Marasmus

To maintain the physiological requirements of the body, it is essential to take a sufficient amount of micro and macronutrients; however, the overconsumption of micronutrients and macronutrients can also be harmful. As defined by the World Health Organization (WHO), malnutrition is an ‘inadequate or excess intake of protein, energy, and micronutrients such as vitamins, and the frequent infections and disorders that result’. The excess intake would be known as overnutrition, whereas an insufficient intake would be known as undernutrition. Undernutrition can be further classified according to the cause and presentation. The term ‘protein-energy malnutrition’ refers to acute malnutrition as a result of an insufficient intake of protein and calories. This includes the conditions of kwashiorkor and marasmus. Acute malnutrition is an inadequate weight relative to vertical height. Severe acute malnutrition is further divided into two main categories: marasmus and kwashiorkor. Chronic malnutrition, otherwise known as growth stunting, is characterized by linear growth (length/height) below the average for age. A micronutrient deficiency refers to a deficiency of the essential vitamins and minerals which are needed for physiological function and development. The main micronutrient deficiencies in developing countries are in iodine, vitamin A, iron, and zinc. Kwashiorkor is a severe manifestation of protein-energy malnutrition. It is associated with a poor-quality diet high in carbohydrates but low in protein content such that the child may have a sufficient total energy intake. Severe protein insufficiency leads to characteristic bilateral pitting pedal edema and ascites. Marasmus is a severe manifestation of protein-energy malnutrition. It occurs as a result of total calorie insufficiency. This leads to overt loss of adipose tissue and muscle. The child may have a weight-for-height value which is more than 3 standard deviations below the average for age or sex. A child with marasmus may develop pitting edema due to protein insufficiency, this is known as marasmic-kwashiorkor. This article will review the etiology, epidemiology, history, evaluation, and management of marasmus.