate.
Ketone bodies: The short chain fatty acid metabolites acetoacetate and
P-hydroxybutyrate and acetone.
Triglyceride: A glycerol molecule with each hydroxyl group esterified
with a fatty acid moiety.