Marasmus is severe form of protein energy malnutrition. The disease is characterized by wasting of muscle and loss of fat as well as tissue mass of the body. Malnutrition occurs when the body is not able get enough amount of protein and calories. This can range from undernourishment and deficiency of vitamins to absolute starvation.
Marasmus is usually seen in children, especially in developing countries such as Africa, Latin America and South Asia. Poverty, inadequate food supply, famine, contaminated water supply etc are some of the underlying problems that are more prevalent in this part of world.While in developed countries people suffering from anorexia can become marasmic. Malnourishment occurs when there is inadequate supply of food. Contaminated water contains bacteria and germs that cause infection, thus worsening the condition.
Severe growth retardation, extreme emaciation, chronic diarrhea, lethargy, hanging skin etc are prominent symptoms of marasmus. If the disease is caused only due to poor nutrition, change in diet is enough for correcting the problem. However, additional treatment may be necessary if there is an underlying disease involved.
Causes And Risk Factors Of Marasmus
Marasmus is a severe nutritional disorder that occurs due to insufficient intake of protein as well as calories.Due to this shortfall, body starts using the available calories for producing energy. Thus it results in wasting of muscles and other symptoms of protein energy malnutrition. Marasmus generally is common in children, especially below the age of 2 years.
The disease is widely prevalent in developing countries of Asia and Africa. Especially in places where food is in short supply. Poverty and water contamination add up to the problem. Nevertheless marasmus can also occur in developed countries. Here early and abrupt weaning and introduction of diluted milk formula can particularly lead to marasmus.Marasmus in adults may be due to anorexia nervosa. Childhood bacterial and viral infections as well as parasitic infections are usually associated with marasmus.
Below are given certain risk factors for marasmus, they are:
- Chronic starvation.
- Contaminated water supply.
- Insufficient food intake.
- Deficiency of vitamins.
- Diet that lacks enough protein.
What Are The Symptoms Of Marasmus?
The symptoms of marasmus may be variable depending on the severity of the condition and associated infection if any. But some of the characteristic manifestations are severe growth retardation and extreme emaciation. The child appears like an old man or his face appears like monkey face. The skin folds are loose and hanging especially over the arms and buttocks. His skin appears wrinkled. In fact a typical body of a marasmic child can be described as made up of nothing but ‘skin and bones’.
Majority of children suffering from marasmus have chronic diarrhea which leads to dehydration and deficiency of nutrients. They appear tired and lethargic. They may not have enough energy even to cry. Adult marasmic patients may have fainting spells and partial paralysis of lower limbs. There is no control over bladder and bowel in severe form of marasmus.
Dietary Management For Marasmus Patients
The mainstay treatment of an individual suffering from marasmus is to provide healthy and nutritious diet comprising of protein and calories. Both of which are required in larger quantity than normal requirement for a rapid recovery.
- Initially milk based diet is preferable in children. Dry milk powder can be used for preparing the milk formula.
- Sugar and vegetable oil can be added to the milk. Both increase the energy content. It can be enriched with vitamin A.
- If the patient refuses to consume any diet, he has to be fed through naso- gastric tube or can be spoon fed.
- Once the child has improved his appetite, he may be fed with solid food. This may consist of cereal, pulses, dried skim milk powder, and sugar. Adding vegetable oil increases the density of the solid diet.
- Since diarrhea is very common in marasmus, correction of dehydration is the priority of treatment. In case of severe dehydration patient may need to be hospitalized for intravenous fluids. Re-hydration solution can be given if dehydration is less. It can be given frequently at regular interval.
- Appropriate antibiotic treatment is started as infection is common in these patients. Children with parasitic intestinal infection may need medicines to treat round worm or giardiasis.
Usually after starting the treatment improvement is evident within a week or 15 days. Patient’s appetite improves dramatically and he starts to gain weight.