Diagnostic Considerations

When approaching the possible diagnose of malnutrition, it is important to consider whether it is an acute versus chronic malnutrition. It is also important to recognize that there are different subtypes within acute malnutrition depending on the presence or absence of edema. Malnutrition without edema is marasmus; with edema, it is kwashiorkor. Thus, the presence or absence of edema should not sway a clinician away from or toward protein-energy malnutrition.

Differential Diagnoses

Workup

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Media Gallery

This photograph shows children and a nurse attendant at a Nigerian orphanage in the late 1960s. Note that four of the children have gray-blond hair, a symptom of the protein-deficiency disease kwashiorkor. Image courtesy of Dr Lyle Conrad and the Centers for Disease Control and Prevention Public Health Image Library.
This late 1960s photograph shows a seated, listless child who was among many individuals found with kwashiorkor in Nigerian relief camps during the Nigerian-Biafran war. Kwashiorkor is a disease that develops due to a severe dietary protein deficiency. This child, whose diet fit such a deficiency profile, presented with symptoms including edema of the legs and feet; light-colored, thinning hair; anemia; a pot-belly; and shiny skin. Image courtesy of Dr Lyle Conrad and the Centers for Disease Control and Prevention Public Health Image Library.

of 2

Author

Hadi Atassi, DO Resident Physician, Department of Internal Medicine, University of Louisville Hospital

Hadi Atassi, DO is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, Greater Louisville Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas L Abell, MD Professor and Arthur M Shoen MD Chair in Gastroenterology, Division of Gastroenterology, Hepatology and Nutrition, Faculty, Uro-Gynecology Fellowship, University of Louisville School of Medicine; Director of GI Motility Clinic at Jewish Hospital/U of Louisville Physicians; Former Director of Nutritional Support, Medical Staff, University of Mississippi Medical Center; Former Medical Staff, Mississippi Methodist Rehabilitation Center

Thomas L Abell, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, International Society for Quality-of-Life Studies

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: ADEPT-GI<br/>Received research grant from: Theravance; Vanda; Allergan<br/>Have a 5% or greater equity interest in: ADEPT-GI<br/>Received income in an amount equal to or greater than $250 from: Theravance<br/>GI Editor for MedStudy for: Reviewer for UpToDate.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Noah S Scheinfeld, JD, MD, FAAD † Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Anusuya Mokashi, MD, MS Resident Physician, Department of Radiology, Staten Island University Hospital

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Dr. Dino Santoro, to the development and writing of this article.

Protein-Energy Malnutrition Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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