Marasmus: Symptoms, Causes, Treatment and Prevention

What is Marasmus?

Marasmus is a severe and life-threatening form of malnutrition which is caused when the body doesn’t get enough proteins and calories. This lack of important nutrients can cause energy levels to drop dangerously low, making it hard for the body to function to weaken or even stop. While marasmus can affect both adults and children, it is most often seen in young children in developing countries where nutrition is limited or not balanced.

What is the difference between Marasmus and Kwashiorkor?

Both marasmus and kwashiorkor are types of protein-energy malnutrition, but they have different causes and symptoms. While marasmus results from due to overall deficiency of calories and protein, kwashiorkor occurs primarily due to protein deficiency with adequate calorie intake.

The primary symptom of marasmus includes significant weight loss and muscle wasting. In contrast, kwashiorkor is primarily caused by a deficiency of protein, even when calorie intake is sufficient. Symptoms of kwashiorkor include edema (swelling), skin changes, hair loss, slow growth, lethargy, and irritability.

Who does Marasmus Affect?

Anyone can develop marasmus from severe malnutrition, but it most frequently affects children under five in developing countries. This is usually due to famine, food shortages, or an unbalanced diet. UNICEF estimates that nearly half of all deaths in children under this age group, approximately 3 million each year, are caused by nutritional deficiencies like marasmus.

What Happens to the Body in Marasmus Disease?

Marasmus is a sever type of malnutrition that occurs when the body lacks enough calories. In this condition, the body goes into survival mode, using its own tissues for energy by first breaking down fat and then muscle.

This can lead to several noticeable changes in the body, including:

• In marasmus, fat stores are depleted, muscles shrink, and the skin becomes loose and wrinkled
• The eyes may appear sunken while hair becomes thin and dry
• The person's growth is stunted, and they appear extremely thin with prominent bones
• Immune function is compromised, increasing susceptibility to infections
• The digestive system also suffers, leading to diarrhoea and nutrient absorption issues
• Affected children may experience lethargy, irritability, and developmental delays
• Marasmus can be life-threatening if not treated promptly with adequate nutrition and medical care
• Refeeding must be done carefully to avoid refeeding syndrome, where a sudden intake of nutrients can cause dangerous shifts in electrolyte and fluid balance
• Early intervention and nutritional rehabilitation are essential for recovery and long-term health
• Children with marasmus are typically underweight, weighing less than 60% of the expected amount for their age.
• Muscle wasting usually begins in the armpits and groin, then spreads to the thighs, buttocks, chest, abdomen, and face.

What are the Main Causes of Marasmus?

Marasmus causes typically revolve around severe malnutrition resulting from:

• Inadequate intake of nutritious food
• Over-reliance on a single type of food with limited nutrients
• Health conditions that impair nutrient absorption and processing

It’s important to note that these factors alone may not cause marasmus; the condition usually develops when calorie availability is critically low. Other contributing factors can include premature birth, low birth weight, diseases like HIV/AIDS or celiac disease, and prolonged breastfeeding without introducing solid foods after six months.

What are the External Signs of Marasmus?

Marasmus symptoms are often visibly distressing. A person with marasmus may exhibit:

• Severe weight loss
• Muscle Wasting
• Sunken eyes
• Loose skin folds
• Thin and brittle hair

In children with marasmus, stunted growth is a common symptom. Older adults suffering from marasmus may exhibit signs of wasting, when height is typical for their age.

What Other Symptoms and Complications can Marasmus Cause?

Marasmus can lead to infections, heart problems, malabsorption, developmental delays, stunted growth, electrolyte imbalances, and endocrine dysfunction, along with marasmus symptoms like dry skin and anemia.

How is Marasmus Diagnosed?

Marasmus is diagnosed through a combination of clinical examination and nutritional assessments. Doctors checks for physical signs like severe weight loss, muscle wasting, and a "skin-and-bones" appearance, particularly in children. They also measure weight-for-age, weight-for-height, and mid-upper arm circumference to evaluate malnutrition severity.

Laboratory tests can be performed to check nutrient deficiencies, electrolyte imbalances, and organ function. Blood tests may reveal low levels of proteins, vitamins, and minerals, while a low body mass index (BMI) and reduced skinfold thickness indicate fat and muscle loss.

Early diagnosis is important to prevent complications and initiate proper marasmus treatment, which involves careful nutritional rehabilitation and management of any underlying conditions contributing to malnutrition.

What Tests are Used to Diagnose Marasmus?

Diagnosing marasmus involves several tests to assess the severity of malnutrition and its impact on the body.

• Physical examination is the first step, looking for signs like extreme weight loss and muscle wasting. Anthropometric measurements, such as weight-for-age and mid-upper arm circumference, are used to evaluate growth and nutritional status.
• Blood tests help identify deficiencies in essential nutrients like proteins, vitamins, and minerals, which are crucial for marasmus prevention.
• Other tests include electrolyte panels and liver function tests to monitor organ health and detect any complications.

Regular screenings in high-risk groups are essential for early detection and marasmus prevention, ensuring timely intervention and effective nutritional support.

How is Marasmus Treated?

Marasmus treatment requires a phased approach to address both immediate and long-term nutritional needs.

Stage 1: Rehydration And Stabilisation

The initial focus is to rehydrate the patient and stabilise their vital signs. To combat dehydration, oral rehydration solutions (ORS) or intravenous fluids are administered. Medications are given to treat infections, diarrhoea, or other complications.

This phase is crucial for stabilising the patient before solid food can be introduced

Stage 2: Nutritional Rehabilitation

Once stabilised, the patient is gradually reintroduced to food, beginning with a nutrient-rich, easily digestible diet. This may consist of diluted milk or specialised therapeutic milk formulas mixed with water and electrolytes. The diet is carefully increased in calories and protein to prevent complications like refeeding syndrome, which can occur from a sudden influx of nutrients leading to harmful metabolic imbalances.

Stage 3: Follow-up And Prevention

After recovery, it’s essential to maintain a balanced diet that is rich in protein and energy to promote ongoing growth and healing. Ongoing marasmus treatment should include regular monitoring and dietary education to help prevent relapse. In regions affected by marasmus, educating the community about proper nutrition, breastfeeding, as well as food security is essential for reducing the risk of recurrence and ensuring long-term recovery.

How can I Prevent Marasmus?

Marasmus prevention primarily depends on ensuring a balanced diet that is rich in essential nutrients, particularly for infants and young children. Breastfeeding mothers should ensure they are well-nourished themselves. For older adults living alone, meal services or support from family can help them maintain a balanced diet.

Can You Recover from Marasmus?

Yes, recovery from marasmus is achievable with timely and effective treatment. However, long-term health consequences may occur if marasmus symptoms persist untreated over time.

Conclusion

Marasmus is a serious type of malnutrition that can lead to serious consequences if left untreated. However, by understanding marasmus causes and symptoms and seeking a prompt medical care, it can be effectively managed and even prevented.

At Metropolis Healthcare, we are committed to empowering individuals with healthcare knowledge through our pathology testing services, which include everything from basic blood tests to comprehensive health check-ups. Our dedicated team provides at-home sample collection for your convenience. In the battle against malnutrition, knowledge is power - be proactive about your health and the health of your loved ones.