Severe malnutrition, clinically known as Severe Acute Malnutrition (SAM), is a major global health concern, particularly affecting children in low-income and middle-income countries. However, its clinical manifestation varies, leading to different medical names. Understanding the specific terminologies, their differences, and the severe implications is crucial for effective prevention and treatment.
Forms of severe malnutrition
Severe protein-energy malnutrition (PEM), or severe macronutrient undernutrition, is broadly categorized into two main forms based on their distinct clinical features: marasmus and kwashiorkor.
Marasmus: This is the result of a severe deficiency in both calories and protein over a prolonged period. It leads to extensive wasting of body fat and muscle tissue, giving the affected individual an emaciated, withered appearance. The word marasmus comes from the Greek word marasmos, meaning "withering". Infants and young children are particularly susceptible, often presenting with stunted growth.
Kwashiorkor: This type of severe malnutrition is caused by a severe protein deficiency, often while the person's diet still contains some carbohydrates. Unlike marasmus, kwashiorkor is characterized by bilateral pitting edema (swelling) of the legs and feet, giving a deceptively full or bloated appearance. Other signs include an enlarged belly, liver problems, and changes in hair color. It typically affects children after they are weaned from breastfeeding.
Marasmic Kwashiorkor: This is a combination of both conditions, where the person exhibits features of both marasmus and kwashiorkor, including both wasting and edema.
Differentiating marasmus and kwashiorkor
While both are severe forms of undernutrition, the differences in nutrient deficiencies and physical symptoms are significant. Healthcare professionals use these distinctions to aid in diagnosis and treatment planning.
| Feature | Marasmus | Kwashiorkor |
|---|---|---|
| Primary Deficiency | All macronutrients (calories, protein, fats) | Primarily protein |
| Appearance | Wasted, shriveled, emaciated | Puffy, swollen, often with a bulging belly |
| Fluid Retention | Minimal to none; may experience dehydration | Significant edema, especially in legs and face |
| Fat and Muscle | Severe loss of both subcutaneous fat and muscle mass | Muscle wasting present, but may be masked by edema |
| Age Group | Affects infants and very young children, often under 1 year | Common in children who have been weaned, typically over 18 months |
Symptoms and health consequences
The consequences of severe malnutrition extend far beyond the immediate physical signs. They impact nearly every system in the body, leading to a cascade of life-threatening complications.
- Weakened Immune System: One of the most immediate and dangerous effects is compromised immunity, which makes individuals highly susceptible to infections. Severe infections like pneumonia and diarrhea are frequent and often fatal complications in malnourished children.
- Cognitive and Developmental Impairment: In children, severe malnutrition can lead to permanent developmental delays and reduced intellectual ability. This can affect their long-term educational and economic potential.
- Metabolic and Organ Failure: The body’s organs, including the heart, liver, and kidneys, can fail as the body struggles to function with insufficient energy and nutrients. Conditions like hypoglycemia and severe electrolyte imbalances are medical emergencies.
- Refeeding Syndrome: During treatment, reintroducing nutrients too quickly can cause a dangerous and potentially fatal metabolic shift called refeeding syndrome. This requires careful medical supervision during rehabilitation.
Treatment and prevention
Treating severe malnutrition requires a careful, staged approach, especially to mitigate the risks of refeeding syndrome. The World Health Organization (WHO) outlines a 10-step protocol for inpatient care.
- Stabilization Phase: The initial focus is on treating immediate life-threatening conditions. This includes correcting hypoglycemia, hypothermia, and dehydration with specialized therapeutic fluids and formulas. Any infections are treated with broad-spectrum antibiotics, as malnourished individuals often show no typical signs of infection.
- Rehabilitation Phase: Once stable, the patient is transitioned to a high-energy, high-protein diet to promote weight gain and rebuild tissue. Ready-to-use therapeutic foods (RUTFs) are highly effective for this phase. Micronutrient deficiencies are also corrected with supplements.
- Follow-up and Prevention: Preventing relapse is key. This involves continued nutritional support, health education, and improving living conditions to address the root causes, such as poverty and food insecurity.
Preventing severe malnutrition is a multi-faceted challenge that requires a combination of public health strategies, economic development, and social support. Initiatives promoting proper infant and child feeding, improving sanitation, and ensuring access to clean water are vital for creating resilient, healthy communities.
Conclusion
In conclusion, the medical term for what is severe malnutrition called depends on its clinical signs. While marasmus signifies overall caloric and protein deficiency with severe wasting, kwashiorkor is characterized by protein deficiency leading to edema. A mixed presentation is marasmic kwashiorkor. All forms require urgent and delicate medical intervention to reverse the potentially irreversible physical and cognitive damage and improve survival rates.
What are the key distinctions between Marasmus and Kwashiorkor?
- Nutrient Deficiencies: Marasmus involves a severe deficiency of all macronutrients (protein, fats, carbohydrates), whereas Kwashiorkor primarily results from a severe protein deficiency.
- Physical Appearance: Marasmus leads to severe wasting and emaciation, while Kwashiorkor is characterized by swelling (edema), which can mask underlying muscle wasting.
- Underlying Cause: Marasmus is linked to long-term starvation or overall low food intake, while Kwashiorkor can occur even when a child consumes enough calories, but those calories lack sufficient protein.
Can a person recover from severe malnutrition?
Yes, with early detection and appropriate medical treatment, most individuals with severe malnutrition can recover. However, some long-term consequences, particularly cognitive and developmental delays in children, may be irreversible.
How is severe malnutrition in children diagnosed?
Diagnosis typically involves a physical examination to assess for visible signs like wasting and edema, measuring weight-for-height (or length) and mid-upper arm circumference (MUAC), and conducting blood tests to check for specific nutrient deficiencies.
What are the immediate risks of severe malnutrition?
Immediate risks include a compromised immune system leading to severe infections, as well as metabolic disturbances such as hypoglycemia (low blood sugar) and electrolyte imbalances.
What is Refeeding Syndrome, and why is it dangerous during malnutrition treatment?
Refeeding syndrome is a potentially fatal metabolic complication that can occur when nutrition is reintroduced too quickly after a period of starvation. The sudden shift can cause dangerous electrolyte fluctuations, leading to cardiac or respiratory failure.
Can someone be malnourished and still be overweight or obese?
Yes. Malnutrition refers to an imbalance of nutrients, which can be deficiencies (undernutrition) or excesses (overnutrition). A person who is overweight or obese can still have micronutrient deficiencies if their diet is low in vitamins and minerals.
What are the long-term consequences of severe malnutrition?
Long-term consequences can include permanent stunting in children, impaired cognitive development, and a higher risk of developing chronic diseases in adulthood, such as heart disease and diabetes.
How can severe malnutrition be prevented?
Prevention strategies include improving access to clean water and sanitation, promoting exclusive breastfeeding for the first six months, ensuring access to nutrient-dense complementary foods, and providing community-based health and nutrition support, especially in vulnerable populations.
