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.
What causes 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 anorexia,
and in older adults. According to the University of
Florida Health, many people in nursing homes lack enough protein in
their diet.
Where is it most common?
The condition is rare in the United States. Its prevalence
is highest in the following areas:
- Southeast
Asia
- Central
America
- Congo
- Puerto
Rico
- Jamaica
- South
Africa
- Uganda
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.
Symptoms of kwashiorkor
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
- dehydration
- 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
Diagnosis
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.
Kwashiorkor vs. marasmus
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.
Treatments
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.
Kwashiorkor
complications
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.
Summary
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.
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