3. Introduction
⮚ Marasmus is derived from the Greek word Marasmos, which means
withering or wasting.
⮚ It is a severe form of PEM that consists of the chronic wasting away
of fat, muscle and other tissues in the body.
⮚ Marasmus represents the end result of starvation where both protein
and calories are deficient due to inadequate intake.
⮚ It occurs in individuals at any time but is more common at the age
before 1 year.
4. Contd…
⮚ Marasmus is commonly seen in children of developing nation like latin
America, Africa and South Asia, where insufficient food supplies and
contaminated water are hugely prevalent.
⮚ Grading of marasmus
Grade I: Wasting starting in axilla and groin.
Grade II: I + wasting in thigh and buttocks region.
Grade III: II + chest and abdomen
Grade IV: Buccal pad of fat.
5. Causes
⮚ Poverty that lead to the low food availability and poor child care.
⮚ Inappropriate breast feeding and weaning practices.
⮚ Prolonged breastfeeding without introduction of other foods.
⮚ Cultural and social practices such as food taboos and fads.
⮚ Environmental factors like drought, flood, earthquakes, famine etc.
⮚ Poor farming practices often due to lack of knowledge, money, time
or equipment.
⮚ Overcrowded and unsanitary living conditions.
⮚ Maternal morbidity.
6. Clinical features
⮚ Severe wasting of weight by less than 60%
⮚ Growth retardation
⮚ Loss of subcutaneous fat
⮚ Loose skin and thin arm
⮚ Patient is extremely emaciated
⮚ Muscle atrophy
⮚ Patient looks older than the age or senile face
⮚ Decreased in blood protein
⮚ Vitamin A deficiency
7. Symptoms
⮚ Frequent diarrhea
⮚ Abdominal distention
⮚ Persistent dizziness
⮚ Alert but miserable
hungry
⮚ Failure to thrive
8. Contd…
⮚ Severe lethargy
⮚ Delayed wound healing
⮚ Problems with bladder and
bowel control
⮚ Persistent vomiting
9. Complications
⮚ Hypoglycemia
⮚ Hypothermia
⮚ Severe anemia
⮚ Complete and partial paralysis
⮚ Joint deformities
⮚ Severe weakness
⮚ Permanent vision loss
⮚ Abnormality of tongue
⮚ Organ failure
⮚ Coma
10. Treatments
⮚ Provide the affected individual healthy and nutritious diet which
is rich in proteins and calories.
⮚ Provision for adequate breastfeeding.
⮚ When available, care must be taken to feed with small amounts
at first
⮚ In artificial feeding one should encounter the danger of
prolonged starvation and over-feeding.
⮚ Medical management of complications, infectious illness and
deficiency states.
⮚ In the absence of life threatening complications individual should
be kept in Nutrition Rehabilitation Centre.
11. Adult Marasmus
◻ Marasmus generally occurs
in children below one year
of age. However, it is also
seen in adult.
12. Contd….
The causes of adult marasmus are:
⮚ Insufficient food due to famine, severe war, civil disturbances,
natural disasters etc.
⮚ Infections especially chronic, untreated or untreatable. The most
common is HIV/AIDS which cause marked wt. loss and severe
wasting.
⮚ Malabsorption due to inability of the body to digest or absorb
certain foods and nutrients.
⮚ Malignancies.
⮚ Eating disorder such as anorexia nervosa, which occurs more
commonly in adolescent females than males and in affluent
society than poor.
13. Preventive measures
⮚ Start weaning a child at 4 to 6 month of age.
⮚ Development of low cost weaning.
⮚ Food fortification.
⮚ Breastfeeding should be encouraged.
⮚ Proper guidance to mother.
⮚ Pregnancies in quick succession should be avoided and mother’s
health should be looked after.
⮚ Increase the intake of carbohydrate and protein rich foods.
