How to remember kwashiorkor vs marasmus? Simple mnemonics and key differences

October 27, 2025 •

4 min read

Approximately 45% of deaths in children under five in developing countries are due to malnutrition. Learning how to remember kwashiorkor vs marasmus is crucial for health professionals and students to accurately diagnose and treat these distinct forms of severe acute malnutrition (SAM).

Quick Summary

Kwashiorkor, primarily a protein deficiency, is characterized by edema, while marasmus results from severe overall nutrient and calorie deprivation leading to extreme wasting. Key distinguishing factors include physical appearance, age of onset, and specific metabolic derangements caused by each condition.

Key Points

The 'O' Mnemonic for Kwashiorkor: Remember Kwashi-O-rkor by associating the 'O' with Oedema (swelling), the swollen Overall appearance, and the Only protein deficiency.
The 'M' Mnemonic for Marasmus: Recall Marasmus by associating the 'M' with Muscle Mass wasting and More of a total energy and calorie deficiency.
Distinct Appearances: Kwashiorkor leads to a bloated abdomen and swollen limbs (edema) which masks underlying muscle wasting, while marasmus presents as severe emaciation or a 'skin and bones' look.
Type of Deficiency: Kwashiorkor is primarily a severe protein deficiency, while marasmus results from an overall caloric deficiency impacting all macronutrients.
Age and Onset: Kwashiorkor often develops in older infants and toddlers after weaning, whereas marasmus typically occurs in younger infants due to general food scarcity.
Pathophysiology: Kwashiorkor involves fluid imbalance (low serum albumin), fatty liver, and oxidative stress, whereas marasmus is a metabolic adaptation to starvation.
Prognosis: Kwashiorkor has a higher mortality rate in the acute phase, often complicated by infection and metabolic derangements, while marasmus has a better prognosis if treated early.

Understanding Severe Acute Malnutrition

Severe acute malnutrition (SAM) is a life-threatening condition affecting millions, especially children in low-income countries. It manifests in two primary forms: kwashiorkor and marasmus. Both are serious and require immediate intervention, but they have distinct causes, symptoms, and physiological impacts. Knowing the specific differences is critical for proper diagnosis and treatment. Kwashiorkor is typically caused by a protein deficiency despite adequate calorie intake, whereas marasmus results from a more general and severe deficiency of both calories and protein.

Kwashiorkor Explained

Kwashiorkor is defined as edematous malnutrition, meaning it is characterized by swelling (edema). The name comes from the Ga language of coastal Ghana, meaning "the sickness the baby gets when the new baby comes," referring to a toddler being weaned from breast milk onto a starchy, protein-poor diet upon the birth of a sibling.

Causes of Kwashiorkor

Predominant protein deficiency: Often occurs in a diet high in carbohydrates but low in protein.
Weaning practices: Inappropriate introduction of complementary foods, especially low-protein cereals, after breastfeeding ceases.
Stressors: Infections, parasites, and environmental toxins like aflatoxins can trigger or worsen the condition by increasing metabolic demands.

Symptoms of Kwashiorkor

The signs of kwashiorkor are distinct from those of marasmus, most notably due to the presence of fluid retention.

Bilateral pitting edema: Swelling, especially of the ankles, feet, hands, and face, is a classic sign.
Distended abdomen: A bloated or protruding belly is common due to fluid accumulation (ascites) and an enlarged, fatty liver.
Changes in skin: Dermatosis with hyperpigmentation, cracking, and peeling, sometimes described as a 'flaky paint' appearance.
Hair changes: Hair may become sparse, brittle, dry, and lose its color (depigmentation), sometimes showing a striped pattern known as a 'flag sign'.
Other symptoms: Fatigue, apathy, irritability, and a loss of appetite are also common.

Marasmus Explained

Marasmus, from the Greek word marasmos meaning "wasting away," is a type of severe malnutrition characterized by a total deficiency of both calories and protein. It primarily affects younger infants and children. The body adapts to the lack of nutrients by using all available energy stores, leading to a severely emaciated appearance.

Causes of Marasmus

Overall energy deficiency: Inadequate intake of all macronutrients—protein, carbohydrates, and fats.
Poverty and food scarcity: Lack of access to sufficient food is the primary driver.
Infections and disease: Chronic diarrhea, parasites, and infectious diseases can deplete the body's energy stores and impair absorption.
Early weaning: In some cases, stopping breastfeeding too early without an adequate replacement diet can contribute to marasmus in infants.

Symptoms of Marasmus

Unlike kwashiorkor, the key feature of marasmus is extreme wasting without edema.

Severe wasting: The most striking feature is the dramatic loss of muscle mass and subcutaneous fat, leaving the child looking severely emaciated ('skin and bones').
Old man face: Loss of facial fat gives children with marasmus a wrinkled, aged appearance.
Loose, dry skin: The skin hangs in loose folds due to the loss of underlying tissue.
No edema: A key differentiating factor is the absence of swelling.
Behavioral changes: Children are often weak, irritable, apathetic, and may have a poor appetite.

How to Remember Kwashiorkor vs Marasmus: Easy Mnemonics

Remembering the core differences is key. Use these mnemonics to solidify your understanding:

The 'O' Mnemonic for Kwashiorkor: Kwashi-O-rkor has an 'O' in the middle, which can stand for Oedema (fluid retention), the swollen Overall appearance, and the Only protein deficiency. The child is "WASHED" in extra fluid.
The 'M' Mnemonic for Marasmus: Marasmus starts with an 'M' for Muscle Mass wasting and More of a total energy and calorie deficiency. The child has the appearance of an "Miniature Man" or "Mars bar" (no calories).

Kwashiorkor vs Marasmus: A Comparison Table


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Protein deficiency, with generally adequate calories.	Deficiency of all macronutrients (protein, fat, carbohydrates).
Physical Appearance	Bloated or swollen appearance due to edema. Limbs may appear emaciated while the abdomen is distended.	Wasted, severely emaciated ('skin and bones') with visible ribs and prominent bones.
Edema (Swelling)	Present and is a defining characteristic.	Absent.
Subcutaneous Fat	Relatively preserved.	Almost completely lost.
Muscle Wasting	Present, but often masked by edema.	Severe, visible wasting.
Hair	Brittle, sparse, and changes color ('flag sign').	Thin and dry, but less severe discoloration than kwashiorkor.
Skin	Dermatosis with peeling and hyperpigmentation ('flaky paint').	Dry, loose, and wrinkled skin.
Liver	Often enlarged and fatty (hepatic steatosis).	Liver function is largely preserved; no significant enlargement.
Appetite	Poor or lost (anorexia).	Can be ravenous, but may also be poor.
Age of Onset	Typically older children, around 18 months to 3 years, after weaning.	More common in infants and very young children, under 1 year.

Diagnosis and Treatment Overview

Diagnosing these conditions involves a physical examination and taking anthropometric measurements like weight-for-height and mid-upper arm circumference (MUAC). The presence of bilateral pitting edema is the key diagnostic indicator for kwashiorkor, differentiating it from marasmus. Blood tests confirm nutrient deficiencies and metabolic abnormalities.

Treatment follows a multi-stage approach, guided by organizations like the World Health Organization (WHO), focusing on stabilizing the child and addressing immediate life-threatening issues like hypoglycemia and hypothermia. Rehydration with special solutions (like ReSoMal) and treating infections are also prioritized. Nutritional rehabilitation, starting with cautious, frequent feeding of therapeutic formulas (like F-75 then F-100), is critical for recovery. Emotional and sensory stimulation are also important for a child's development.

Conclusion

Kwashiorkor and marasmus represent two ends of the severe acute malnutrition spectrum, differentiated primarily by the presence of edema. Understanding how to remember kwashiorkor vs marasmus using mnemonics and comparing their distinct clinical features is a fundamental skill for healthcare providers. Early and accurate diagnosis, followed by a careful, structured therapeutic approach, is vital for improving prognosis and reducing mortality rates in affected populations. For more detailed information on global health initiatives addressing malnutrition, visit the Action Against Hunger website.

Frequently Asked Questions

The primary difference is the nature of the nutritional deficiency. Kwashiorkor results from a severe protein deficiency with relatively adequate calorie intake, leading to edema (swelling). Marasmus is caused by an extreme deficiency of all macronutrients (protein, carbohydrates, and fats), resulting in severe wasting.

The swelling, known as edema, is caused by hypoalbuminemia (low albumin in the blood) resulting from the severe protein deficiency. Albumin is essential for maintaining proper osmotic pressure in the blood vessels, and without enough protein, fluid leaks into tissues and the abdomen.

A child with marasmus appears severely emaciated with a 'skin and bones' look due to the extensive loss of both muscle mass and subcutaneous fat. They often have prominent bones, and their skin may appear loose and wrinkled.

Yes, a child can present with a mixed form of severe malnutrition known as 'marasmic-kwashiorkor.' This condition combines the severe wasting of marasmus with the edema characteristic of kwashiorkor.

A useful mnemonic is to remember the 'O' in Kwashi-O-rkor. The 'O' can stand for Oedema (swelling) and the swollen Overall appearance. Some also use the phrase "kwashi-WASH-iorkor" to associate it with being "washed" in extra fluid.

Diagnosis involves clinical assessment, physical examination, and anthropometric measurements like weight-for-height and mid-upper arm circumference (MUAC). The presence of bilateral pitting edema is a clear sign for kwashiorkor, while severe wasting indicates marasmus. Blood tests can also confirm nutritional status.

The initial treatment for severe malnutrition focuses on stabilizing the child and addressing life-threatening issues. This includes treating and preventing hypoglycemia, hypothermia, dehydration, electrolyte imbalances, and infections before beginning gradual nutritional rehabilitation.