What type of disorder is marasmus and kwashiorkor? Exploring Severe Protein-Energy Malnutrition

October 16, 2025 •

4 min read

According to the World Health Organization (WHO), undernutrition accounts for nearly half of all deaths in children under 5 years of age, and severe forms like marasmus and kwashiorkor represent the most critical spectrum. What type of disorder is marasmus and kwashiorkor? Both are severe forms of protein-energy malnutrition (PEM), stemming from extreme deficiencies in calories and/or protein, predominantly affecting children in low-income areas.

Quick Summary

Marasmus and kwashiorkor are severe nutritional deficiency diseases classified as protein-energy malnutrition, primarily affecting children. While marasmus results from an overall calorie deficit, kwashiorkor is predominantly a protein deficiency that causes edema.

Key Points

PEM Manifestations: Marasmus and kwashiorkor are severe forms of protein-energy malnutrition (PEM), typically affecting children in resource-limited settings.
Distinct Features: Marasmus is defined by extreme wasting and overall calorie deficiency, while kwashiorkor is characterized by bilateral edema due to severe protein deficiency.
Refeeding Danger: The risk of refeeding syndrome—a life-threatening electrolyte imbalance—makes gradual, monitored nutritional rehabilitation essential for treatment.
Comprehensive Treatment: Treatment for severe cases involves a multi-step process including initial stabilization, infection management, and gradual nutritional rehabilitation under medical supervision.
Prevention Focus: Preventing marasmus and kwashiorkor requires addressing root causes like poverty, food scarcity, and poor public health infrastructure through education and policy.
Long-Term Impact: Without timely and correct treatment, these conditions can lead to lasting physical and intellectual stunting, developmental delays, and other chronic health issues.

Understanding Protein-Energy Malnutrition (PEM)

Protein-energy malnutrition (PEM) describes a wide spectrum of disorders caused by a deficiency of protein and energy. Marasmus and kwashiorkor represent two distinct, yet sometimes overlapping, manifestations of severe acute malnutrition (SAM). These conditions are most prevalent in resource-limited countries, particularly affecting infants and young children. PEM compromises the immune system, making individuals highly vulnerable to infections, which can worsen their nutritional status.

What is Marasmus?

Marasmus is a form of severe undernutrition resulting from a total lack of calories, protein, and other nutrients. It is characterized by severe wasting, where the body consumes its own muscle and fat tissues for energy. The term comes from the Greek word marasmos, meaning 'withering'. While it can affect individuals of any age who lack sufficient overall nutrition, it is most common in infants under one year old.

Clinical signs of marasmus include:

Wasting: Extreme loss of muscle mass and subcutaneous fat, leaving the individual looking emaciated and shrunken.
Visible Bones: The skeletal structure, particularly the ribs, becomes prominent under the skin.
Skin and Hair Changes: Dry, wrinkled skin that hangs in loose folds, resembling an 'old man's' face in children. Hair may be dry and sparse.
Altered Appetite: Individuals may have a voracious appetite despite their appearance, though some can develop anorexia.
Lethargy and Apathy: Severe fatigue and a general lack of energy are common symptoms.
Stunted Growth: Children experience severely stunted growth and may have developmental delays.

What is Kwashiorkor?

Kwashiorkor is a type of PEM resulting primarily from a severe protein deficiency, often with relatively adequate calorie intake from carbohydrates. It typically occurs in children who have been weaned from breastfeeding and are given a high-carbohydrate, low-protein diet, often when a new sibling is born. It is most prevalent in children between the ages of 6 months and 3 years.

The defining feature of kwashiorkor is edema, or fluid retention, which can mask the underlying wasting. This swelling is caused by a lack of protein (specifically albumin) in the blood, which leads to fluid leaking into the tissues.

Clinical signs of kwashiorkor include:

Edema: Bilateral pitting edema, particularly in the ankles, feet, hands, and face, and a distended belly.
Muscle Wasting: Despite the bloated appearance, there is a significant loss of muscle mass, which is often hidden by the edema.
Hair and Skin Discoloration: Changes in hair texture and color (often reddish or yellowish), sparse hair, and dermatosis, which may look like flaky paint peeling off.
Enlarged Liver: Caused by fatty deposits in the liver due to impaired synthesis of lipoproteins.
Irritability and Apathy: Children are typically lethargic and irritable.
Poor Appetite: Unlike marasmus, a poor appetite is a common symptom.

Key Differences: Marasmus vs. Kwashiorkor

While both are severe forms of malnutrition, their distinct physiological effects and clinical presentations are important for diagnosis and treatment. The presence of edema is the most critical differentiator in clinical settings.

Comparison of Marasmus and Kwashiorkor


Feature	Marasmus	Kwashiorkor
Primary Deficiency	Total caloric and nutrient intake.	Severe protein deficiency, often with adequate calories.
Defining Symptom	Severe muscle and fat wasting.	Bilateral pitting edema (swelling).
Appearance	Emaciated, shrunken, and withered, often with visible bones.	Puffy, swollen limbs, face, and abdomen, masking wasting.
Subcutaneous Fat	Markedly absent or severely depleted.	Still present, though muscle mass is lost.
Appetite	Can be voracious, though sometimes poor.	Poor appetite (anorexia) is common.
Liver	No fatty liver.	Enlarged and fatty liver is common.
Age of Onset	Typically affects younger infants (under 1 year).	More common in toddlers (6 months to 3 years) post-weaning.

The Dangers of Refeeding Syndrome

Upon treatment, malnourished individuals, particularly those with marasmus, face a high risk of refeeding syndrome. This is a potentially fatal complication caused by rapid fluid and electrolyte shifts as the body re-establishes normal metabolic function. The reintroduction of carbohydrates triggers insulin secretion, which causes a rapid shift of electrolytes like potassium, phosphate, and magnesium from the bloodstream into cells. This can lead to serious cardiac, respiratory, and neurological problems. For this reason, nutritional rehabilitation must be carefully managed and monitored, beginning with slow, incremental feeding.

Treatment and Prevention

The treatment of both marasmus and kwashiorkor is a phased process, typically beginning in a hospital setting for severe cases. The World Health Organization outlines a 10-step approach focusing on initial stabilization and gradual nutritional rehabilitation.

Phased treatment approach:

Stabilization Phase: This initial 1-2 day period focuses on treating life-threatening issues like hypoglycemia, hypothermia, dehydration (using special low-sodium formulas like ReSoMal), and infection with broad-spectrum antibiotics. Deficiencies in key vitamins and minerals are also corrected.
Nutritional Rehabilitation: Once the patient is stable, feeding is gradually increased. Ready-to-use therapeutic foods (RUTFs) provide energy-dense nutrition that promotes catch-up growth. Caregivers are trained on proper feeding techniques.
Follow-up and Prevention: Education is provided to prevent recurrence, addressing issues like food and water hygiene, breastfeeding support, and disease prevention.

Preventing PEM requires a multifaceted approach that addresses the root socioeconomic and public health issues. Promoting nutritious diets, improving food security, and increasing health education are critical strategies.

Conclusion

Marasmus and kwashiorkor are severe nutritional disorders representing the two primary types of protein-energy malnutrition (PEM). While marasmus stems from an overall caloric deficit and presents with severe wasting, kwashiorkor is primarily a protein deficiency characterized by edema. The distinction is crucial for diagnosis and treatment, which must be carefully managed to prevent fatal complications like refeeding syndrome. Ultimately, addressing the underlying issues of poverty, food insecurity, and poor hygiene is vital for preventing these devastating conditions globally. More information on global health issues related to malnutrition can be found via reputable sources like the World Health Organization.

Frequently Asked Questions

The primary difference lies in the nature of the nutritional deficiency. Marasmus is caused by a severe deficiency of all macronutrients, including calories and protein, leading to extreme wasting. Kwashiorkor is caused by a severe protein deficiency, often with an adequate or near-adequate intake of calories from carbohydrates, resulting in edema (swelling).

No, marasmus and kwashiorkor are not contagious. They are nutritional deficiency disorders and cannot be spread from person to person.

While these conditions most commonly affect children, adults can develop them under specific circumstances. In developed countries, marasmus can occur in elderly individuals, those with chronic illnesses, or severe eating disorders like anorexia. Kwashiorkor in adults is rare but can be associated with certain medical conditions or bariatric surgery.

Refeeding syndrome is a dangerous and potentially fatal complication that can occur when severely malnourished individuals begin to eat again. The sudden metabolic shift can cause severe electrolyte imbalances (especially low phosphate, potassium, and magnesium), leading to heart failure, respiratory distress, and other serious issues.

Survivors may experience long-term consequences, including stunted growth, persistent growth impairment, and developmental delays. There is also a higher risk for chronic diseases later in life, such as obesity and diabetes. Recovery is possible, but early intervention is key to minimizing these effects.

Diagnosis primarily relies on clinical examination and anthropometric measurements, such as weight-for-height and mid-upper arm circumference. The presence or absence of bilateral pitting edema is a key factor distinguishing kwashiorkor from marasmus. Blood tests can also help identify specific nutrient deficiencies and electrolyte imbalances.

Prevention requires a multi-pronged approach involving access to adequate and diverse food, public health education, and efforts to combat poverty. Promoting breastfeeding, teaching proper weaning practices, and improving sanitation are also critical preventive measures.