Understanding Severe Malnutrition: What is a severe form of protein calorie malnutrition called?

October 9, 2025 •

5 min read

According to the World Health Organization, protein-energy malnutrition, particularly Severe Acute Malnutrition (SAM), contributes to a significant number of preventable deaths in young children annually. This highlights the critical importance of understanding and addressing the question: what is a severe form of protein calorie malnutrition called? The most profound types are known as marasmus, kwashiorkor, and a combined state, marasmic kwashiorkor.

Quick Summary

Severe forms of protein-calorie malnutrition are most commonly known as marasmus, kwashiorkor, and a combination called marasmic kwashiorkor, all under the umbrella of Severe Acute Malnutrition (SAM). Marasmus features severe wasting, while kwashiorkor is characterized by edema. Marasmic kwashiorkor presents with a mix of both symptoms.

Key Points

Severe Acute Malnutrition (SAM): The medical term encompassing the most severe forms of protein-calorie malnutrition.
Marasmus: Characterized by severe wasting of muscle and fat due to an overall deficiency of calories and protein, giving an emaciated appearance.
Kwashiorkor: Primarily caused by a protein deficiency, it is distinguished by edema (fluid retention) and a swollen abdomen, which can mask the underlying malnutrition.
Marasmic Kwashiorkor: The most severe form of malnutrition, combining the extreme wasting of marasmus with the edema of kwashiorkor.
Refeeding Syndrome: A potentially fatal complication during treatment, requiring a gradual reintroduction of nutrients under medical supervision.
Prevention: Strategies include improving food security, access to healthcare, and community education on nutrition and hygiene.

Severe Acute Malnutrition: The Umbrella Term

Protein-Calorie Malnutrition (PCM), also known as protein-energy malnutrition (PEM), occurs when there is an inadequate intake of protein and calories to meet the body's nutritional needs. While there are various degrees of severity, the most critical cases are categorized as Severe Acute Malnutrition (SAM). Within SAM, healthcare providers recognize three primary forms, which are differentiated by their specific clinical signs. These forms are marasmus, kwashiorkor, and the combined condition, marasmic kwashiorkor.

Marasmus: The Wasting Form

Marasmus, which derives from the Greek word meaning 'withering', is a form of PCM caused by a severe, overall deficiency of calories and all macronutrients—proteins, carbohydrates, and fats. It is most common in infants and young children and is characterized by a shrunken, emaciated appearance due to significant muscle and fat wasting.

Symptoms of marasmus include:

Pronounced muscle wasting, leaving bones visible beneath the skin.
Severe weight loss, often more than 40% of normal body weight.
A wizened, 'old man' face appearance due to the loss of cheek fat.
Loose, hanging folds of skin.
Stunted growth in children.
Apathy, lethargy, and weakness.
Frequent infections due to a compromised immune system.

Kwashiorkor: The Edematous Form

Kwashiorkor, named after a Ga word from Ghana meaning 'the sickness the baby gets when the new baby comes', is primarily caused by a severe protein deficiency, often with relatively adequate, or even high, calorie intake from carbohydrates. This form is distinguished by the presence of edema, or fluid retention, which can cause swelling in the ankles, feet, and face, and a characteristic bloated abdomen. This swelling can mask the underlying malnutrition.

Key features of kwashiorkor include:

Bilateral pitting edema in the legs and feet.
Distended abdomen due to ascites (fluid accumulation) and an enlarged liver.
Thin, dry, and peeling skin, often with hyperpigmentation.
Dry, brittle, and discolored hair that can fall out easily.
Irritability and anorexia.
Impaired immune function.

Marasmic Kwashiorkor: The Combination

Representing the most severe type of PCM, marasmic kwashiorkor exhibits characteristics of both marasmus and kwashiorkor. Individuals with this condition suffer from both severe muscle wasting and prominent edema. They are profoundly underweight and display the classic symptoms of both energy and protein deficiency, making it particularly life-threatening.

Causes and Risk Factors

Severe malnutrition is a complex issue with multiple contributing factors, often intertwined with social, economic, and environmental conditions. Key causes and risk factors include:

Poverty and food insecurity: A lack of access to sufficient and nutritious food is a primary driver.
Poor diet quality: In regions of food scarcity, diets may be high in low-cost carbohydrates but critically low in protein and micronutrients.
Infections and disease: Chronic or recurrent infections, such as measles, HIV/AIDS, and tuberculosis, can significantly increase the body's nutritional needs and impair nutrient absorption.
Lack of education: Insufficient knowledge about proper infant feeding practices, especially during weaning, can contribute to malnutrition in children.
Environmental factors: Natural disasters, war, and civil unrest disrupt food supplies and exacerbate living conditions, leading to widespread malnutrition.
Medical conditions: Certain medical disorders can affect nutrient absorption or increase metabolic demands, leading to secondary malnutrition.

Comparison of Severe Malnutrition Types


Feature	Marasmus	Kwashiorkor	Marasmic Kwashiorkor
Primary Deficiency	Severe deficiency of all macronutrients (protein, calories, fat).	Predominant deficiency in protein, often with adequate calories.	Severe deficiency of both protein and calories.
Physical Appearance	Emaciated, wasted, visibly thin with no subcutaneous fat.	Edematous (swollen) face, limbs, and abdomen.	A combination of extreme wasting and edema.
Body Weight	Significantly reduced weight-for-height (<60% or < -3SD).	Often normal or deceptively high weight-for-height due to fluid retention.	Significantly reduced weight, even with edema present.
Skin & Hair	Thin, dry, wrinkled skin, dry brittle hair.	Dermatitis, peeling skin, depigmentation of hair.	Displays skin lesions and poor hair quality.
Appetite	Often voracious but may be poor.	Typically poor appetite (anorexia).	Variable appetite, often poor.
Edema	Absent.	Present (bilateral pitting edema).	Present.

Diagnosis and Treatment

Diagnosing severe PCM relies on a combination of clinical signs, physical examination, and laboratory tests. Anthropometric measurements, such as Mid-Upper Arm Circumference (MUAC) and weight-for-height scores, are essential for classification. Lab tests can identify specific nutrient deficiencies and underlying infections.

Treatment follows a phased approach to manage the severe metabolic and physiological changes. Inpatient care is often required due to the risk of refeeding syndrome—a potentially fatal shift in fluid and electrolytes that occurs during refeeding.

Treatment Steps:

Stabilization: Correcting hypoglycemia, hypothermia, dehydration, and electrolyte imbalances is the first priority. Cautious rehydration and feeding are initiated using specific formulas like ReSoMal.
Nutritional Rehabilitation: Once stabilized, a slow increase in nutritional intake begins. Ready-to-use therapeutic foods (RUTFs) and special therapeutic milk formulas (e.g., F-75, F-100) are used to promote catch-up growth.
Follow-up and Prevention: Continued monitoring and support are critical after hospital discharge to prevent relapse. Caregiver education on nutrition, hygiene, and disease prevention is vital for long-term recovery.

Preventing Severe Malnutrition

Prevention is the most effective strategy for combating severe malnutrition. It involves a multi-faceted approach addressing the root causes and ensuring access to appropriate nutrition and healthcare.

Promote Breastfeeding: Exclusive breastfeeding for the first six months provides optimal nutrition and protects against infections.
Improve Access to Nutritious Food: Addressing poverty and food insecurity through economic development, food aid, and sustainable agriculture programs is crucial.
Enhance Public Health Education: Educating communities on balanced diets, proper hygiene, and the importance of protein and micronutrients can empower families to make healthier choices.
Provide Timely Healthcare: Ensuring access to healthcare, including immunizations and treatment for infections, can prevent the progression of nutritional deficiencies.
Identify and Screen Vulnerable Populations: Routine screening in clinics and communities can help identify at-risk individuals, especially children, and provide early intervention.

Conclusion

While the answer to what is a severe form of protein calorie malnutrition called includes specific terms like marasmus and kwashiorkor, it's important to understand the broader context of Severe Acute Malnutrition. These conditions, and particularly the combined form marasmic kwashiorkor, are life-threatening but can be treated with a structured, phased approach. However, the most effective long-term solution lies in proactive prevention, addressing the social, economic, and health factors that contribute to this global health crisis. For more detailed guidelines on diagnosis and treatment, consult the World Health Organization.

Frequently Asked Questions

Marasmus is caused by a severe deficiency in overall calories and protein, leading to extreme wasting of muscle and fat. Kwashiorkor is primarily a severe protein deficiency, resulting in edema (swelling) and fluid retention, which can mask weight loss.

Marasmic kwashiorkor is often considered the most severe form of protein-calorie malnutrition because it combines the extreme wasting seen in marasmus with the edema characteristic of kwashiorkor, resulting in a dual deficit.

Symptoms vary by type but can include severe weight loss, muscle wasting, fluid retention (edema), stunted growth, skin and hair changes, a compromised immune system, and extreme fatigue.

Infants and young children are most vulnerable, especially in low-income regions experiencing food insecurity. The elderly, individuals with chronic diseases, or those in crisis situations are also at high risk.

Diagnosis involves a clinical assessment of symptoms, a physical exam, and anthropometric measurements like Mid-Upper Arm Circumference (MUAC). In children, weight-for-height is often measured. Lab tests can identify nutritional deficiencies.

Treatment is phased and often starts with inpatient care to stabilize the patient, address infections, and correct electrolyte imbalances. This is followed by gradual refeeding using specialized therapeutic foods to help the body recover.

With proper and timely treatment, many children can make a strong recovery. However, long-term effects like stunted growth or cognitive impairment are possible, particularly if the malnutrition was severe or prolonged.