What are the symptoms of kwashiorkor and marasmus?

December 20, 2025 •

4 min read

Globally, nearly half of all deaths in children under five are linked to undernutrition, highlighting the critical importance of recognizing its different forms. Two of the most severe types, kwashiorkor and marasmus, present with distinct and dangerous symptoms that require immediate medical attention.

Quick Summary

Kwashiorkor is defined by swelling from severe protein deficiency, while marasmus is marked by extreme wasting due to overall calorie and nutrient insufficiency, with both carrying serious health risks.

Key Points

Protein vs. Calorie Deficiency: Kwashiorkor results primarily from a protein deficiency, leading to fluid retention (edema), while marasmus is caused by an overall calorie and nutrient deficiency, resulting in severe wasting.
Edema is a Key Indicator: Bilateral pitting edema, or swelling, is the most crucial distinguishing sign of kwashiorkor and is absent in marasmus.
Distinct Appearance: Kwashiorkor often presents with a swollen abdomen and mask-like edema on the face, whereas marasmus causes a severely emaciated, "old man" look with wrinkled skin.
Severe Wasting is Marasmus: Marasmus is defined by a visible and acute loss of body fat and muscle, with a child's weight falling significantly below standard norms.
Irreversibility: Long-term complications, such as physical and mental disabilities or stunted growth, are possible if treatment is delayed, especially in severe cases affecting children.
High-Risk Population: Young children, infants who are weaned too early, and people in areas with famine or chronic diseases are at the highest risk for both conditions.
Treatment Urgency: Both kwashiorkor and marasmus are medical emergencies requiring phased nutritional rehabilitation and treatment of underlying infections.

Severe malnutrition, or protein-energy undernutrition, manifests in two primary forms: kwashiorkor and marasmus. The ability to distinguish between these conditions is critical for proper diagnosis and life-saving intervention. While both are caused by a lack of adequate nutrients, their underlying causes and clinical presentations differ significantly.

Understanding Kwashiorkor Symptoms

Kwashiorkor, stemming from a severe protein deficiency, can develop even when a person's overall calorie intake is sufficient, a situation often seen when a child is weaned from protein-rich breast milk to a carbohydrate-heavy diet. The most defining symptom is edema, or swelling, which can tragically mask the underlying state of malnourishment.

Key Kwashiorkor Symptoms:

Edema: Swelling in the ankles, feet, hands, and face is a classic sign of kwashiorkor, caused by low levels of albumin in the blood.
Enlarged Abdomen: The abdomen often appears distended or bloated, known as a "pot belly," due to fluid accumulation (ascites) and an enlarged fatty liver.
Skin and Hair Changes: The skin can develop a flaky, peeling rash with discolored patches, sometimes described as having a "flaky paint" appearance. Hair may lose its color (turning reddish or pale) and become dry, brittle, and sparse.
Mental and Emotional State: Children may be irritable, lethargic, apathetic, and withdrawn.
Fatigue and Weakness: A lack of protein leads to muscle mass loss and overall weakness, though the swelling may hide this wasting.
Liver Enlargement: Infiltration of fat into the liver (hepatomegaly) is a common symptom.

Understanding Marasmus Symptoms

In contrast to kwashiorkor, marasmus is a result of a severe deficiency in all macronutrients, including protein, carbohydrates, and fats. This causes the body to deplete its own fat and muscle stores for energy, leading to a state of severe emaciation.

Key Marasmus Symptoms:

Extreme Wasting: The body appears severely underweight, with visible ribs, bones, and prominent joints, giving a "skin and bones" appearance.
Loss of Subcutaneous Fat: Fat and muscle mass waste away, leaving loose, wrinkled, and dry skin that hangs in folds.
"Old Man" Face: The face often takes on a wizened, aged appearance due to the severe loss of facial fat.
Apathy and Irritability: While some may appear withdrawn and apathetic, others, especially children, can be irritable.
Stunted Growth: In children, both height and weight are significantly below the expected rates for their age.
Diarrhea: Chronic diarrhea is a common symptom, which can further exacerbate malabsorption.
Appetite Changes: Appetite can vary, with some patients displaying ravenous hunger while others have anorexia.

The Combination: Marasmic Kwashiorkor

Some individuals may present with symptoms of both kwashiorkor and marasmus, a condition known as marasmic kwashiorkor. These patients exhibit both severe wasting and generalized edema, representing the most dangerous form of severe acute malnutrition. They are extremely underweight for their age, with a body weight below 60% of the standard for their age, and also show bilateral pitting edema.

Comparing Kwashiorkor and Marasmus Symptoms

The following table outlines the key differentiators between kwashiorkor and marasmus, based on their distinct clinical presentations.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Severe protein deficiency, often with adequate or high calorie intake.	Severe deficiency of all macronutrients and overall calories.
Edema (Swelling)	Present (especially in the ankles, feet, and face).	Absent.
Overall Appearance	Bloated or distended abdomen; muscle wasting is masked by fluid retention.	Severely emaciated, "skin and bones" look, with prominent ribs.
Subcutaneous Fat	Some fat reserves may still be present.	Severely depleted or virtually absent.
Skin Condition	Flaky, peeling, and discolored patches ("flaky paint").	Dry, thin, and wrinkled skin, hanging loosely in folds.
Appetite	Poor appetite is common.	Can be good, but anorexia may also be present.
Liver Condition	Often enlarged due to fatty infiltration.	No fatty enlargement of the liver.

Who is at Risk?

Globally, children in low-income countries are most vulnerable due to food scarcity, poor nutrition, and infectious diseases. Other at-risk groups include the elderly in long-term care, individuals with chronic illnesses (like cancer or AIDS), and those with eating disorders. Early intervention and education about balanced nutrition are crucial for prevention.

Potential Long-Term Complications

Untreated or prolonged cases of kwashiorkor and marasmus can lead to irreversible and devastating health complications. Children who survive may suffer from permanent growth stunting, cognitive impairments, and developmental delays. Both conditions severely compromise the immune system, leaving individuals susceptible to recurrent infections, which further deplete their energy reserves. Long-term effects can also include chronic diseases such as liver cirrhosis and cardiac failure. For further reading on the management of severe malnutrition, resources from the National Institutes of Health provide valuable insights into treatment protocols, such as those discussed in a publication on the topic.

Conclusion

Recognizing the distinct symptoms of kwashiorkor and marasmus is vital for addressing severe malnutrition. Kwashiorkor is defined by edema resulting from protein deficiency, while marasmus is characterized by extreme wasting due to overall calorie depletion. The combined form, marasmic kwashiorkor, is especially dangerous. These life-threatening conditions require immediate and comprehensive medical intervention to prevent long-term health complications. Addressing the root causes, including food insecurity and poverty, is essential for prevention and improving global health outcomes.

Frequently Asked Questions

The main difference is the primary nutrient deficiency. Kwashiorkor is a severe protein deficiency, while marasmus is a deficiency of all macronutrients (protein, carbohydrates, and fats). This leads to different key symptoms, notably the presence of edema in kwashiorkor and severe wasting in marasmus.

While both are life-threatening, kwashiorkor can be more dangerous in its later stages. The edema, hepatic dysfunction, and multisystem involvement can be more severe than the extreme wasting seen in marasmus.

A person with marasmus appears severely emaciated with a wasted, shriveled appearance. They have a near-complete loss of subcutaneous fat and muscle, and their skin is often loose and wrinkled.

Yes, both conditions can be treated, but require immediate and supervised medical care. Treatment involves correcting electrolyte imbalances, rehydration, and a gradual, careful nutritional rehabilitation phase to avoid life-threatening refeeding syndrome.

Severe protein deficiency in kwashiorkor causes low levels of albumin in the blood (hypoalbuminemia). This leads to a decrease in the osmotic pressure of the blood, allowing fluid to leak out of the blood vessels and accumulate in body tissues, causing swelling.

While most common in young children in developing regions, adults can also develop these conditions. In developed countries, adult cases may be linked to anorexia nervosa, chronic diseases, or neglect.

Marasmic kwashiorkor is a form of severe malnutrition that has features of both marasmus and kwashiorkor. Affected individuals show signs of both extreme muscle wasting and bilateral pitting edema.