Marasmus

Malnutrition is an imbalance between the body's supply and demand of nutrients that affects function or growth. Protein-energy malnutrition (PEM) is a potentially fatal condition prevalent in developing countries.

PEM disproportionately affects children and pregnant women and accounts, directly and indirectly, for approximately half of under 5-year-old mortality worldwide. The two forms of PEM are marasmus and kwashiorkor. Marasmus is a condition caused by chronic lack of calorie sources in the diet, whereas kwashiorkor is caused by a lack of dietary protein.

Calories are the measurement units for how much energy is in food; the main sources of calories in the diet are carbohydrates, fat, and protein. A state of chronic caloric deficit is called marasmus and causes include the following: (1) decreased intake of calories, for example, due to socioeconomic status not able to afford adequate food, weaning child from breast milk with inadequate calories in new diet, famine or war leading to lack of available food to buy, lack of appetite, eating disorders, being on a restrictive diet; (2) increased caloric expenditure, for example, when a woman is pregnant, when children are growing, chronic illness such as AIDS or cancer, acute infection, major surgery; and (3) decreased absorption of food, for example, disease or infection of the intestines, dysfunction in the release of the digestive enzymes from the pancreas.

Marasmus is sometimes considered to be a physiologically adaptive response to starvation. Faced with insufficient caloric intake to perform functions required for life, such as breathing, the body begins to break down first its fat and then muscle to generate energy.

This results in a shrunken appearance with prominent bones and decreased muscle mass. Because of these accompanying physical changes, the diagnosis of marasmus can be confirmed using height, weight, and anthropometric measures (if kwashiorkor or another diagnosis is not suspected).

The body also attempts to lower its own energy requirements by decreasing the base metabolic rate and the growth rate, resulting in stunted growth in affected children and low birth weight children for pregnant women.

Marasmic women are at high risk for having low birth weight children, who themselves are more likely to have low birth weight children; this demonstrates the vicious cycle that can be seen with marasmus. Interestingly, because of the biochemical starvation state the body is in, attempting to give a marasmic [Page 1067]person a lot of high carbohydrate foods quickly can kill them, and so acute treatment involves frequent small meals.