Overview of malnutrition
Marasmus is one of the serious conditions of protein-energy malnutrition. The other form is kwashiorkor, caused by protein deficiency. Malnutrition is a condition where there is an imbalance in nutrients that the body needs and nutrients it gets.
Marasmus is a serious form of malnutrition - especially protein-energy undernutrition. It is a deficiency of all macronutrients, such as carbohydrates, fats, and protein. It is due to a lack of calories. People with marasmus are severely emaciated and underweight. Prolonged time of starvation causes marasmus.1
Marasmus can affect anyone, but it is mostly affecting children who require more calories for their growing bodies. When the body lacks energy from food, it begins to get it from its own tissues- first, adipose tissue (body fat) and muscles.
Causes of marasmus
The common causes are:
- Poverty and food scarcity: The condition is more commonly seen in low-income countries where there is limited food variety, which results in mineral and vitamin deficiency. Proper growth requires a balanced diet, and any nutrient deficiency can lead to marasmus.
- Chronic diarrhoea: Chronic diarrhoea is a condition where there are loose stools continuously for more than a week. Any infection or disease can cause chronic diarrhoea. Diarrhoea causes dehydration, which causes loss of water and electrolytes. Electrolytes are minerals found in body fluids, where the losses can affect the heart, lungs, brain and nervous system. Dehydration can lead to kidney disease.
- Anorexia nervosa: Anorexia nervosa is an eating disorder where the person follows extreme food restrictions because of fear of weight gain.
- Early weaning of infants: Introducing foods or fluids to the baby other than breastmilk before 6 months can risk illness and can even be life-threatening. When a baby starts weaning and stops breastfeeding, they are no longer getting any nutrition from the breast milk.4
- Dementia: It is a condition that represents a group of illnesses that affects memory, reasoning, personality, mood and behaviour. This can affect the person's daily activities.
Symptoms and signs of marasmus
- Severe Weight Loss and Wasting of Muscle Mass
People affected with marasmus have a loss of body fat and tissue, after which bones gradually become visible under the skin, loss of body mass and sunken eyes. In children, the main symptom is stunted growth; there is a certain standard growth measurement for children.
- Fatigue and Weakness
The scarcity of food and starvation causes tiredness and weakness. Marasmus also causes the wasting of fat and muscles.
- Growth Impairment in Children
Marasmus develops slowly because the reduction in food intake causes a lack of nutrients which causes growth retardation, where the height and weight of the child is stopped. As children lose body weight, their nutrient requirements decrease. Then, the body shows decreased activity, such as decreased heart rate, kidney function, the activity of the sodium-potassium pump, and the inability to regulate body temperature. Reduced cardiac activity causes a decrease in blood circulation and often leads to heart failure.
- Decreased Immune Function
In marasmus, a generally acquired immuno-deficiency occurs, with a decrease in secretory immunoglobulin A(IgA) and an impairment of the local defence system; bacteremia, candidiasis and pneumocystis carinii infection occur frequently. In the case of moderate malnutrition, immune impairment is less frequent. Severely malnourished child is at high risk for infection because of their weak immune system, and they are exposed to infection because of unhygienic condition, and not having proper clean water and safe food.
Diagnosis and Screening
Initially, a physical examination of the body is required, where the shrunken, wasted appearance of the body fat is seen. Body circumference is taken to assess the adiposity.
- Anthropometric Measurements (Weight, Height, and Arm Circumference): It is a method of measuring the size and proportions of the body. The measurements include height, weight, head circumference, body mass index (BMI), and body circumference to assess the adiposity of the waist, hip, limbs, calf muscles, elbow amplitude and knee-heel length.6
- Blood Tests to Assess Nutritional Status: A blood test is taken to identify the effect of marasmus by evaluating specific vitamins, minerals, enzymes and electrolyte deficiencies. This helps to know the nutritional requirements of the adult or child.
- Complete blood count: This is done to find if any disease or infection is present.
- Haemoglobin: Decreased levels indicate the patient is suffering from anaemia.
- Stool examination: To find out if any parasites are present through microscopic examination.
- Children in Developing Countries
In developing countries, there are poor families experiencing poverty and food scarcity. In this condition, there is a limited variety of food, and this results in vitamin and mineral deficiency. A proper balanced diet is needed for a healthy body; any nutritional deficiency can lead to marasmus.
- Elderly Individuals
In developed countries, mostly the elderly persons who are staying in care homes or residential care facilities where forms of malnutrition can occur. The reasons are the limited choice of food and social factors like loneliness and depression, which can affect residents’ eating habits and reduce motivation to eat. All these lead to malnutrition.
- People with Chronic Illnesses
Chronic illness increases the risk of malnutrition and decreased nutrient absorption. Malnutrition can lead the person’s health to deteriorate further and can worsen their condition. Persons with chronic illness may have symptoms like reduced appetite, malabsorption, and difficulty in eating, which can all lead to malnutrition. Chronic illnesses are:
- Inflammatory bowel disease
- Chronic kidney disease
- Chronic heart failure
- Chronic obstructive pulmonary disease
- Neurological disorder
- Rheumatoid arthritis
Complications of Marasmus
- Organ Damage: Prolonged malnutrition can lead to tissue damage and cause damage to organs as they use reserves for energy, which can lead to the derangement of their function.
- Increased Susceptibility to Infections: Malnutrition causes a deranged immune system, and the person’s body is weak and more prone to getting infections due to unhygienic surroundings and improper food and water.
- Impaired Cognitive Development in Children: Cognitive impairment is when a person has trouble remembering, learning new things, concentrating and making decisions. In severe cases, marasmus can cause brain atrophy, and it can lead to cognitive impairment due to malnutrition.
- Weak immune system: Malnutrition causes a weakened immune system, and people are more susceptible to infections.
- Gastrointestinal complaints: Malnutrition can lead to malabsorption and issues such as diarrhoea and constipation.5
Treatment and Management
Persons with marasmus are at risk of refeeding syndrome, a life-threatening complication that can cause the body to restart fast. The rehabilitation occurs in stages, and they are :
- Rehydration and stabilisation: This is the first stage, where the dehydration, electrolyte imbalance and nutrient deficiencies are addressed, and supplementary nutrition is given. The formula is given orally or through a nasogastric tube, and during this process, it is important to keep the patient warm to avoid hypothermia.
- Natural rehabilitation: This is the second stage where tube feeding is used, and refeeding begins slowly with carefully balanced carbohydrates, proteins and fats. The patient’s progress is visible here.
- Follow-up and prevention: Since marasmus can reoccur, a complete education is given before they are discharged. They are educated about the importance of breastfeeding, safe drinking water and having a balanced diet.
Prevention of marasmus can be done by implementing proper awareness education in society; some of the preventive measures are :
- Promoting breastfeeding and proper infant nutrition.
- Educating about the importance of nutritious food.
- Education on a balanced healthy diet.
- Fighting poverty.
- Controlling the spread of infectious diseases.
- Improving sanitation.
- Improving elder care in developed countries.
Comparison with Other Forms of Malnutrition
Distinction from kwashiorkor
Kwashiorkor is a condition caused by severe protein malnutrition, which leads to bilateral extremity swelling because of fluid retention in the tissues. People may look emaciated in their limbs but will have swollen hands, feet, face and belly. People with kwashiorkor are not deprived of calories but are deprived of protein-rich food.2
Differentiating from cachexia
Cachexia (wasting syndrome) is a complex condition of the body where there is weight loss despite eating normally. In the condition of cachexia, the body uses protein, carbohydrates and fat in a changed manner. Calories are burnt up faster than normal.3
Global impact of marasmus
Marasmus is a severe form of malnutrition which has significant global impacts in the regions facing poverty, food scarcity and limited healthcare access. Other impacts are :
- Child mortality: Marasmus mostly affects infants and children; this weakens the immunity system and makes children more susceptible to infections. It can lead to a high mortality rate in affected populations.
- Limited healthcare system: In regions where the healthcare system is limited, the condition of people having marasmus worsens. As they need special medical treatment and nutritional support for betterment. Treating malnutrition includes increased healthcare expenses, which it can affect financially deprived families and governments.
- Globally, strategies should be implemented to improve food security; awareness should be given regarding proper nutrition, clean water, sanitation, and a proper healthcare system for everyone.
What are the symptoms of marasmus
Marasmus is a life-threatening malnutrition due to protein energy malnutrition. Symptoms are loss of body fat and muscle tissues. In infants and children, impaired growth.
How can I prevent marasmus
Marasmus can be prevented by improving awareness about proper balanced diet, sanitation, nutritional education, controlling widespread infectious disease in developing countries and improving elder care in developed countries.
Is marasmus treatable
By proper care and supplement of a nutritionally balanced diet, maintaining proper hygiene and availability of clean food and clean water can help in treating marasmus.
Marasmus is a serious form of malnutrition - especially protein-energy undernutrition. It is a deficiency of all macronutrients, such as carbohydrates, fats, and protein. People with marasmus are severely emaciated and underweight. Prolonged time of starvation causes marasmus. Globally, strategies should be implemented to improve food security; awareness should be given regarding proper nutrition for everyone, clean water, sanitation and a proper healthcare system for everyone.
- Titi-Lartey OA, Gupta V. Marasmus. 2022 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32644650.
- Thi Phuong Thao Pham, Maryam Tidjani Alou, Matthieu Million. Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment. 2021 Jan; Available from: https://www.researchgate.net/publication/348194215_
- Miriam Ferrer , Tracy G. Anthony, Janelle S. Ayres, Giulia Biffi. Cachexia: A systemic consequence of progressive, unresolved disease. 2023 Apr 27;Volume 186(Issue 9):Pages 1824-1845. Available from: https://doi.org/10.1016/j.cell.2023.03.028
- Praborini A, Wulandari RA, Nafiriana O. Treatment modalities in breastfeeding babies with marasmus and kwashiorkor associated with ankyloglossia. Indonesian Journal of Perinatology. 2023 Feb 2;4(1):1-6. https://www.perinasiajournal.id/index.php/InaJPerinatol/article/view/32
- Mehraj M, Feroz F, Sri RM, Ravichandran S. Harmful effects of malnutrition and possible sustainable solution.https://www.ijcbr.in/html-article/15614
- P.C. Anacleto Filho, Lincoln da Silva, Diego Mattos, Ana Pombeiro , H.I. Castellucci, Ana Colim, et al. Establishing an anthropometric database: A case for the Portuguese working population. 2023 Sep;97. Available from: https://doi.org/10.1016/j.ergon.2023.103473