While significant clinical differences between kwashiorkor and marasmus exist, some studies suggest that marasmus represents an adaptation to starvation while kwashiorkor represents a dysadaptation to starvation. In addition to PEM, children may be affected by micronutrient deficiencies, which also have a detrimental effect on growth and development. While fortification programs have helped diminish deficiencies of iodine, vitamin A, and vitamin D in individuals in the US, these deficiencies remain a significant cause of morbidity in developing countries. Micronutrient deficiencies as well as protein and calorie deficiencies must be addressed in order for optimal growth and development to be attained in these individuals. Dietary protein is needed to provide amino acids for synthesis of body proteins and other compounds that play a variety of functional roles.
Energy is essential for all biochemical and physiologic functions in the body.
In addition, micronutrients are essential in many metabolic functions in the body as components and cofactors in enzymatic processes. In addition to the impairment of physical growth and of cognitive and other physiologic functions, immune response changes occur early in the course of a child with significant malnutrition. An additional 200 million children have stunted height secondary to poor nutrition. More than half of young children in South Asia have protein-energy malnutrition, which is 5 times the prevalence in the Western Hemisphere. Two thirds of all malnourished children in the world live in Asia and another one fourth live in Africa.