Marasmische

Marasmische, or marasmic, is an adjective used in medical terminology to describe conditions associated with marasmus, a form of severe malnutrition caused by chronic energy deficiency. The marasmic phenotype is characterized by marked loss of body fat and muscle mass (wasting) with relatively minimal edema, and often significant growth impairment in children. It is distinguished from edema-predominant forms such as kwashiorkor, where edema and fatty liver are more prominent.

Causes and pathophysiology: Marasmic malnutrition results from prolonged inadequate intake of calories and protein, frequently in the context of poverty, famine, or chronic illness. The body mobilizes fat and lean tissue to meet energy needs, leading to wasting and impaired organ function. Immune competence declines, increasing susceptibility to infections. Clinically, patients appear thin with prominent muscle wasting and often have stunted growth in children.

Diagnosis: Diagnosis relies on clinical assessment and anthropometric measurements. Severe wasting is indicated by low weight-for-height or weight-for-age, and a very low mid-upper arm circumference. Additional signs include growth faltering, apathy, and reduced physical activity. Distinguishing marasmus from kwashiorkor is important due to differing management priorities.

Treatment and prognosis: Management focuses on safe refeeding, gradual restoration of caloric intake, and correction of electrolyte and fluid imbalances to prevent refeeding syndrome. Treatment also addresses infections, deworming when indicated, and micronutrient supplementation (including vitamins and minerals). With timely, appropriate treatment, recovery is possible, though prognosis worsens with extreme wasting, concurrent illness, or delayed care. Prevention centers on improved food security, early detection, and integration with broader public health measures.