Kwashiorkor is a form of acute malnutrition that occurs due to protein deficiency.
Kwashiorkor is a serious condition that can happen when a person does not consume enough protein. Severe protein deficiency can lead to fluid retention, which can make the stomach look bloated.
Kwashiorkor is most common in children, especially if they do not have access to adequate nutrition soon after they stop breastfeeding. If a child experiences kwashiorkor, they need immediate medical attention.
Other terms for kwashiorkor include:
- protein malnutrition
- malignant malnutrition
- protein-calorie malnutrition
In this article, we look at the causes, prevalence, diagnosis, and treatment of kwashiorkor.
Kwashiorkor is the result of severe malnutrition or lack of protein. It is different than marasmus, a form of malnutrition that is due to lack of calories.
Proteins are responsible for maintaining fluid balance in the body. Insufficient protein causes fluid to shift to areas of the body that it should not be in, where it accumulates in the tissues. A fluid imbalance across the walls of capillaries can lead to fluid retention, or edema.
The exact cause of the condition is not clear, but experts have associated it with diets consisting mainly of maize, cassava, or rice. A lack of dietary antioxidants may also contribute.
Kwashiorkor usually occurs after a child stops breastfeeding, and before they reach 4 years of age. It may occur then because the child is no longer getting the same nutrients and proteins from their diet.
It is most common in areas with low food supplies and high rates of malnutrition.
There have also been cases of kwashiorkor resulting from eating disorders, such as
Where is it most common?
The condition is rare in the United States. Its prevalence is highest in the following
- Southeast Asia
- Central America
- Puerto Rico
- South Africa
Kwashiorkor may occur in areas in which there is a limited food supply or a lack of official guidance about nutrition.
It is more common in areas that experience low food security, possibly due to a natural disaster, drought, conflict, or low economic activity.
Children with kwashiorkor often have very little body fat, but this is not always the case.
Edema can mask how little body weight a child has. The child may appear to be a typical weight or even plump, but this appearance is swelling due to fluid, not the presence of fat or muscle.
Symptoms may include:
- loss of appetite
- changes in the color of the hair, which may appear yellow or orange
- pitting edema or swelling, usually on the legs and feet, when pressing the skin leaves a finger mark
- lack of muscle and fat tissues
- lethargy and irritability
- dermatosis, or skin lesions that are cracked, flaky, patchy, depigmented, or have a combination of these characteristics
- frequent skin infections or slow healing wounds
When diagnosing kwashiorkor in a child, doctors begin by taking a medical history and performing a physical examination.
They will look for the characteristic skin lesions or rash, as well as edema on the legs, feet, and, sometimes, the face and arms. They will also measure how the child’s weight relates to their height.
In some cases, the doctor may order blood testing for electrolyte levels, creatinine, total protein, and prealbumin.
Typically, however, it is possible to diagnose kwashiorkor from a child’s physical symptoms and a description of their diet.
Children with kwashiorkor tend to have low blood sugar levels, as well as low levels of protein, sodium, zinc, and magnesium.
There are three forms of acute malnutrition:
- Marasmus: Severe weight loss and muscle wasting due to lack of nutrition and calories.
- Kwashiorkor: Swelling or edema due to water retention from lack of protein.
- Marasmic-kwashiorkor: A combination of muscle wasting and bilateral edema.
According to the worldwide relief organization Unicef, marasmus is the most common form of acute malnutrition in food shortage emergencies. This condition affects both children and adults.
These conditions are severe forms of malnutrition that require urgent treatment.
Although kwashiorkor is a condition that relates to malnutrition, merely feeding a child or adult will not correct all of the deficiencies and effects of the condition.
If a child has been living without sufficient protein and nutrients for a long time, they can find it difficult to take in food. It is, therefore, essential to reintroduce food carefully to avoid refeeding syndrome.
Refeeding syndrome involves life threatening electrolyte and fluid shifts that occur with rapid refeeding of malnourished individuals.
Many children with kwashiorkor will also develop lactose intolerance. As a result, they may need to avoid milk products or take enzymes so that their body can handle milk.
Doctors treating the condition will first give carbohydrates, then add in proteins, vitamins, and minerals. The reintroduction of food may take a week or more to accomplish safely.
Additionally, if a child’s condition is so advanced that they are in shock, with low blood pressure and a high heart rate, they may need to take medication to support their blood pressure.
Without treatment, kwashiorkor can lead to the following complications:
- cardiovascular problems
- urinary tract infections
- gastrointestinal problems
- an enlarged liver, known as hepatomegaly
- loss of immune system function
- impaired cellular functions
- electrolyte imbalances
Children with kwashiorkor may not grow to an expected height due to malnutrition at an early age.
The condition also makes a person more vulnerable to infection, which, alongside a weakened immune system, can lead to life threatening complications.
Early diagnosis and treatment will improve a person’s outlook.
Kwashiorkor is a type of severe malnutrition that is most common in children. It occurs due to a lack of protein in the diet, which affects the balance and distribution of fluids in the body and often leads to a swollen belly.
Effective treatment can usually reverse many of the signs and symptoms of kwashiorkor. It is important to reintroduce foods slowly and carefully to avoid refeeding syndrome.