Kwashiorkor (malignant malnutrition, protein-calorie malnutrition also known as edematous malnutrition) is a condition characterized by the severe protein deficiency caused by its insufficient consumption with food.
Kwashiorkor is also known as edematous malnutrition as this condition is characterized by edema related to fluid retention and low oncotic pressure caused by protein insufficiency. Unlike marasmus, kwashiorkor develops when in general calorie intake per day is normal but there is a lack of protein sources in foods. The disease is usually seen in children. It is suggested that its prevalence is higher among kids who were withdrawn from breastfeeding as they receive food high in carbohydrates and low in protein. Other possible causes of kwashiorkor include the diseases that affect nutrients absorption and metabolism, though it is relatively rare.
It is not clear what causes kwashiorkor, however, insufficient protein content in diet is considered to be one of the causes. Protein in the blood creates oncotic pressure that holds the liquid part of blood within the blood vessels when oncotic pressure is too low the blood leak through the walls of the blood vessels into the interstitial tissues causing edema. Furthermore, proteins are necessary for the growth and development of the body so their deficiency leads to growth retardation and muscle wasting as the body has to use its own muscular system as a source of proteins.
This condition is very rare in countries where the food supply is adequate. On the contrary, the disease is relatively common in Africa and other countries with limited food sources.
In developed countries, insufficient protein consumption with food is not so common. In these countries in these countries, malnutrition may be caused by inadequate absorption of the nutrients or metabolism disorders including cystic fibrosis, liver diseases, chronic renal failure, etc. Some psychiatric disorders (for example, anorexia nervosa) may also contribute to inappropriate nutrition.
Symptoms of kwashiorkor become obvious when protein deprivation lasts for several weeks. They include:
- Loss of appetite (anorexia) and failure to thrive (cachexia);
- Muscle atrophy (loss of muscle mass);
- The large, distended abdomen also referred to as pot belly caused by ascites (fluid accumulation in the abdominal cavity related to low albumin levels in the blood);
- Generalized swelling (pitting edema), most prominent on the ankles and abdomen, hands may also be involved;
- Irritability and anxiety;
- Skin discoloration, cracked and patched skin with desquamative rash;
- Hair depigmentation, thinning of hair, it becomes sparse and brittle;
- Thinning of the nails, nails are soft with fissures;
- Loss of teeth;
- Enlarged fatty liver;
- Frequent skin infections due to immune dysfunction;
- Long-term wound healing;
The diagnosis is usually obvious based on the history and symptoms of protein deficiency.
Additional testing may be necessary to estimate nutrients deficiencies. Iron deficiency anemia is a common complication of protein malnutrition. Vitamin deficiencies may also develop.
Treatment should be initiated as soon as possible to provide the best outcomes for the child and prevent mental and physical retardation.
Kwashiorkor treatment should include the correction of the electrolytes and fluid imbalance. It is recommended to reintroduce food containing proteins slowly and give vitamins and mineral supplements.