[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Nutritional pathology](https://durgical.com/en/general-pathology/#a-nutrition) › Severe acute malnutrition: marasmus and kwashiorkor [General pathology](https://durgical.com/en/general-pathology/) · [Nutritional pathology](https://durgical.com/en/general-pathology/#a-nutrition) # Severe acute malnutrition: marasmus and kwashiorkor - Topic Children who lack enough food waste away (marasmus) or swell with oedema (kwashiorkor); both weaken immunity and can be fatal. Updated 2026-11-01 ## Key points - Marasmus = wasting without oedema; kwashiorkor = oedema, fatty liver, skin and hair changes. - Fatty liver in kwashiorkor: too few apolipoproteins to export triglyceride. - Malnutrition is the commonest cause of secondary immunodeficiency worldwide. - Refeeding syndrome: hypophosphataemia, hypokalaemia, heart failure and arrhythmia. ## What it is Severe acute malnutrition remains a major cause of child death in low-income settings, and in Colombia it still affects children in areas such as La Guajira. Marasmus is a lack of total energy with severe wasting; kwashiorkor shows oedema, fatty liver and skin changes, classically when protein is especially lacking, often triggered by infection. Both cause atrophy of many organs and a secondary immunodeficiency. ## Key facts - Marasmus: loss of muscle and subcutaneous fat, «skin and bones», old-looking face; serum albumin near normal; no oedema. - Kwashiorkor: pitting oedema, low albumin, large fatty liver, flaky-paint skin, sparse light-coloured hair with bands of colour. - Both: small intestine villous atrophy (diarrhoea), thymic atrophy with low T-cell immunity, anaemia and micronutrient deficiencies. - Brain growth may be impaired when malnutrition occurs in the first years of life. ## Step by step - Intake falls short of needs; glycogen is used in hours, then fat, then muscle protein. - Insulin falls and cortisol rises: muscle is broken down to feed the liver. - In kwashiorkor the liver makes too little albumin and apolipoproteins: oedema and fatty liver. - Mucosal and thymic atrophy cripple barriers and T cells: diarrhoea, pneumonia and measles become deadly. - Fast refeeding shifts phosphate, potassium and magnesium into cells: refeeding syndrome. ## Marasmus and kwashiorkor compared | Form | Main deficit | Oedema and albumin | Liver | Skin and hair | | --- | --- | --- | --- | --- | | [Marasmus](https://durgical.com/en/conditions/marasmus/) | Total energy | No oedema; albumin near normal | Normal size | Thin, loose skin; muscle and fat wasted | | [Kwashiorkor](https://durgical.com/en/conditions/kwashiorkor/) | Relatively more protein, often with infection | Pitting oedema; low albumin | Enlarged, fatty | Flaky-paint dermatosis; sparse, pale hair with colour bands | ## Memory aid Marasmus melts the child away; kwashiorkor swells the belly and the legs. ## Test yourself Think of the answer, then tap the question to see it. ## Why does a child with kwashiorkor have a fatty liver? Without enough protein the liver cannot make the apolipoproteins needed to export triglycerides as VLDL. ## Which feature best separates kwashiorkor from marasmus? Oedema with low albumin; the marasmic child is wasted but has no oedema. ## Which electrolyte typically falls dangerously during refeeding of a malnourished patient? Phosphate, which moves into cells when insulin rises; potassium and magnesium also fall. ## Why do malnourished children die of common infections? Thymic and mucosal atrophy weaken T-cell immunity and barriers, and micronutrient deficiencies add to the problem. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/general-pathology/severe-acute-malnutrition-marasmus-and-kwashiorkor/) ## Related - [Atrophy](https://durgical.com/en/general-pathology/atrophy/) - [Fatty change (steatosis)](https://durgical.com/en/general-pathology/fatty-change/) - [Cachexia, anorexia nervosa and bulimia](https://durgical.com/en/general-pathology/cachexia-anorexia-nervosa-and-bulimia/) - [Vitamin deficiencies: what each one does to tissue](https://durgical.com/en/general-pathology/vitamin-deficiencies-what-each-one-does-to-tissue/) - [Edema and effusions: the four mechanisms](https://durgical.com/en/general-pathology/edema-and-effusions-the-four-mechanisms/) ## Related conditions - [Marasmus](https://durgical.com/en/conditions/marasmus/) - [Kwashiorkor](https://durgical.com/en/conditions/kwashiorkor/) - [Refeeding syndrome](https://durgical.com/en/conditions/refeeding-syndrome/) - [Failure to thrive (faltering growth)](https://durgical.com/en/conditions/failure-to-thrive/) - [Malnutrition and unintentional weight loss in older adults](https://durgical.com/en/conditions/malnutrition-and-unintentional-weight-loss-in-older-adults/) - [Vitamin A deficiency (night blindness and xerophthalmia)](https://durgical.com/en/conditions/vitamin-a-deficiency/) - [Zinc deficiency (acrodermatitis enteropathica)](https://durgical.com/en/conditions/zinc-deficiency/) - [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/) - [Acute (viral) gastroenteritis](https://durgical.com/en/conditions/acute-gastroenteritis/) - [Dehydration in children (acute diarrhoeal disease)](https://durgical.com/en/conditions/dehydration-in-children/) - [Measles](https://durgical.com/en/conditions/measles/) ## Elsewhere in DurgiPedia - [Fed, fasting and starvation states](https://durgical.com/en/biochemistry/topics/fed-fasting-and-starvation-states/) - [Prolonged fasting and starvation](https://durgical.com/en/physiology/prolonged-fasting-and-starvation/) - [Protein quality and essential amino acids](https://durgical.com/en/biochemistry/topics/protein-quality-and-essential-amino-acids/) - [Nitrogen balance and body protein](https://durgical.com/en/physiology/nitrogen-balance-and-body-protein/) - [Albumin](https://durgical.com/en/biochemistry/enzymes/albumin/) - [Secondary immunodeficiency: HIV, malnutrition, drugs, asplenia](https://durgical.com/en/immunology/secondary-immunodeficiency-hiv-malnutrition-drugs-asplenia/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Fact sheets - Malnutrition](https://www.who.int/news-room/fact-sheets/detail/malnutrition) (World Health Organization, 2026); [Kwashiorkor: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001604.htm) (MedlinePlus, US National Library of Medicine, 2026); [Malnutrition: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000404.htm) (MedlinePlus, US National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/severe-acute-malnutrition-marasmus-and-kwashiorkor/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/severe-acute-malnutrition-marasmus-and-kwashiorkor/