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. Contd…
⮚ Infectious diseases like diarrhea, measles and other respiratory
infections.
⮚ Poor infant and child rearing due to ignorance.
⮚ Defective hygiene.
⮚ Deficiency of certain nutrients like vitamin A, and K
⮚ Inadequate diets for women during and after pregnancy.
⮚ low quality, expensive, non-existent or unfriendly Health services.
⮚ Premature birth, mental deficiency and digestive upsets
(malabsorption, vomiting, etc.)
⮚ Mother’s desire to feed her baby from the bottle rather than the
breast.
7. 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
8. Symptoms
⮚ Frequent diarrhea
⮚ Abdominal distention
⮚ Persistent dizziness
⮚ Alert but miserable
hungry
⮚ Failure to thrive
9. Contd…
⮚ Severe lethargy
⮚ Delayed wound healing
⮚ Problems with bladder and
bowel control
⮚ Persistent vomiting
10. Complications
⮚ Hypoglycemia
⮚ Hypothermia
⮚ Severe anemia
⮚ Complete and partial paralysis
⮚ Joint deformities
⮚ Severe weakness
⮚ Permanent vision loss
⮚ Abnormality of tongue
⮚ Organ failure
⮚ Coma
11. 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.
12. Contd…
⮚ The methods such as use of IV fluids, rehydration solutions
administered orally, and feeding through NG tubes should be used
for refeeding and rehydrating.
While choosing the food for treatment following principles should be
followed:
⮚ Fat is poorly digested and therefore best kept low if prescribed in
ordinary mixtures.
⮚ It is desirable to feed with as much carbohydrate as possible.
⮚ Protein is better digested than the other food elements, and it has
therefore been customary to rely on a high protein diet in these
cases.
13. Feeding Pattern
⮚ The initial food given should be of low volume containing adequate
energy.
⮚ The initial diet should provide no more than the requirements of
energy and protein.
⮚ Once the patient is free from complications, energy content of the
diet should be increased.
⮚ Along with feeding, emotional stimulation, play and tender loving
care is important.
⮚ A mixture of multiple micronutrients should be fed.
⮚ Though anaemia is present, iron supplementation is not given in the
initial stages.
14. Adult Marasmus
◻ Marasmus generally occurs
in children below one year
of age. However, it is also
seen in adult.
15. 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.
16. 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.
17. Contd…
⮚ Prompt treatment of childhood inter-current infections and diseases.
⮚ Do not substitute infant formula in place of mother’s milk.
⮚ Improvement in the economic status of families.
⮚ Promote good personal and community hygiene practices.
⮚ Improve household level feeding practices and health care.
⮚ Promote adequate and hygienic food preparation and consumption.
19. Recommendations
⮚ Provide nutrition education including demonstration.
⮚ Market-based interventions to ensure food remains affordable.
⮚ Cash transfers by government to ensure families have sufficient
money to purchase food.
⮚ General food distribution where food is unavailable or un-affordable.
⮚ Raise crop production, local market prices, and health service
statistics.
⮚ Regular home visits to educate the mother on feeding oneself and the child
and also hygiene measures.
⮚ Educate mother on danger signs specifically so that she can take the child
early to a health center in case of infection.
