Is the child becoming noticeably thinner day by day? That could be a dangerous condition called Marasmus!

Have you ever noticed that sometimes a small child or an adult becomes unusually thin day by day, so weak that their bones are exposed? We may think, "Oh, they must not be eating properly." However, this can be a much more serious condition. That is the type of severe malnutrition that we are going to talk about today, called Marasmus. It is like a car that stops running without any fuel.

What is Marasmus?

Simply put, Marasmus is a severe malnutrition condition . Specifically, it is a protein-energy undernutrition . That is, this condition occurs when the three main nutrients that our body needs to function and grow on a daily basis – carbohydrates, fats, and proteins – are suddenly depleted. Imagine, what happens when our body doesn’t get anything like gasoline or diesel? That’s how it is. As a result, the body loses the energy it needs to maintain normal activities. When you see someone with Marasmus, you can see how weak, emaciated, and the flesh on their bodies has almost completely melted away. In the case of a small child, their growth can be completely stunted . If this condition continues, it can go from starvation to death .

What is the difference between Marasmus and Kwashiorkor?

When talking about malnutrition, you may have also heard the name Kwashiorkor. Both are severe protein-energy malnutrition conditions. However, there is a slight difference between the two.

• Marasmus: As we mentioned earlier, this is a condition where all the major nutrients (carbohydrates, fats, and proteins) are reduced. This means that the total calorie intake is reduced. A person with marasmus often appears thin, shrunken, and dry .
• Kwashiorkor: This is mainly caused by protein deficiency . They may be able to eat carbohydrates (bread, rice, cereals) but not protein-rich foods (fish, meat, eggs, lentils). A characteristic feature of kwashiorkor is edema, which is swelling of the body due to fluid retention. The abdomen and face are especially swollen.

So, in marasmus, the body becomes thin, while in kwashiorkor, the body may appear swollen. Both are dangerous, but the way they occur and the symptoms are slightly different.

Who is most affected by Marasmus?

This condition of marasmus can affect anyone, that is, anyone who is generally undernourished. However, it is especially common in young children, especially infants, because their bodies are growing rapidly and they need more calories.

This condition is most common in developing countries, where poverty and food shortages are widespread. Parasites and various infectious diseases can also contribute to this condition by depleting the body's energy. In some areas of Sri Lanka, there are families who cannot afford a balanced diet due to economic difficulties. Such people are at greater risk.

Even in developed countries, this risk exists for elderly people in nursing homes or hospitals, or for elderly people who live alone and have little support .

What happens to the body in a state of Marasmus?

When the body is starved of energy from food, the body does something amazing (but dangerous). It starts to break down its own tissue to get energy. The first thing that breaks down is the fat tissue (we call it oil). Then the muscles start to break down.

Not only that, but the body slowly reduces some of its activities to conserve energy.

• Cardiac activity decreases. This means that the heart rate decreases, blood pressure decreases, and body temperature decreases. In some cases, this can even lead to heart failure.
• The immune system is weakened. As a result, people suffering from malnutrition are easily susceptible to various infections, and when they do get sick, it takes longer to recover.
• The growth and development of young children is completely stunted. They may be stunted and have intellectual disabilities. Even with treatment, these effects can sometimes last a lifetime.
• Parts of the digestive system begin to shrink because they are not being used properly. The danger of this is that even though you can eat, you may not be able to properly absorb the nutrients from that food. Surprisingly, marasmus can sometimes cause a loss of appetite .

What are the main causes of Marasmus?

There are several reasons for this. Let's break them down by age group.

Common causes that affect everyone:

• Poverty and food shortage: This is the main reason. Lack of economic power to obtain nutritious food.
• Diseases that deplete the body: For example, diseases like `(AIDS)`.
• Infections that cause long-term diarrhea: This makes it difficult for the body to absorb nutrients.
• Eating disorders such as anorexia: Conditions that result from aversion to food or loss of control over eating.

Causes that particularly affect children:

• Newborns not getting enough breast milk or stopping breastfeeding too early: Breast milk is the best nutrition for babies in the first few months.
• Neglecting or abusing children: Children can also be malnourished for such sad reasons.

Causes affecting adults:

• Forgetful diseases such as dementia: People with these diseases may not even remember what they ate or drank.
• Neglect or abuse of elderly people: Elderly people who are unable to take care of themselves are at risk.

What are the external signs of Marasmus?

There are several signs that we can recognize when we see someone with this condition:

• The fat and flesh on his body had almost completely melted away, and he looked very thin.
• The bones are clearly visible.
• The head may appear large in comparison to the body.
• The face can look aged and wrinkled.
• The skin may become dry and sag. This is called skin atrophy.
• Hair becomes dry, brittle, and may even fall out.
• The soft spots on the top of babies' heads (fontanelles) may have sunken in.
• Constant fatigue, lack of interest, and weakness.
• Loss of more than 40% body weight.
• Having a Body Mass Index (BMI) of less than 16. (BMI is a measure of whether you are at a healthy weight for your height, but it is not the only basis for this.)

What other symptoms and complications can occur due to Marasmus?

In addition to external symptoms, many problems can also occur internally:

• Dehydration: Loss of water in the body.
• Electrolyte imbalances: Electrolytes are substances like salts that are essential for things like water balance and nerve function in our bodies. Too much or too little of these can be dangerous.
• Low blood pressure.
• Decreased heart rate.
• Decrease in body temperature.
• Gastrointestinal malabsorption.
• Growth retardation.
• Developmental delays.
• Anemia: Lack of blood in the body.
• Bone-weakening diseases (Osteomalacia in adults, Rickets in children).

How to recognize Marasmus?

The first thing doctors do is to examine the patient carefully. There are some symptoms that are characteristic of marasmus, the main one being that the fat and flesh on the body have melted away as far as the eye can see. These people are very emaciated and look like skeletons. The skin may appear wrinkled and saggy as the fat and muscle underneath the skin are lost.

In addition to appearance, doctors measure the patient's height, weight, and upper arm circumference . Various standardized tables are used to determine whether a person is at a healthy weight for their age and height. Marasmus is a condition that falls far below the normal range of these tables. For example, the body mass index (BMI) is less than 16, which is what most people know. These measurements are used to confirm the diagnosis and assess the severity of the condition.

What tests are used to diagnose Marasmus?

Diagnosis is mainly based on body measurements. The severity of malnutrition is assessed by things like upper arm circumference and weight for height. In children, growth delays are identified by looking at their height for age. Doctors usually identify whether it is marasmus based on physical characteristics alone.

The next step is to do a blood test. This can help determine the secondary effects of marasmus, such as specific vitamin, mineral, enzyme, and electrolyte deficiencies. This information can help determine what to give during refeeding. A complete blood count can also check for infections that may be causing or contributing to marasmus. A stool sample may also be tested for parasites. If there are any infections, they should be treated separately.

How to treat Marasmus? (This is very important!)

There is one thing to be very careful about when treating marasmus. That is a potentially life-threatening complication called "refeeding syndrome." This is a problem that occurs when a severely malnourished body is given too much food at once, because the body is not used to it. Think of it like what happens when a machine that has been working for a long time is suddenly given a heavy load.

Therefore, treating a person with marasmus involves several steps, with great care. It is best to do this treatment in a hospital, under the close supervision of doctors and nurses. Medical staff trained in refeeding syndrome can prevent it from occurring, or if it does occur, can quickly manage it by replacing depleted electrolytes and micronutrients.

Phase One: Stabilize the Body and Treat Dehydration

The first phase of treatment focuses on treating dehydration, correcting electrolyte imbalances, and addressing micronutrient deficiencies. This is done to prepare the body for re-nutrition. Often, the same solution is used for all of these, a special rehydration solution for malnutrition (REhydration SOlution for MALnutrition - ReSoMal). This can be given by mouth or through a nasogastric tube.

It is also important to keep the patient warm , as hypothermia can occur as the body temperature drops. Any infections are also treated, as infections further weaken the body's immune system. Depending on the patient's condition, it may take several hours, or even days, for the body to stabilize enough to resume feeding.

Stage two: restoring nutrition

Refeeding begins very slowly, with liquid foods. These foods are carefully balanced in terms of carbohydrates, protein, and fat. Doctors prefer to give tube feeding to people who are in the hospital. This allows for a gradual, but continuous supply of nutrients.

Initially, calories are given at about 70% of the recommended daily allowance for a person of that age. This amount is gradually increased. In the case of a child with stunted growth, calories may be increased up to 140% of the recommended daily allowance to meet his growth needs. This phase can last from two to six weeks. During this time, the patient is gradually introduced to regular solid foods by mouth.

Phase Three: Follow-up and Relapse Prevention

Marasmus is a relapsing condition, so a complete treatment plan includes education and ongoing support for the patient and/or their caregiver before the patient is discharged from the hospital .

In a developing country like Sri Lanka, this may include raising awareness about the importance of breastfeeding, providing advice on safe drinking water and proper food preparation methods, providing immunizations, and educating on the prevention of common diseases. In a developed country, caregivers may need guidance on how to recognize signs of malnutrition in those they care for. Tools such as the Malnutrition Universal Screening Tool (MUST) can help identify those at risk of malnutrition.

How to prevent Marasmus?

We can help prevent marasmus by speaking up for our own communities, especially for children and older people (especially those in hospitals and nursing homes) who cannot speak up for their needs.

Globally, marasmus can be prevented by:

• We need to fight poverty.
• "Food deserts" where nutritious food is not easily available must be eliminated.
• Nutrition education needs to be improved.
• We need to control widespread infectious diseases.
• Sanitation facilities need to be improved in developing countries.
• Elderly care needs to be improved in developed countries.

Is it possible to fully recover from Marasmus?

Marasmus usually takes about 42 days to heal. After treatment, those who are placed in an environment with the resources and care needed to maintain good health can make a full recovery. Although many children seem to recover from their growth and development delays, studies are still being conducted on these long-term effects. Continuing to take vitamin and mineral supplements may help.

Marasmus is caused by a total caloric deficit. The lack of food is enough to cause it. But its effects are much more complex. Because marasmus is not just hunger - it is a series of adaptations that the body makes to survive starvation. It takes time and care to reverse those adaptations and restore overall health. But with those resources, people can recover in remarkable ways.

Take-Home Message

• Marasmus is a severe malnutrition condition. It means a sudden decrease in all the nutrients the body needs.
• This can especially affect young children and the elderly .
• The main symptoms are abnormally thin body, stunted growth, and frequent illness .
• There is treatment for this, but it needs to be done in a hospital, under medical supervision, in several stages.
• You need to be careful about refeeding syndrome.
• Poverty, food shortages, and lack of awareness about nutrition are the main reasons for this.
• This situation can be prevented through proper nutrition, hygiene, and community-level support .

If you suspect that you or someone you know has these symptoms, please seek medical advice immediately. Early treatment can lead to much better results.

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