marasmus

Marasmus is a form of severe malnutrition caused by chronic energy deficiency. It leads to extreme wasting and a marked loss of both fat and muscle stores. It is defined by weight loss and wasting with little or no edema. It most often affects infants and young children in settings of poverty, food insecurity, or severe illness, but can occur in adults after prolonged starvation.

Clinical features include severe stunting of growth in children, reduced subcutaneous fat, and visible skeletal outlines. The child appears cachectic with prominent bones, dry and hypotrophic skin, and hair that may be coarse. Mental status may be irritable or lethargic. Hypothermia or hypoglycemia can occur, and infections are common due to impaired immunity.

Causes are chronic insufficient intake of calories, inadequate protein, and illnesses that increase metabolic demands or reduce intake. Risk factors include poverty, famine, neglect, premature weaning, and chronic diseases. Marasmus can coexist with other forms of malnutrition and may complicate recovery.

Diagnosis relies on anthropometric measurements showing severe wasting, such as weight-for-age or weight-for-height more than two standard deviations below reference values, or low mid-upper arm circumference. The absence of edema helps distinguish marasmus from kwashiorkor, another severe malnutrition form.

Management involves stabilization, treatment of infections, correction of fluid and electrolyte abnormalities, and careful refeeding. Initial energy intake is increased gradually to prevent refeeding syndrome, with a focus on high-energy, protein-adequate nutrition using therapeutic milks and foods where available. Ongoing monitoring of weight, growth, and clinical status is essential. With timely care, many children recover, although severe cases carry significant mortality risk.

Prevention centers on improving food security, exclusive breastfeeding for six months, appropriate complementary feeding, and early identification of at-risk children. Public health measures to reduce poverty and increase access to nutritious foods are critical to reducing marasmus incidence.