Marasmus is a severe manifestation of protein-energy malnutrition. It occurs as a result of total calorie insufficiency. This leads to overt loss of adipose tissue and muscle. The child may have a weight-for-height value that is more than 3 standard deviations below the average for age or sex. A child with marasmus may develop pitting edema due to protein insufficiency, this is known as marasmic-kwashiorkor.