This refers to a range of different pathological conditions caused by a deficiency of protein. It varies in a form ranging from mild to severe. It is responsible for a lot of pathological conditions such as kwashiorkor, marasmus, or combination of the both.  We live in an era, where an average person eats a lot of junk due to tight work schedule or availability of fast foods and restaurants.

There are different classes of foods such as carbohydrates, proteins, vitamins, minerals and water that are essential for the vital growth of the human body. Intake of food deficient in any of these essential nutrients can cause various pathological conditions.

Forms of protein-energy malnutrition

There are 3 primary forms of protein-energy nutrition depending on the signs of symptoms present. The types of protein-energy malnutrition include:

  • Kwashiorkor
  • Marasmus
  • Marasmic- Kwashiorkor



This is a severe form of malnutrition that occurs as a result of protein deficiency. Itis is prevalent in undeveloped countries or developing countries. This disease is characterized by :

  • pitting edema (hand and feet),
  • enlarged liver infiltrate
  • distended abdomen
  • Hepatomegaly
  • thinning of the hair
  • teeth loss,
  • depigmentation of skin
  • dermatitis
  • sores
  • diarrhea,
  • Stunted growth
  • Anorexia and irritability.

The primary cause of the edema is due to lack of protein reducing the oncotic pressure that holds water in tissue; the excessive water loss leads to the development of edema in the also causes irregularities in the lymphatic system, it reduces its ability to recover fluid. The sites are due to hypoalbuminemia and enlarged fatty liver.

                                            Physical Examination for Kwashiorkor

  • Inspection: The medical practitioner performs an inspection of body organs top detect the presence of pathognomic symptoms such as sores, short stature, red or purple patches, peeling, cracking and sloughing of skin, and reddish hair.
  • Palpation-: During palpation, there are different irregularities that can be discovered in people suffering from this type of malnutrition.
  • Percussion: increase in the diameter of the liver due to hepatomegaly is the most common sign detected during percussion.
  • Auscultation: Muffled heart sounds and increased peristalsis are the most common symptoms heard during auscultation. Heart sound is muffled if there is an accumulation of fluid in the pericardial sac

                                               Laboratory Tests

There are numerous laboratory examinations performed for detecting this disease. The most common tests include:

  • Arterial blood gas
  • complete blood count
  • creatine clearance test,
  • serum creatine
  • serum   potassium
  • total protein level


The treatment option for kwashiorkor depends on the symptoms and severity of the disease. The treatment options include:


  • Antibiotics to treat infections
  • Increase dietary calorie intake, e. (carbohydrate, fat, sugar)
  • Eliminating electrolyte imbalance
  • Lactase
  • Vitamin and mineral supplements are essential for treating nutrient  deficiencies

                                            Complications of Kwashiorkor

When kwashiorkor is left untreated or detected late, it could lead to different complications such as:

  • Anemia
  • Coma
  • frequent infections
  • intellectual disability
  • physical ability,
  • poor wound healing
  • shock,
  • short statures
  • fatty liver



This is a form of severe malnutrition.. it is more common in children, especially in developing countries. The prognosis depends on its severity and time of detection.

Symptoms of Marasmus

There are different signs and symptoms presented by marasmus patients depending on the organs of the body affected. The signs and symptoms include:

  • Chronic diarrhea
  • respiratory infections
  • intellectual disability

                                              Causes of Marasmus

There are many etiologies linked to the development of marasmus such as:

  • Iron deficiency: This is more common in people eating foods deficient in iron or other vital nutrients.
  • zinc deficiency
  • Vitamin A deficiency: it could also affect the visual function of the patient especially in people living in tropical

                                         Risk Factors for Marasmus

The primary etiology of marasmus is a nutritional deficiency. However, there are some risk factors that increase the likelihood of someone having marasmus. The presence of any of this risk factors increases the chances:


  • Famine
  • Lactose insufficiency
  • Living in developing countries
  • Poverty
  • Illiteracy
  • infections

                                        Diagnosis of Marasmus

   There are numerous examination and tests carried out for the diagnosis of marasmus in people. The most common diagnosis includes:

 Physical examination: during a physical examination, the medical doctors try to detect evidence of malnutrition and stunted growth.

Weight: The weight of a child is considered pathological or marasmus when it is less than 60% of the standard value.

Fat Loss: There is an extreme fat loss in marasmus patient due to malnutrition and restricted calorie intake.

   Muscle wasting:  medical practitioners watch out for muscle wasting and other symptoms of malnutrition.

Underlying Infections:  it is necessary to diagnose the presence of underlying infections such otitis media or another malnutrition-related disease.

                                           Laboratory Findings for Marasmus

  • Blood glucose level,
  • hemoglobin level,
  • urinalysis
  • stool tests
  • electrolyte test


  • Diet: the primary aim of treatment is to correct electrolyte imbalance and eliminate malnutrition. There is numerous homemade natural treatment which includes the combination of dried milk powder, boiled water, and vegetable oil.


  • Rehydration: Marasmus can be treated by giving the patient Intravenous fluid to correct the malnutrition and electrolyte imbalance.

                                      Complications of Marasmus.


There are numerous complications of untreated marasmus. The most common ones include:

  • Stunted growth in child
  • joint deformities
  • severe weakness of the body
  • Visual Disabilities
  • organ failure
  • coma


This is when both the symptoms of kwashiorkor and marasmus are present in a child.      Children with this combined condition rapidly deteriorate with evident edema. Children with this condition have a weight that is below 60% of the median (50th centile).

                                     Mortality and Morbidity

WHO in 2000 estimated that 32% of children < 5 years old in developing countries are underweight   (182 millions of children). When measured regarding weight, around 150 million children younger than 5 years are malnourished. In the eastern African and South Asian, about half of children have growth retardation due to protein-energy malnutrition. Approximately 50 % of the 10 million deaths seen in developing countries each year is due to these conditions.

                                        Causes of Marasmic-Kwashiorkor

  • Dietary inadequacy: Most children suffer from protein deficiency due to the rapid transition from breastfeeding to regular
  • Poverty
  • Lack of Awareness
  • Poor weaning
  • Child Abuse
  • Infections such as diarrhea and measles
  • Aflatoxins

Signs and Symptoms of Marasmus

The clinical assessment is divided into three namely

  1. Constant manifestation
  2. Usual manifestation
  3. Occasional manifestation
  • Constant manifestations:These includes symptoms that are present for an extended period of time such as:Growth retardation, edema, poor muscle/fat ratio, psychomotor changes, hair changes, thin face, ribs and skin clearly visible through the skin, persistent dizziness, sunken eyes, diarrhea, frequent dehydration, severe wasting,and  loss of subcutaneous fat.
  • Usual manifestations: These includes common signs and symptoms which can be present in another disease. The signs and symptoms include Anorexia, vomiting, diarrhea, Increased pigmentation, ulceration, petechiae, hepatomegaly, anemia, deficiency of vitamin A, B, E and C, Poor resistance and increased risk for infections.
  • Occasional Manifestations: There are some signs and symptoms that occur occasionally and not pathognomic for marasmus.

                                        Laboratory Findings of Marasmus

  • plasma protein: There is a regular or reduced level of total plasma protein(less than 4mg/dl)
  • Albumin: There is a reduced level of albumin(less than 2mg/dl)
  • Urea: reduction of blood and urine urea is common in marasmus patient.
  • Hypokalemia: There is hypokalemia due to excessive fluid loss during diarrhea.
  • Hypoglycemia: Low glucose level due to deficiency of glycogen storage in the liver cells.

                                                 Treatments for Marasmus

The primary goal of treatment for marasmus is eliminating electrolyte dysbalance and rehydrating the patient. The treatment options include:

  1. Rehydration
  2. A balanced diet meal

This is a prevalent disease in developing countries that can be eliminated if detected early and appropriately treated.


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Hijazi, S. (1974). EVOLUTION OF KWASHIORKOR AND MARASMUS. The Lancet303(7867), 1175.

Mac Keith, R. (1953). MARASMUS TODAY. The Lancet261(6752), 196.