Twelve patients with recent weight loss to less than 85% of standard weightheight ratio and a serum albumin level of at least 3 gm/100 ml were considered to have the adult equivalent of marasmus. Cellular immune function was assessed by delayed hypersensitivity skin testing to Monilia and streptokinase-streptodornase, peripheral lymphocyte count, proportion of T and B cells, whole blood and isolated lymphocyte transformation to phytohemagglutinin, pokeweed mitogen, concanavalin A, Monilia, and streptokinase-streptodornase. Significant impairment of skin test reactivity while in vitro responsiveness remained intact was noted in the marasmic patients. No impairment was found in 12 individuals with recent weight loss who remained at a weight greater than the 85% weight-height ratio. In four marasmic individuals in whom weight loss was arrested by nutritional repletion, skin reactivity returned without substantial change in weight.
In this type of marasmus, both depleted nutritional status and weight loss must be present for impairment of skin test responsiveness. These findings confirm relative sparing of more vital functions dependent on protein metabolism in adult marasmus compared to the kwashiorkorlike syndrome of hypoalbuminemic malnutrition seen in adults.
(Arch Intern Med 137:1408-1411, 1977)