Marasmus and kwashiorkor

Feature

Marasmus

Kwashiorkor

Age of onset 

<1 year old 

1-5 year old 

Cause

Calorie deficiency 

Protein deficiency 

Appearance 

Alert child

Lithargic child

Weight 

Severe weight loss

Moderate weight loss or

maintained weight with edema

Edema 

Not present 

Present (especially in

legs and abdomen)

Fatty liver

(Hepatomegaly)

Rare 

Common 

Wasting 

Visible

Masked due to edema

Appetite 

Good

Poor / Absent

Facial

appearance 

Monkey / Old man / Simian

facies (Buccal fat loss)

Moon face / Sugar baby appearance 

Skin changes

Baggy pants appearance 

(loose skin of the buttocks

hanging down)

Flaky paint dermatosis

Hair changes 

No characteristic changes

Flag sign / Black & white hair

(alternating bands of hypopigmentation)