Marasmus is felt to result from a diet that is fairly equally deficient in protein and in calories. In contrast, kwashiorkor is usually explained as being caused by a diet deficient more in proteins than in calories. This explanation for kwashiorkor has been questioned by Golden and Ramdath,1 who suggested that the pathogenesis could be better explained by an imbalance between the quantity of free oxygen radicals and scavengers of those free oxygen radicals. The authors of this paper took anemia as one of the usual clinical features of kwashiorkor and attempted to verify this hypothesis by measuring "the presence of non-heme iron and endogenous products of lipid peroxidation in the erythrocyte membranes of normal and kwashiorkor subjects and assessed the susceptibility of the membranes to exogenously generated reactive oxygen species." The extent of lipid peroxidation in the erythrocytes of kwashiorkor subjects was three times that found in erythrocytes of normal subjects. The erythrocytes from kwashiorkor subjects were much more susceptible to oxidative stress than were the erythrocytes from normal subjects and the oxygen free radicals reduced the erythrocyte calcium-pump function in kwashiorkor subjects to a greater extent than in normal subjects. These findings lend support for the hypothesis of the pathogenesis of kwashiorkor proposed by Golden and Ramdath.
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