Can Adults Get Marasmus or Kwashiorkor? Understanding Protein-Energy Malnutrition

January 4, 2026 •

4 min read

Protein-energy malnutrition (PEM) affects millions globally, and while commonly associated with childhood, adults are not immune to its severe forms, marasmus and kwashiorkor. These conditions can arise from chronic illness, malabsorption disorders, or severe dietary restrictions, leading to life-threatening complications if left untreated.

Quick Summary

Adults can develop severe protein-energy malnutrition, including marasmus and kwashiorkor, driven by factors like chronic disease, malabsorption, and insufficient nutrient intake. Recognizing the distinct symptoms and addressing underlying causes are critical for effective treatment and recovery.

Key Points

Adults Can Get Marasmus and Kwashiorkor: These severe forms of malnutrition are not limited to children and can occur in adults due to complex health factors beyond simple food scarcity.
Causes Differ in Developed Nations: In adults, especially in developed countries, malnutrition is often secondary to chronic diseases, post-surgical complications, or mental health conditions, not just primary starvation.
Symptoms of Marasmus: Adult marasmus is characterized by severe muscle and fat wasting, leading to an emaciated, shriveled appearance and marked weakness.
Symptoms of Kwashiorkor: Adult kwashiorkor presents with significant edema (swelling) in the extremities and face, which can mask underlying weight loss.
Refeeding Syndrome Risk: Treatment must be gradual and medically supervised to prevent refeeding syndrome, a dangerous electrolyte imbalance that can occur with rapid re-nourishment.
Underlying Issues Must Be Treated: Effective recovery depends on addressing the specific root cause, whether it's a chronic illness, an eating disorder, or social isolation.
Elderly at High Risk: Older adults are particularly vulnerable due to factors like reduced appetite, dementia, and limited mobility, requiring vigilant monitoring.

Can adults get marasmus or kwashiorkor?

While marasmus and kwashiorkor are most often identified in pediatric populations in low-income regions, these severe forms of protein-energy malnutrition (PEM) can and do affect adults. In developed countries, adult PEM is typically linked to chronic diseases, eating disorders, or other complex health issues rather than simple food scarcity. In elderly populations, factors like decreased appetite and poor nutrient absorption can significantly increase risk. For many adults, the malnutrition may be a combination of both conditions, known as marasmic-kwashiorkor.

Causes of adult marasmus and kwashiorkor

Unlike the simple dietary deficiency often seen in children, the root causes of severe malnutrition in adults are often multi-faceted. They can be broadly categorized into primary (inadequate intake) and secondary (underlying disease) factors.

Primary Causes: These result from a prolonged, severe reduction in nutrient intake.
- Anorexia nervosa or other severe eating disorders.
- Fasting for cultural or religious reasons over an extended period.
- Extreme poverty or homelessness where access to food is severely limited.
- Social isolation and neglect, particularly among the elderly.
Secondary Causes: These are more common in industrialized nations, where a disease or treatment interferes with the body's ability to absorb or utilize nutrients.
- Gastrointestinal Disorders: Conditions like Crohn's disease, celiac disease, or pancreatic insufficiency can lead to malabsorption, preventing the body from absorbing adequate protein and calories.
- Post-Surgical Complications: After bariatric surgery, especially gastric bypass, some adults may develop kwashiorkor due to significant malabsorption.
- Chronic Diseases: Wasting diseases such as AIDS, cancer, or chronic obstructive pulmonary disease (COPD) increase the body's metabolic demands, leading to a state of cachexia that can manifest as marasmus or kwashiorkor.
- Liver and Kidney Disease: Severe liver cirrhosis or chronic kidney disease can impair the body's ability to produce or retain vital proteins, contributing to kwashiorkor.
- Mental Health: Dementia, depression, and other cognitive impairments can lead to an inability to manage one's own nutritional needs.

Symptoms of adult protein-energy malnutrition

The signs of marasmus and kwashiorkor in adults can differ significantly, particularly in the presence of edema. However, both present with severe fatigue and a compromised immune system.

Adult marasmus

Adults with marasmus exhibit severe wasting and an emaciated appearance due to the depletion of fat and muscle.

Visible Wasting: Loss of fat and muscle mass is pronounced, making bones protrude and skin hang loosely.
Low Body Temperature: The body's functions slow down to conserve energy, leading to a low body temperature.
Dehydration and Diarrhea: Chronic diarrhea is common, contributing to dehydration and further nutrient loss.
Apathy and Weakness: Patients often feel extremely weak, fatigued, and apathetic.

Adult kwashiorkor

Kwashiorkor in adults is primarily characterized by edema, or swelling from fluid retention, which can mask the underlying malnutrition.

Edema: Swelling typically affects the hands, feet, face, and abdomen, which may appear bloated.
Skin and Hair Changes: The skin can develop a flaky, peeling, or cracked texture with red patches. Hair may become thin, brittle, and discolored.
Enlarged Liver: A fatty liver (hepatomegaly) is a common internal symptom.
Fatigue and Irritability: While muscle mass is lost, the fluid retention from edema can hide the overall weight loss.

Comparison Table: Marasmus vs. Kwashiorkor in Adults


Feature	Marasmus	Kwashiorkor
Primary Deficiency	Severe lack of all macronutrients (protein, carbs, fats).	Primarily a protein deficiency, with often adequate caloric intake from carbohydrates.
Key Physical Sign	Visible wasting of fat and muscle, emaciated appearance.	Edema (swelling) in the legs, feet, face, and abdomen.
Weight Loss	Severe, obvious weight loss.	Weight loss may be masked by fluid retention.
Body Appearance	Shriveled, skeletal, and withered.	Bloated belly and face, but thin limbs.
Hair & Skin	Dry, loose skin; brittle hair or hair loss.	Skin lesions, peeling skin; dry, discolored, or sparse hair.
Appetite	Often poor or food aversion.	Can have a poor appetite or be irritable.

Treatment for adult protein-energy malnutrition

Treating adult marasmus and kwashiorkor requires a cautious, multi-staged approach, typically beginning in a hospital setting. A critical risk during treatment is refeeding syndrome, a potentially fatal shift in fluid and electrolytes that occurs when malnourished patients are fed too quickly.

Initial Stabilization: The first stage focuses on correcting dehydration, electrolyte imbalances, and severe micronutrient deficiencies. Infections, which are common due to a compromised immune system, must also be treated.
Gradual Nutritional Rehabilitation: Nutrients are reintroduced slowly to prevent refeeding syndrome. This often begins with liquid formulas administered orally or via a nasogastric tube. Gradually, the patient transitions to a balanced diet with solid food.
Addressing the Root Cause: The underlying reason for the malnutrition must be addressed. This might involve treating a chronic illness, managing a psychiatric disorder, or providing ongoing nutritional and social support, especially for elderly patients.
Follow-up Care: Recovery requires long-term dietary counseling and monitoring to prevent relapse. For some, this includes fortified foods or oral nutritional supplements.

Conclusion

Adults are susceptible to marasmus and kwashiorkor, although the circumstances often differ from those affecting children. Rather than being solely a product of food scarcity, adult protein-energy malnutrition is frequently a complication of chronic disease, malabsorption, or mental health issues. Proper diagnosis requires a careful physical examination to identify telltale signs like edema or severe wasting, combined with a thorough understanding of the patient's medical history. Early and cautious treatment, with a strong focus on stabilizing fluid and electrolyte levels before slowly introducing nutrition, is vital for recovery and preventing life-threatening complications like refeeding syndrome. Awareness of adult malnutrition and its complex causes is essential for effective intervention and improved patient outcomes.

For more detailed clinical guidelines on diagnosing and managing malnutrition in adults, including recent updates on the Global Leadership Initiative on Malnutrition (GLIM) criteria, see the article "Evolution of the diagnosis of malnutrition in adults" published in Frontiers in Nutrition.

Frequently Asked Questions

The main difference is the type of nutrient deficiency and resulting symptoms. Adult marasmus is a deficiency of all macronutrients (protein, carbs, and fat), causing severe wasting and an emaciated look. Adult kwashiorkor is primarily a protein deficiency, leading to fluid retention and edema (swelling), which can mask weight loss.

Yes, it is possible for an adult to have a combination of both conditions, known as marasmic-kwashiorkor. This mixed condition presents with both muscle wasting and edema.

Many chronic diseases can contribute to severe malnutrition by increasing metabolic demands or impairing nutrient absorption. These include cancer, AIDS, chronic obstructive pulmonary disease (COPD), severe liver or kidney disease, and malabsorption disorders like Crohn's disease.

Rapid re-nourishment can lead to refeeding syndrome, a life-threatening complication characterized by severe shifts in fluids and electrolytes, such as potassium and phosphorus. The body, after adapting to starvation, is overwhelmed by a sudden influx of nutrients.

Diagnosis involves a physical examination to look for signs of wasting or edema, a review of medical history, and sometimes a blood test to check for electrolyte imbalances, protein levels, and vitamin deficiencies. Anthropometric measurements, like body mass index (BMI) or mid-upper arm circumference (MUAC), may also be used.

Yes, elderly individuals are at a higher risk due to various factors. These include age-related changes affecting taste and appetite, conditions like dementia, social isolation, and chronic illnesses that impact nutrition and absorption.

Long-term consequences can include permanent impairment of physical or intellectual functions, stunted growth (if occurring during early adulthood), and an increased susceptibility to infection due to a weakened immune system.