Obvious muscle wasting and severe fat wasting is a feature of which of the following disease?

NIA - 29 January 2023

Applied Nutrition & Dietetics

Easy

Appeared in: NIA - 29 January 2023

Explanation

Marasmus is a form of severe acute malnutrition (SAM) caused by a significant deficiency in all macronutrients (carbohydrates, fats, and proteins), leading to a total calorie and energy deficit.
The body compensates for the lack of energy intake by breaking down its own tissues, resulting in severe wasting of both skeletal muscle (the somatic protein compartment) and subcutaneous fat stores.
This catabolism leads to the characteristic emaciated or 'wasted' appearance, often described as a 'wizened' or 'old man' face, with prominent bones and loose, wrinkled skin due to the loss of underlying fat.

Option A: In Kwashiorkor, muscle wasting is often masked by generalized edema (swelling), which is the hallmark sign of this condition. Subcutaneous fat is also relatively preserved, which contradicts the 'severe fat wasting' described in the question.
Option B: Anemia is a hematological disorder characterized by a deficiency of red blood cells or hemoglobin. Its primary symptoms are pallor, fatigue, and shortness of breath, not severe muscle and fat wasting.
Option D: Rickets is a bone disorder in children caused by a deficiency in vitamin D, calcium, or phosphate. It leads to soft, weak bones and skeletal deformities like bowed legs or a pigeon chest, not the primary wasting of muscle and fat.

Clinical Relevance

Nursing practice connection: Knowing Clinical differentiation of protein-energy malnutrition (PEM) types helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must be able to differentiate between Marasmus and Kwashiorkor because their management, especially during the initial refeeding phase, differs. Incorrect refeeding can lead to 'refeeding syndrome,' a life-threatening complication.
Accurate nutritional assessment is a critical nursing skill in pediatric and community health settings. This includes measuring weight-for-height, mid-upper arm circumference (MUAC), and checking for pitting edema to classify the type and severity of malnutrition.
What if? If the question described a child with features of both wasting and edema, the condition would be classified as Marasmic-Kwashiorkor, representing a mixed clinical picture and the severe end of the malnutrition spectrum.

How to Approach the Question

First, identify the most critical keywords in the question stem: 'obvious muscle wasting' and 'severe fat wasting'. These are the defining clinical signs you need to match.
Next, systematically evaluate each option based on your knowledge of its pathophysiology.
Recall the two main types of protein-energy malnutrition. Marasmus is a total energy deficiency, so the body consumes its own muscle and fat. Kwashiorkor is a protein deficiency, where edema is the primary feature and can mask wasting.
Eliminate options that are clearly unrelated to this specific presentation. Anemia is a blood disorder, and Rickets is a bone disorder; neither is defined by severe wasting.
Conclude that the description of severe, visible wasting of both muscle and fat perfectly aligns with the clinical presentation of Marasmus.

Concept Tested & Keywords

Concept Tested: Clinical differentiation of protein-energy malnutrition (PEM) types
Stem keywords: muscle wasting, severe fat wasting
Lead-in keywords: feature of
Negative lead-in flag: false

QGZxWjHSy8nBMMCtddCdG2

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 441-443