Aetiology and dietary management of marasmus

Introduction

Marasmus is a serious worldwide problem that involves more than 50 million children younger than 5 years. According to the World Health Organisation (WHO), 49% of the 10.4 million deaths occurring in children younger than five years in developing countries are associated with protein energy malnutrition (PEM).

Marasmus is a severe form of malnutrition that consists of the chronic wasting of fats, muscles and other tissues in the body. Marasmus is one of the two (2) forms of serious PEM. The other two (2) forms are kwashiorkor (KW) and marasmic KW. These forms of serious PEM represent a group of pathologic condition associated with a nutritional and energy deficit ocuring mainly in young children from developing countries at the time of weaning. Malnutrition occurs when your body doesn’t get enough protein or calories. This lack of nutrition can range from a shortage of vitamins to complete starvation. Marasmus is a condition primarily caused by deficiency in calories and energy. Marasmus is a serious problem and is most common in children of 1 – 5 years in developing regions, such as Africa, Latin America, and South Asia, where poverty, along with inadequate food supplies and contaminated water, are prevalent.

Marasmus is a condition primarily caused by a deficiency in calories and energy, whereas kwashiorkor indicates an associated protein deficiency resulting in an oedematous appearance. Marasmic kwashiorkor indicates that, in practice, separating these entities conclusively is difficult; this term indicates a condition that has features of both.

These conditions are frequently associated with infections, mainly gastro-intestinal. The reasons for a progression of nutritional deficit into marasmus rather than kwashiorkor are unclear and cannot be solely explained by the composition of the deficient diet (i.e., a diet deficient in energy for marasmus and a diet deficient in protein for kwashiorkor). The study of these phenomena is considerably limited by the lack of an appropriate animal model. Unfortunately, many authors combine these entities into one, thus precluding a better understanding of the differences between these clinical conditions.

Definition of marasmus

Marasmus is defined as a state of extreme malnutrition and emaciation especially in children which result from inadequate intake of food or form of malabsorption or metabolic disorders. Marasmus is a form of undernourishment causing a child’s weight to be significantly low for their age.

Marasmus can also be defined as a severe form of malnutrition that consist of the chronic wasting away of fat, muscles and other tissues in the body. This form of malnutrition occurs when the body does not get enough protein and calories. Marasmus is one of the three form of serious forms of (PEM) while the others are kwashiorkor and marasmic kwashiorkor. These forms of serious PEM represent a group of pathologic condition associated with a nutritional and energy deficit occurring mainly in young children from developing countries at the time of weaning. Marasmus can also be defined as a state of severe malnutrition due to lack or reduced ingestion of protein and calories which can be as a result of poor diet, eating habit, parent-child relationship or metabolic defects.

Marasmus is also a form of protein-calories malnutrition occurring chiefly in the first year of life, with growth retardation and wasting of subcutaneous fat and muscles, but usually with retention of appetite and mental alertness. It is considered to be related to “kwashiorkor”.

Causes of marasmus

Marasmus is a form of malnutrition in which inadequate amounts of both protein and calories are consumed, resulting in an energy deficit in the body. Marasmus occurs most often in developing nations or in countries where poverty along with inadequate food supplies and contaminated water are prevalent. Marasmus often affects children in regions with high rate of poverty such as Africa, Latin America and South Asia. However, malnutrition and marasmus can also occur in people in developed countries.

What are the risk factors of marasmus

A number of factors increase the risk of developing marasmus. Not all people with risk factors will get marasmus. Risk factors for marasmus uncludes:

1. Chronic hunger
2. Contaminated water supplies
3. Inadequate food supplies
4. Other vitamin deficiencies (vitamin A, E or K)
5. Poor, unbalanced diet lacking in grains, fruits and vegetables, and protein
6. Drought
7. War

Potential complications of marasmus

Complications related to marasmus or malnutrition are particularly serious in infant and young children. Lack of proper nutrition can lead to delays in physical and mental development. Complications of untreated marasmus can be serious and may include:

1. Growth problems in children
2. Joint deformity and destruction
3. Loss of strength
4. Loss of vision and blindness
5. Organ failure or dysfunction
6. Unconsciousness and coma
7. Oedema

 Signs and symptoms of marasmus

Symptoms of marasmus can range from mild to severe depending on the degree of malnutrition. You may experience marasmus symptoms daily or just once in a while. At times any of these marasmus symptoms can be severe.

The common signs and symptoms include:

1. Chronic or persistent diarrhea
2. Distended abdomen
3. Dizziness
4. Dry peeling skin
5. Emaciated appearance (unlike kwashiorkor)
6. Failure to achieve an appropriate weight to age/size.
7. Fatigue

Marasmus if not treated and managed early may result to the following serious or severe symptoms:

• Fainting or change in level of consciousness or lethargy
• Full or partial paralysis of the legs
• Loss of bladder or bowel control
• Prolonged vomiting or diarrhea.

Other symptoms include:

• Little or no subcutaneous fat (muscle wasting)
• The infant is usually irritable, fretful and apathy.
• The child is wizards (looks like wizard old man)
• There is no oedema.
• There is hypothermia (low body temperature)

Dietary management of marasmus

Since marasmus is a form of malnutrition, a nutritious, well balanced diet with lots of fresh fruits, vegetables, grains and protein will reduce the risk of malnutrition and any form of related marasmus.

Treatment of marasmus involves a special feeding and rehydration plan and close medical observation to prevent and manage complications of marasmus. Paediatric nutrition rehabilitation centres have been established in some countries and regions to co-ordinate treatment of malnourished children. Intravenous fluids oral rehydration solution (ORS) and nasogastric feeding tubes are forms of treatment that may be used. Eating a well balanced diet containing protein-energy will help curb marasmus.

The food sources include:

1. Fish
2. Meat
3. Vegetables
4. Energy giving food (staple foods)
5. Fruits
6. Soyabeans, etc.

References

Awuli, N. I. (2015). Food Science and Nutrition: NUD 123 [Lecture Note]. Ofuoma – Ughelli: Delta State College of Health Technology.

Johor, F., Badaloo, A., Reid, M. & Forrester, T. (2008). Protein Metabolism in Severe Childhood Malnutrition. Am. Trop. Paediatr. 17 (3), 87 – 93

Miller, K. (2003). Encyclopaedia and Dictionary of Medicine, Nursing and Allied Health (7^th ed.). New York: Saunders Elsevier.

Pawellek, I., Dokoupil, K. & Koletzko, B. (2008). Prevalence of Malnutrition in Paediatric Hospital Patients. Clin Nutr. 20(5),590-6

Spoelstra, M. N., Mari, A., Mendel, M., Senga, E., Van Rheenen, P. & Van Dijk, T. (2012). Kwashiorkor and Marasmus are both associated with Impaired Glucose Clearance related to Pancreatic B-cell dysfunction. Journal of Metabolism 97(6),561-67

Scrimshaw, N.S. & Viteri, F.E. (2010): Studies of Kwashiorkor and Marasmus. Journal of Food and  Nutrition 31(1),34-41.