Abstract

Marasmus and kwashiorkor, the two most common forms of protein-energy malnutrition (PEM), are caused, respectively, by successful adaptation and failure to adjust to a changing environment [1-5]. Rao have proposed that kwashiorkor is caused by the adrenal cortex's inability to respond adequately to the stresses caused by nutritional deprivation. This inability manifests itself as an inability to mobilize a sufficient quantity of amino acids from muscle in order to maintain normal levels of albumin and apo-protein production in the liver. This condition leads to fatty infiltration of the liver as well as hypoalbuminemia and edema as a subsequent complication. On the other hand, these hepatic responses are avoided in children who have marasmus because of an appropriate response of the adrenal cortex. The fact that increasing serum albumin and liver protein concentrations through the injection of glucocorticoids to malnourished animals inhibits fatty infiltration of the liver further lends support to this concept. This is an attempt to resolve the controversies that have been raised regarding this topic. We evaluated the adrenal cortical reserve in a select group of children with marasmus and kwashiorkor by determining the reaction of blood cortisol to exogenously administered ACTH.

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