Anatomic changes

Digestive tract

• The entire digestive tract from mouth to rectum is affected. The mucosal surface is smooth and thin, and secretory functions are impaired. The decrease in gastric hydrochloric acid excretion results in bacterial overgrowth in the duodenum. The peristalsis is slow. Proportionally, the digestive tract is the organ system that loses the largest mass during marasmus.
• In addition to the anatomic changes associated with protein-energy malnutrition, the frequent intestinal infections by viruses, bacteria, and toxins also contribute to the changes in the digestive tract. Liver volume usually decreases, as do other organ volumes. An enlarged liver suggests the possibility of other diagnoses, such as kwashiorkor or hepatitis. Liver synthesis function is usually preserved, although protein synthesis is decreased, as reflected by the decreased albumin and prealbumin levels. The neoglycogenesis is decreased, further increasing the risk of hypoglycemia.

Endocrine system

• The main perturbations are observed in the thyroid, insulin, and growth hormone system. As in any stressed state, the adrenergic response is activated. This response is functional in marasmus. Muscle proteins are converted into amino acids, used for the hepatic synthesis of lipoproteins. These lipoproteins contribute to the mobilization of triglycerides from the liver.
• Furthermore, in serious marasmus, a significant degree of hypothyroidism, with a decrease in the size of the thyroid gland repercussions on the brain function and psychomotor development exists.