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What Is Marasmus?

Medically Reviewed by Dan Brennan, MD on May 16, 2021

Marasmus is a type of protein-energy malnutrition that can affect anyone but is mainly seen in children. You can get marasmus if you have a severe deficiency of nutrients like calories, proteins, carbohydrates, vitamins, and minerals. ‌

It is more common in developing countries, like in some areas of Asia and Africa. People in these nations are prone to having poor access to food, making it difficult to get enough nutrients. A risk of certain infectious diseases can cause marasmus if left untreated. 

Symptoms of Marasmus

Severe protein and calorie deficiency in children can result in loss of fat and muscle mass. The most common symptom of marasmus is being underweight due to malnourishment. The following symptoms can occur due to deficiency, dehydration, electrolyte imbalance, or infection if marasmus remains untreated for a long time:‌

A lack of food and nutrients can cause both the body and mind to suffer. Children with severe marasmus tend to appear tired and bored. They are always low in energy and enthusiasm. Such children are often irritable, short-tempered, and uninterested in things. This symptom can be confused as a sign of kwashiorkor, which is another type of malnutrition. 

Causes of Marasmus

‌Marasmus is mainly caused by nutrient deficiency due to malnourishment. Here are some risk factors of marasmus: 

Poor diet. A nutrient-rich, balanced diet is important for growth, especially in children. If you have a poor diet that lacks essential nutrients, you may be at risk of developing marasmus. ‌

Food shortages. Marasmus is more common in developing countries that have high poverty and lack of food. These regions also have frequent famines and natural disasters, resulting in food shortages. Children and adults living in these areas are at a higher risk of getting marasmus.‌

Insufficient breastfeeding. Mother's milk is rich in nutrients that help children grow. If mothers are malnourished, they are unable to feed their infants enough milk during breastfeeding. This can increase the chances of protein-energy malnutrition in children. 

Infections and diseases. Infections and diseases caused by viruses, bacteria, parasites, and other pathogens can cause loss of appetite. This can lead to a low intake of essential nutrients in infected children and adults. Diseases such as HIV/AIDS and malaria in rural areas can cause marasmus. It can also be caused by poor absorption of nutrients due to celiac disease and pancreatic problems.

Anorexia. Although marasmus in developed countries is quite rare, any person can get this condition if they are subject to a severe lack of nutrients. If someone isn't getting enough food due to an eating disorder, their body will be at risk of malnutrition.

Difference Between Marasmus and Kwashiorkor

‌Like marasmus, kwashiorkor is a type of malnutrition caused by protein deficiency. It mainly occurs in children who are weaning off breast milk, while marasmus can develop in infants. If your diet has a lot of carbohydrates and very little proteins, you may develop kwashiorkor. This is not a concern for most people living in developed countries, and only occurs in severe cases of malnutrition. 

The main symptoms of kwashiorkor include:‌

  • Edema, or swelling, due to fluid retention in your body
  • ‌Round, puffy, or swollen face
  • ‌Bulging or distended belly
  • ‌Skin, nail, and hair diseases
  • ‌Cracking or pain at the corner of your lips
  • ‌Stunted growth
  • ‌Low energy and lethargy‌

Doctors can differentiate kwashiorkor from marasmus by the presence of edema or swelling. But some children may show symptoms of both. This is known as marasmic kwashiorkor.

Diagnosis of Marasmus

Your doctor can diagnose marasmus by physically examining your body. They generally check if your height and weight are appropriate for your age. In children, doctors measure the girth of the middle-upper arm to check for malnutrition. To rule out kwashiorkor, your doctor may also check whether you have edema. 

You may have to undergo lab tests to check your hemoglobin, blood cell count, blood glucose levels, and so on. This is done to confirm whether you have any infection or disease that can cause marasmus. 

Treatments

‌If severe marasmus is left untreated, it can cause death due to infection, electrolyte imbalance, heart failure, or hypothermia. Clinical treatment for marasmus includes the following steps:

Resuscitation. This step involves rehydration. This can be done by injecting a rehydrating solution into your vein or by orally feeding it to you. You may also be given antibiotics and medicines to treat underlying infections or diseases. 

Children are generally nursed in a warm room as they may be cold due to hypothermia. 

Stabilization. This step involves gradual feeding to improve the levels of nutrients in your body. Your doctor will start by feeding you some milk or formula mixed with water. You will also receive a rehydrating solution containing electrolytes, amino acids, glucose, vitamins, and minerals by mouth or by vein.  

Nutritional rehabilitation and follow-up. This step involves increasing your nutrient intake through a protein and energy-rich diet. The nutrients help your body repair and grow normally. It also helps you restore your optimal weight and height over time. 

Once your symptoms have gone and you recover, you must stick to a balanced and nutrient-rich diet to stay healthy. This is also good advice to follow even if you aren't at risk of malnutrition. 

WebMD Medical Reference

Sources

SOURCES:

CMAJ: “Malnutrition and health in developing countries.”

‌FREEDOM FROM HUNGER CAMPAIGN: “MALNUTRITION AND DISEASE.”

Postgraduate Medical Journal: “Marasmus- 1985.”

‌StatPearls: “Marasmus.”

Case Reports Hepatol: "Acute Liver Injury with Severe Coagulopathy in Marasmus Caused by a Somatic Delusional Disorder."

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