Marasmus is a very common disease, especially in developing countries, and is the result of chronic malnutrition. Due to prolonged malnutrition, the nutritional status is disturbed. What are the consequences of this disease and how can it be combated?
What is marasmus?
Marasmus occurs primarily in children from infancy to five years of age living in developing countries. In developed countries, marasmus is a result of eating disorders. Protein-energy deficiency syndrome results from a permanent insufficient intake of calories. Gradually, the body depletes the energy and protein reserves. The protein and energy deficiency can lead to death if the diet of affected people does not change. Two types of marasmus can be distinguished. Alimentary marasmus involves significant malnutrition. If the affected person suffers from energy and protein malnutrition, it is called Kwashiorkor marasmus.
Causes
If the body is permanently undersupplied with food, not enough calories, vitamins, fats and trace elements can reach the organism. In developing countries, the disease occurs more frequently when children no longer receive breast milk and are dependent on normal food intake. As a result of malnutrition, the digestion process of the ingested food is also disturbed. Affected children suffer from a deficiency of digestive enzymes and bile acids, which impedes the absorption of fats through the intestines. Other causes of marasmus may include tumor disease, digestive system disease, or consumptive infectious diseases such as tuberculosis.
Symptoms, complaints and signs
The most common and visible sign of malnutrition is reflected in weight loss. The body does not have sufficient fat reserves from which energy could be obtained. The loss of muscle mass is faster because the body needs proteins to survive. The bloated abdomen and the older-looking, sunken face of the children are conspicuous. Affected individuals suffer from diarrhea and anal prolapse (the anal mucosa protrudes in front of the sphincter).
Diagnosis and course of the disease
The lack of energy seriously attacks metabolic processes, and digestive juices, urine, and hormones cannot be adequately produced. Due to the lack of food, the immune system is also not as resilient and performance is greatly reduced. The patient is more susceptible to numerous infections, which can also be fatal. The brain decreases in efficiency and hallucinations can occur. The person becomes apathetic and tends to lose consciousness. Cardiac arrhythmias, which are a result of the heart‘s lack of energy, lead to electromechanical decoupling. This is a common cause of death. Complaints of kwashiorkor include brittleness of the hair and hair loss, as well as decreased performance and impaired fertility. Fluid retention (edema) in the tissues is evident.
Complications
First and foremost, marasmus results in very severe weight loss. In any case, weight loss represents a very unhealthy condition for the patient’s body and should therefore be avoided at all costs. In the long run, this can lead to irreversible damage to the internal organs and finally, in the worst case, to the death of the patient. Those affected suffer primarily from a bloated abdomen and, furthermore, from diarrhea. The quality of life is significantly reduced by the marasmus. The ability to cope with stress also decreases and the patient suffers from severe fatigue and exhaustion. Children can also suffer from developmental disorders as a result of marasmus, which can lead to complications in adulthood. Similarly, malnutrition has a negative effect on the heart, so that cardiac death may occur. It is not uncommon for patients to also suffer from hair loss and hallucinations. Marasmus is treated by therapies and does not lead to success in every case. The success of the treatment usually depends on the duration of malnutrition and the damage present. Therefore, it is not uncommon for this disease to significantly reduce the patient’s life expectancy.
When to go to the doctor?
People who have taken in too little food for a long time, either consciously or due to circumstances, must always undergo an intensive medical examination. The low intake of food causes damage to the organism, which must be controlled and evaluated. If there are various deficiency symptoms, a feeling of illness or internal weakness, a doctor is needed. If the BMI is below the recommended guidelines, a doctor should be consulted. A low body weight combined with a strongly bulging abdomen are indications of existing irregularities that need to be examined and treated. If immediate vomiting or severe diarrhea is evident when feeding after a prolonged period of abstinence, medical attention is necessary. If there is lassitude, severe fatigue, and a loss of strength, a visit to the doctor should be made. Bowel irregularities should be examined and treated by a physician. If the affected person notices that the anal mucosa is outside the sphincter, he should consult a doctor immediately. Chronic malnutrition often manifests itself via severely aged facial features and sunken skin. No layer of fat can be felt below the upper layer of skin on the entire body. Medical attention is necessary, otherwise complications as well as premature death may occur.
Treatment and therapy
If marasmus is diagnosed, treatment follows the ten-step scheme developed by the WHO:
Due to the high loss of adipose tissue, patients are severely hypothermic. Thus, it is important to warm up and observe the body temperature. The low blood sugar levels are brought back into balance with the oral or intravenous administration of a sugar solution (glucose). The child is fed the glucose solution every two hours for at least one day. This therapy prevents further hypoglycemia. Dehydration, as the only symptom of the disease, cannot be treated according to the standard WHO regimen. Due to inadequate nutrition, the affected children are severely heart failure. When an oral rehydration solution is administered, the amount of sodium is very high. If too much sodium is supplied, the heart would be overloaded. Therefore, a modified rehydration solution is administered that contains little sodium but is very rich in potassium. Furthermore, patients must be given important vitamins and trace elements. The immune system is so severely weakened that infections are very difficult to recognize as such. By administering a broad spectrum antibiotic, even infections that are not visible are treated. Trace elements are increased in dose daily until iron is also administered in the second week of treatment. During the second week of therapy, protein and caloric intake must be increased to achieve an appropriate normal body size for the appropriate age. Children who suffered from marasmus show a decrease in growth and it also negatively affects their intelligence in adulthood. In order to diagnose marasmus, a self-test can be performed by the person in question. Has the person lost weight unintentionally lately, or eaten less food? At the first signs, a doctor should be consulted, who will clarify the symptoms in a conversation. If an examination takes place, a suspicion can be confirmed with the help of the Nutritional Risk Screening (NRS 2002). The physician then determines the severity of the condition and clarifies the cause of malnutrition. The life expectancy of malnourished individuals is severely limited. If the person is not treated in time, the organs of the body change, which in the worst case can lead to death.
Outlook and prognosis
Marasmus mainly affects children under the age of five. These live predominantly in poor conditions. Risk areas are located in Asia, Africa and Latin America. International organizations put the annual death toll at five million. Marasmus rarely occurs in the western industrialized nations. There, it is usually caused by severe illnesses and mental disorders. There are actually sufficient therapeutic approaches to combat marasmus. However, cases in which the disease has been present unnoticed for years appear to be problematic.Normalization of the body balance through therapies can then take a long time. Developmental deficits cannot always be completely remedied. Severe organic disorders may be irreparable. Particularly in countries where malnutrition stems from a shortage of food, there are inadequate supply systems. There, the outlook is poor, as evidenced by the high number of deaths. Malnutrition can also be caused by infections or tumors. The prospects of recovery then depend on the extent to which doctors can eliminate the disease of origin. Eating disorders also lead to marasmus. In this case, the success of treatment is based on the willingness to change one’s life. If left untreated, marasmus leads to a greatly shortened life expectancy.
Prevention
To prevent an outbreak of marasmus, it is important to inform and educate people, especially in developed countries. Malnutrition is not just a problem that exists in the developing world. People must be given access to a balanced and adequate diet. More attention must be paid to nutrition for people who cannot feed themselves, because malnutrition is a widespread problem, especially among the elderly or seriously ill patients.
Follow-up
Marasmus primarily causes rapid and severe weight loss in affected individuals. Due to the weight loss, the body is in a general unhealthy state. For this reason, during follow-up care with the treating physician, affected individuals should try to compensate for the weight loss and strengthen their general resilience. The quality of life of sufferers is significantly reduced. The help of relatives and friends in everyday life is indispensable. Affected persons suffer from fatigue and exhaustion. A balanced diet and a healthy lifestyle promote recovery. Treatment of marasmus does not lead to an improvement or cure of the disease in every case. Improvement depends on the severity of the damage as well as the duration of malnutrition. In many cases, the life expectancy of affected individuals is reduced because of this.
This is what you can do yourself
If marasmus is present, the affected person must be taken to a doctor immediately. The treatment developed by the World Health Organization can be supported by various measures. First, any dehydration must be compensated for by ensuring that the patient drinks enough fluids. Nutrient deficiencies can be compensated for by administering nutritional supplements, but also by a complete diet, which must be fed to the affected person very slowly. Since the immune system is usually severely weakened during the disease, the affected person must take it easy. A few days of bed rest, supported by regular visits to the doctor, are ideal. A balanced and wholesome diet can prevent renewed malnutrition. The prerequisite for this is that the circumstances for the marasmus are recognized and remedied. In this country, organizations such as the Tafel or community churches offer free or low-cost food. Affected persons can also turn to government offices and apply for assistance. If malnutrition occurs due to other circumstances, such as during a trip or due to illness, a doctor must be consulted in any case. The nutrient deficiency must be corrected as soon as possible to prevent long-term consequences.
