What is the difference between marasmus and kwashiorkor disease?

January 10, 2026 •

4 min read

According to the World Health Organization (WHO), malnutrition is responsible for nearly half of all deaths in children under five globally. Among the most severe forms are marasmus and kwashiorkor, two distinct diseases caused by protein-energy malnutrition (PEM). While both are devastating, understanding the specific differences between marasmus and kwashiorkor disease is crucial for proper diagnosis and effective treatment.

Quick Summary

Severe forms of malnutrition, marasmus stems from a general calorie and protein deficiency, leading to severe wasting and emaciation, while kwashiorkor is primarily a protein deficiency, characterized by edema, a distended belly, and fatty liver.

Key Points

Nutrient Deficiency: Marasmus results from a severe deficiency of all macronutrients (protein, carbs, and fats), while kwashiorkor is primarily caused by a protein deficiency.
Edema Presence: Kwashiorkor is uniquely characterized by edema, a swollen appearance caused by fluid retention, which is absent in marasmus.
Physical Appearance: Marasmus patients appear emaciated and severely wasted, often with a 'skin and bones' look, whereas kwashiorkor patients have a characteristic swollen belly and extremities.
Cause of Wasting: In marasmus, the body breaks down its own fat and muscle stores for energy, causing severe wasting, an adaptive response to starvation.
Liver Condition: Kwashiorkor often leads to an enlarged and fatty liver due to impaired protein synthesis and fatty acid metabolism, a feature not typically seen in marasmus.
Treatment Approach: Treatment for both must be gradual to prevent refeeding syndrome, but kwashiorkor requires cautious protein reintroduction to avoid overwhelming the compromised liver.
Long-term Effects: Both diseases can cause permanent physical and mental developmental issues if not treated early, though prognosis is generally better with timely and appropriate care.

Marasmus vs. Kwashiorkor: A Breakdown of Severe Malnutrition

Severe acute malnutrition (SAM) manifests in two primary forms, each with unique underlying causes and physiological consequences. Marasmus is the result of a severe deficiency of all macronutrients—proteins, carbohydrates, and fats—while kwashiorkor arises from a primary protein deficiency, even when caloric intake may be somewhat adequate. The distinct clinical features and pathophysiology of these conditions necessitate different approaches to treatment.

The Defining Characteristics of Marasmus

Marasmus, often referred to as "dry malnutrition," results from the body's prolonged attempt to adapt to starvation. When energy intake is insufficient, the body mobilizes its fat and muscle stores for fuel, leading to severe emaciation.

Key signs of marasmus include:

Visible Wasting: A dramatic loss of subcutaneous fat and muscle mass gives the child a 'skin and bones' or 'old man' appearance.
Emaciation: Ribs, spine, and facial bones become visibly prominent.
No Edema: Unlike kwashiorkor, fluid retention is absent.
Poor Growth: Stunted growth and developmental delays are prominent.
Altered Appetite: The child may be either irritable or have a seemingly voracious appetite in some cases.

The Pathophysiology of Kwashiorkor

Kwashiorkor, meaning "the sickness the baby gets when the new baby comes," often occurs when a child is weaned and transitioned to a high-carbohydrate, low-protein diet. The body's inability to synthesize proteins, particularly albumin, is a key feature of this condition.

The specific physiological processes include:

Hypoalbuminemia: Low levels of serum albumin reduce plasma osmotic pressure, causing fluid to leak from blood vessels into interstitial spaces, leading to edema.
Fatty Liver: Impaired synthesis of lipoproteins results in the accumulation of fat in the liver, causing hepatomegaly (liver enlargement).
Oxidative Stress: Deficiencies in essential amino acids and antioxidants contribute to cellular damage.
Altered Gut Microbiota: The balance of gut bacteria is disturbed, contributing to poor nutrient absorption.

A Comparative Look: Marasmus vs. Kwashiorkor


Feature	Marasmus	Kwashiorkor
Primary Deficiency	All macronutrients (protein, carbohydrates, fats).	Primarily protein deficiency, often with adequate or high carbohydrate intake.
Weight Loss	Severe wasting and significant underweight.	Moderate weight loss; actual weight can be masked by edema.
Appearance	Emaciated, skeletal, 'skin and bones'.	Swollen belly, face, hands, and feet due to edema.
Subcutaneous Fat	Markedly reduced or absent.	Often retained, giving a falsely plump appearance.
Edema	Absent.	Present, a defining characteristic.
Hair	Dry and sparse, but less discolored.	Brittle, sparse, and may turn reddish-yellow or white ('flag sign').
Skin	Dry and wrinkled.	Patches of 'flaky paint' dermatitis, often with hyperpigmentation or peeling.
Liver	Normal.	Enlarged and fatty (hepatomegaly).
Metabolism	Adapted for survival, with reduced basal metabolic rate.	Maladapted, with hormonal imbalances and dysfunctional protein synthesis.
Immune System	Compromised, but often less severely than in kwashiorkor.	Significantly impaired, leading to higher risk of severe infections.

Treatment and Outlook

Treatment for both conditions requires careful medical supervision, often in a hospital setting, to prevent refeeding syndrome, a potentially fatal complication. The World Health Organization (WHO) outlines a phased approach.

Initial Stabilization: Focuses on treating immediate life-threatening issues like hypoglycemia, hypothermia, dehydration, and infections. Special rehydration formulas (like ReSoMal) are used to correct electrolyte imbalances.
Nutritional Rehabilitation: Involves the slow, careful reintroduction of nutrients. For marasmus, a balanced refeeding formula is used, while for kwashiorkor, carbohydrates are introduced before protein to avoid overwhelming the system.
Follow-up and Prevention: A complete recovery plan includes ongoing support, nutritional education for caregivers, access to clean water, immunizations, and a consistent, balanced diet. Early intervention increases the chances of a full recovery, though children may experience lasting physical and mental developmental delays if treatment is delayed.

For more detailed information on global malnutrition and intervention strategies, refer to the World Health Organization's fact sheets on malnutrition.

Conclusion

While both marasmus and kwashiorkor fall under the umbrella of severe protein-energy malnutrition, their distinct physiological origins lead to different clinical presentations. Marasmus is characterized by severe wasting due to a total calorie and protein deficit, whereas kwashiorkor is defined by edema resulting from a primary protein deficiency. Effective treatment relies on a clear understanding of these differences and a careful, phased nutritional rehabilitation process. Early diagnosis and intervention are critical for improving long-term outcomes and minimizing permanent damage caused by these devastating diseases.

How to Prevent Kwashiorkor and Marasmus

Ensuring Adequate Nutrition: A balanced diet with sufficient protein, calories, and micronutrients is key.
Prolonged Breastfeeding: Exclusive breastfeeding for the first six months and continued breastfeeding with complementary feeding until age two helps prevent malnutrition in infants.
Nutritional Education: Promoting nutritional literacy, particularly in resource-limited areas, can help caregivers provide appropriate diets.
Public Health Initiatives: Addressing underlying issues like poverty, food insecurity, lack of sanitation, and widespread infectious diseases is essential for long-term prevention.
Early Medical Intervention: Monitoring child growth and seeking medical care for early signs of malnutrition can prevent progression to severe disease.

Frequently Asked Questions

The most significant differentiating sign is edema. A child with kwashiorkor will have characteristic swelling of the face, hands, feet, and a distended belly, while a child with marasmus will show severe emaciation and a 'skin and bones' appearance without edema.

Yes, it is possible for a child to suffer from a combination of both conditions, known as marasmic kwashiorkor. This hybrid state exhibits features of both edema and severe wasting.

The swollen abdomen, or edema, in kwashiorkor is primarily caused by hypoalbuminemia, or low levels of serum albumin protein. Albumin helps maintain plasma osmotic pressure; without enough, fluid leaks from the blood vessels into surrounding tissues.

While these diseases are most commonly associated with children in developing countries, adults can also develop them under conditions of severe starvation, chronic illness, or poor nutrition, such as in cases of anorexia nervosa or other underlying medical conditions.

A gradual reintroduction of nutrients is crucial to prevent refeeding syndrome. This is a dangerous and potentially fatal metabolic complication involving shifts in electrolytes and fluids that can occur when a severely malnourished body is refed too quickly.

Poverty, food scarcity, low maternal education, inadequate breastfeeding practices, recurrent infections, and living in regions affected by conflict or disaster are major risk factors for both marasmus and kwashiorkor.

The prognosis depends heavily on the severity and timeliness of treatment. Generally, kwashiorkor is considered more dangerous due to its systemic effects, including fatty liver and greater susceptibility to infection. Early intervention improves outcomes for both, but delays can lead to permanent developmental problems.