Marasmus – Symptoms, Causes, Diagnosis, and Treatment

Marasmus is a severe form of malnutrition that occurs when there is a lack of calories. Marasmus symptoms include – stunted growth in children and wasting in adults. The definition of Marasmus states that it is a nutritional deficiency disease that is caused by a severe deficiency of protein, nutrients, carbohydrates, and lipids.

Viral, bacterial, and parasitic infections are also major causes of this disorder. In this article, we will study Marasmus symptoms, causes, diagnosis, and treatment options along with the difference between Kwashiorkor and Marasmus.

What is Marasmus?

Marasmus disease is a severe form of malnutrition characterized by energy deficiency. It is more frequent in children of developing countries. Marasmus is caused by a prolonged and severe deficiency of both calories and protein in the diet, which significantly reduces the child’s muscle and fat mass. The only visible parts are the skin and bones because of the extreme wasting. Children with marasmus are susceptible to several problems, such as infections, diarrhea, hypoglycemia, hypothermia, and deficiencies in certain micronutrients (such as vitamin A, zinc, copper, iron, etc.).

Children suffering from marasmus disorders have to be treated effectively to avoid morbidity and death. Marasmus occurs in age group of 3 – 9 months, especially in impoverished regions of the world with limited access to nutritious food. It needs prompt attention; otherwise, it can become fatal.

Marasmus Symptoms

Presentation of clinical features of marasmus are influenced by dietary deficits and comorbidities. Some clinical features are:

Clinical Features

• Protein-Energy Malnutrition’s (PEM) severity and how long it has been since its appearance is considered.
• A class of marasmus in children called marasmic-kwashiorkor is identified by the presence of edema in them.
• Signs of Dermatoses, desquamation, ulceration and pigmentations might be presented.

Marasmus Disease Symptoms

Some obvious and observable symptoms of marasmus include:

• Severe weight loss notably more than 40%.
• Body Mass index less than 16.
• Muscle wasting i.e. loss of muscle mass at greater rates.
• Fatigue and weakness due to lack of calories.
• Retarded growth.
• The eyes may appear sunken due to loss of fat and muscle around the eye sockets.
• Skin becomes thin, dry, and may appear wrinkled due to the loss of subcutaneous fat.
• Children may exhibit signs of irritability or apathy due to their weakened state.
• Poor immune function and greater susceptibility to infections.
• Hypothermia
• Abdominal swelling and oedema in severe cases.

What Causes Marasmus?

Marasmus is casued by deficiency of nutrients like proteins and energy-giving nutrients in the diet for a long time. Now this lack of nutrients can be caused by several factors that are listed below.

• Inadequate food intake: Marasmus often occurs in areas with food insecurity or where there is limited access to sufficient and nutritious food. Poverty, drought, famine, and food shortages can lead to insufficient food intake, especially in children.
• Lack of breastfeeding: Breastfeeding the child is important for the first six months of childbirth. In case breastfeeding is absent for this crucial period, severe deficiency of required nutrients can occur resulting in marasmus.
• Poor quality of diet: Even if food is available, it may lack essential nutrients such as protein, vitamins, and minerals necessary for healthy growth. If low low-nutrient diet like grains are taken without including varieties, deficiency disorders can occur.
• Infections and illnesses: Long-term illness or persistent illness can lead to mal absorption of nutrients in diet leading to marasmus.
• Socioeconomic factor: Poverty and lack of education influence the availability of nutritious food and its importance for growth and development. Thus, such socioeconomic factors can cause deficiency disorders like marasmus.

Diagnosis of Marasmus

Early diagnosis of Marasmus is crucial otherwise it might prove fatal. Diagnosis of marasmus can be done through:

• Physical Examination: A thorough physical examination of the patient can be conducted to assess for signs and symptoms characteristic of marasmus. This includes evaluating the child’s weight, height, body mass index (BMI), muscle wasting, skin condition, and overall appearance.
• Growth Monitoring: Patients with marasmus typically exhibit significant weight loss, failure to thrive, and stunted growth. Growth charts can be used to track a child’s growth over time and compare it to standard growth parameters for their age and sex.
• Nutritional Assessment: A detailed dietary history is obtained to assess the child’s nutritional intake, including breastfeeding practices, types of foods consumed, feeding frequency, and any recent changes in dietary habits.
• Laboratory tests: Laboratory tests may also be performed to evaluate levels of key nutrients such as protein, vitamins, and minerals in the blood as well any other disease. Stool tests can also be conducted to understand the symptoms of diarrhoea.
• Skin Prick Test: A skin Prick test can be conducted to check the immune system‘s functioning.

Marasmus Treatment Options

Marasmus malnutrition is a medical emergency and can be fatal if left untreated. The patient has to receive therapy as soon as symptoms show up. Some important measures to treat marasmus are listed below:

• Dietary rehabilitation: Nutritional rehabilitation may include therapeutic feeding programs, specialized therapeutic formulas, or ready-to-use therapeutic foods (RUTFs) that are energy-dense and nutrient-rich. It is done to avoid re-feeding syndrome and introduce nutrients gradually.
• Introduction of Balanced Diet Plant: Providing a balanced diet rich in calories, protein, vitamins, and minerals is essential for promoting weight gain, muscle repair, and overall recovery.
• Breastfeeding Support: If the child is an infant, promoting and supporting breastfeeding is crucial for providing essential nutrients and immune factors.
• Treatment of Complications: Complications such as infections, electrolyte imbalances, organ dysfunctions, and infections should be treated parallelly while trying to deal with nutritional deficiency.
• Regular Monitoring: It is important to have regular follow-ups with the findings and development of the patients so that the diet plans and treatment methods can be customised according to changing needs.

Difference Between Marasmus and Kwashiorkor

Kwashiorkor is another deficiency disorder associated with a lack of proteins in diet. The difference between Marasmus and Kwashiorkar is mentioned below:

Features	Marasmus	Kwashiorkor
Cause	Severe Protein Deficiency.	Severe Deficiency of Calories and Protein.
Appearance	Edema, changes in skin and hair.	Severe wasting, “skin and bone” appearance.
Weight Loss	Moderate to severe, with some masking by oedema.	Severe weight loss.
Growth Retardation	Stunted growth, but not as severe as in marasmus.	Severe growth retardation, significant stunting.
Other Symptoms	Irritability, lethargy, skin lesions, changes in hair.	Extreme weakness, lethargy, loose and wrinkled skin.
Risk Factors	Common after weaning or dietary changes.	Prolonged inadequate intake of both calories and protein.
Prognosis	Generally responds well to treatment.	Recovery may be slower and more challenging.

Prevention of Marasmus

Symptoms of marasmus can be fatal if ignored, as it causes nutrition deficiencies. Complete recovery can take up to months together even with proper diet and medication. Treatment usually involves treating the underlying cause and providing supplements to help the body recover. Surgery may be necessary in some extreme cases. Regular check-ups are important to monitor the condition. Along with the treatment, the patient should also take some preventative steps like:

• Consumption of an adequate amount of calories and protein.
• Following a well balanced and rich in nutrition diet
• Staying hydrated and drinking clean potable water
• Maintaining good sanitation and hygiene practices
• To protect infants from nutritional difficulties and to improve their immunity, mothers should be educated on the importance of nutrition and should provide good nutrition for both pregnant women and lactating mothers.

Conclusion – Marasmus

Marasmus is a severe form of malnutrition that is frequently observed in children of developing countries. It significantly increases the mortality rate for children under five. Children suffering with Marasmus disease have to be treated effectively to avoid morbidity and death. A major clinical feature of marasmus is Protein-Energy Malnutrition (PEM). Some Marasmus symptoms include loss of weight, muscle wasting, electrolyte imbalances, low blood pressure, low body temperature, compromised vitamin absorption, Anaemia and Rickets. A diet rich in minerals, carbs, and calories is essential for the treatment of marasmus patients. Compared to a normal individual for a particular age, they will require more calories.

FAQs on Marasmus

What is Marasmus Definition?

Maramus refers to severe malnutrition and wasting, often seen in famine-stricken areas, requiring urgent nutritional intervention.

What are the Clinical Symptoms of Marasmus?

Clinical features of marasmus include Protein-Energy Malnutrition(PEM). Some symptoms include electrolyte imbalances, low blood pressure, a low body temperature, compromised vitamin absorption, anaemia and rickets

Which Demographic of People are Affected by Marasmus?

Marasmus primarily affects infants and young children living in impoverished or famine-stricken regions with limited access to food and nutrients.

What are Some Dietary Needs of People with Marasmus?

People with marasmus require nutrient-rich foods high in protein, calories, vitamins, and minerals to support their recovery and prevent further malnutrition-related complications.

What is Marasmus vs Kwashiorkor?

Kwashiorkor is mostly a protein shortage, marasmus is a lack of all macronutrients. Kwashiorkor is also known to induce edema, or swelling with fluid, particularly in the face and abdomen, where marasmus appears withered and shrivelled.

How can Marasmus be Diagnosed?

Marasmus is diagnosed by taking a child’s body measurements like arm circumference, height : weight and age : height ratios. Blood tests are done to detect secondary consequences of marasmus like vitamin deficiencies and infections.

What are the Different Types of Malnutrition?

The two major types of malnutrition are: Protein-energy malnutrition – resulting from deficiencies in any or all nutrients and Micronutrient deficiency diseases – In this iron deficiency is the most common form globally.

How is Marasmus Caused?

Marasmus is a nutrition deficiency disease that results from an overall lack of calories. It’s caused by a severe deficiency of protein, vitamins, minerals, carbohydrates, and lipids.

How is Marasmus Different from Kwashiorkor?

Marasmus and kwashiorkor are both types of severe protein-energy undernutrition. Marasmus is a deficiency of all macronutrients, while kwashiorkor is a deficiency in protein predominantly.

Marasmus Occurs in Which Age?

Marasmus can occur in any age, but it is most commonly observed in infants and young children in the age group of 3 – 9 months, particularly those living in impoverished or famine-stricken regions.

Does Marasmus Affect the Brain?

Yes, Marasmus can affect brain development and function due to severe malnutrition, potentially leading to cognitive impairments and developmental delays in children.