In Protein-Energy Malnutrition (PEM), which biochemical finding BEST distinguishes Kwashiorkor from Marasmus?

• A Both Kwashiorkor and Marasmus always show identical serum protein levels
• B Serum albumin is low in Kwashiorkor but normal or mildly reduced in Marasmus ✓
• C Marasmus shows oedema and Kwashiorkor shows muscle wasting
• D Kwashiorkor shows growth retardation and Marasmus shows normal height

Explanation

Kwashiorkor is characterised by predominantly protein deficiency with relatively adequate caloric intake; serum albumin is markedly low (< 2.5 g/dL), causing oedema. Marasmus involves balanced calorie-protein starvation; the body mobilises all stores including visceral protein, but adaptive mechanisms maintain albumin relatively better. Clinically, Kwashiorkor shows oedema, skin changes, and hair discolouration; Marasmus shows severe wasting with preserved sensorium.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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