Marasmus is one component of protein-energy malnutrition (PEM), the other being kwashiorkor . It is a severe form of malnutrition caused by inadequate intake of protein and calories , and it usually occurs in the first year of life, resulting in wasting and growth retardation. Marasmus accounts for a large burden on global health. The World Health Organization (WHO) estimates that deaths attributable to marasmus approach 50 percent of the more than ten million deaths of children under age five with PEM.
The major factors that cause a deficit of caloric and protein intake include the following: the transition from breastfeeding to nutrition-poor foods in infancy, acute infections of the gastrointestinal tract, and chronic infections such as HIV or tuberculosis . The imbalance between decreased energy intake and increased energy demands result in a negative energy balance.
The physiologic response to a negative energy balance is to reduce energy consumption. Children who suffer from marasmus display decreased activity, lethargy, behavioral changes, slowed growth, and weight loss. The subsequent effects on the body are wasting and a loss of subcutaneous fat and muscle, resulting in growth retardation. The majority of children who suffer from marasmus never return to age-appropriate growth standards.
The cornerstone of therapy for marasmus is to supply the body with the necessary nutritional requirements . The nutritional needs of children in the rehabilitation stage require at least 150 kilocalories per kilogram per day. Dehydration must be addressed with oral rehydration therapy, while micronutrient deficiencies, such as vitamin A deficiency, require supplementation. Immunizations must be reviewed and given as necessary to reduce the burden of infectious diseases on children's bodies. Finally, family education must be ongoing to improve behavioral responses to such conditions. Some ready-to-use formulas and foods have also been developed. Such a broad approach must be taken to help reduce the morbidity and mortality caused by this condition.
see also Calorie; Infant Mortality Rate; Kwashiorkor; Malnutrition; Protein.
Seema Pania Kunar
Marasmus is a form of emaciation and wasting in an infant due to protein-energy malnutrition. It is characterized by growth retardation in weight more than height so that the head appears quite large relative to the body. There is a progressive wasting of subcutaneous fat and muscle so that the skin appears loose. Severe prolonged marasmus may result in permanent retardation. Marasmus is common in Third World countries in situations with poor access to protein-rich food sources or where unsanitary water is associated with severe infant diarrhea and a corollary inability to absorb nutrients. The term "marasmus" is also used as roughly equivalent to "anaclitic depression," a term coined by René Spitz to refer to children who suffer from the early loss of a mother without a suitable substitute. Thus, marasmus has come to be associated with parental abuse or neglect that results in a failure to thrive. In some cases parents are unin-formed regarding nutritional or emotional needs of children or are unable to provide sustenance because of poverty. In other cases such failure to thrive stems from emotional deprivation as a result of parental withdrawal, rejection, or hostility. It is hypothesized that the emotional experiences of the child lead to shifts in the production of growth hormone.
See also:FAILURE TO THRIVE
Bennett, S. "Failure to Thrive." Paediatrics and Child Health 1(1996):206-210.
Frongillo, Edward A. Protein-Energy Malnutrition. Vevey, Switzerland: Nestle Nutrition, 1999.
Giardino, Angelo P. A Practical Guide to the Evaluation of Child Abuse and Neglect. Thousand Oaks, CA: Sage, 1997.
Olson, Roberta A. The Sourcebook of Pediatric Psychology. Boston:Allyn and Bacon, 1994.
A severe deficiency of all nutrients, categorized along with other protein energy malnutrition disorders. Marasmus, which means "to waste" can occur at any age but is most commonly found in neonates (children under one year old). Starvation resulting from marasmus is a result of protein and carbohydrate deficiencies. In developing countries and impoverished populations, early weaning from breast feeding and over dilution of commercial formulas places neonates at high risk for getting marasmus.
Because of the deficiency in intake of all dietary nutrients, metabolic processes--especially liver functions--are preserved, while growth is severely retarded. Caloric intake is too low to support metabolic activity such as protein synthesis or storage of fat. If the condition is prolonged, muscle tissue wasting will result. Fat wasting and anemia are common and severe. Severe vitamin A deficiency commonly results in blindness, although if caught early, this process can be reversed. Death will occur in 40% of children left untreated.