Prenatal Factors Contribute to the Emergence of Kwashiorkor or Marasmus in Severe Undernutrition: Evidence for the Predictive Adaptation Model

Terrence E. Forrester, Asha V. Badaloo, Michael S. Boyne, Clive Osmond, Debbie Thompson, Curtis Green, Carolyn Taylor-Bryan, Alan Barnett, Suzanne Soares-Wynter, Mark A. Hanson, Alan S. Beedle, Peter D. Gluckman

Severe acute malnutrition in childhood manifests as oedematous (kwashiorkor, marasmic kwashiorkor) and non-oedematous (marasmus) syndromes with very different prognoses. Kwashiorkor differs from marasmus in the patterns of protein, amino acid and lipid metabolism when patients are acutely ill as well as after rehabilitation to ideal weight for height. Metabolic patterns among marasmic patients define them as metabolically thrifty, while kwashiorkor patients function as metabolically profligate. Such differences might underlie syndromic presentation and prognosis. However, no fundamental explanation exists for these differences in metabolism, nor clinical pictures, given similar exposures to undernutrition. We hypothesized that different developmental trajectories underlie these clinical-metabolic phenotypes: if so this would be strong evidence in support of predictive adaptation model of developmental plasticity.