How Does Kwashiorkor Develop in the Human Body?
Kwashiorkor's Definition: Kwashiorkor disease is a form of severe protein malnutrition and is characterised by oedema and an enlarged liver with fatty infiltration. It is most often seen in regions which experience famine. Kwashiorkor usually is associated with a deficiency of protein in a regular diet. Patients suffering from kwashiorkor have an extremely emancipated appearance throughout the body except their ankles, belly and feet which swell with fluid. If treated early, they can recover completely. The treatment generally involves introducing extra calories and protein into the diet. However, children who contract the disease may not show proper growth and development and if treatment is delayed then complications can be anything from permanent mental and physical disabilities to coma; it can be life-threatening.
Kwashiorkor causes/ What causes Kwashiorkor Disease?
Kwashiorkor is caused by a deficiency of protein in the diet. The human body needs protein to create new cells and repair cells. It is especially important for growth during childhood and pregnancy. Proteins are also responsible for maintaining fluid balance in the body. Insufficient protein intake can cause a fluid shift to areas of the body that it should not be and it accumulated in tissues. The fluid imbalance across the walls of capillaries can lead to fluid retention or oedema.
This disease is rare in developed countries such as the UK or the US, however, it can occasionally happen due to severe neglect, long-term illness and a lack of knowledge about nutrition or a restricted diet.
Kwashiorkor Disease Symptoms
The signs and symptoms of Kwashiorkor
Change in skin and hair colour (to a rust colour) and texture
Diarrhoea
Loss of muscle mass
Fatigue
Failure to grow or gain weight
Irritability
Dermatosis or skin lesions that are cracked, flaky, patchy, depigmented, or have a combination of these characteristics
Oedema (swelling) of the ankles, feet, and belly
Damaged immune system, which can lead to more frequent and severe infections
Shock
Kwashiorkor is generally triggered by diarrhoea, malaria, or pneumonia and the clinical picture is characterised by apathy, anorexia, soft oedema of feet, legs, hands, arms, and face caused by hypoalbuminemia; hepatomegaly with fatty liver commonly occurs.
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Diagnosis of Kwashiorkor
The disease can easily be diagnosed on the basis of a child's physical appearance and questions about their diet and care.
A blood test and urine test can be done to rule out other conditions. This can include tests to:
Measurement of blood sugar and protein levels in the body.
Investigation on how the liver and kidneys are functioning by testing the urine and blood for anaemia.
Measurement of vitamin and mineral levels in the body.
Other tests may include growth measurements, calculating body mass index (BMI), and measuring body water content, taking a sample of skin (biopsy) or hair for testing.
Kwashiorkor Treatment
In the early stages, kwashiorkor can be treated with either specially formulated milk-based feeds or ready-to-use therapeutic food (RUTF).
RUTF is made up of milk powder, peanut butter, vegetable oil, sugar and added vitamins and minerals. Hospitalisation is needed where there are already complications, such as infections.
Hospital treatment involves:
Treating or preventing low blood glucose level
Kwashiorkor can make it harder to generate body heat so one treatment is keeping the person warm.
Treating dehydration with specially formulated rehydration solution
Treating infections with antibiotics – kwashiorkor increases the risk of infections
Treating mineral and vitamin deficiencies – vitamin supplements are usually included in the special milk feeds and RUTF
Introducing small amounts of food and then gradually increasing the amount of food.
The complete course of treatment takes around 2 to 6 weeks.
Complications of Kwashiorkor
In some patients, especially infants and children, complications of untreated or poorly controlled kwashiorkor can be serious and even life-threatening in some cases. The risk can be minimised by following the structured treatment plan.
The complications of kwashiorkor include:
Frequent infections
Intellectual and physical disability
Urinary tract infections
Poor wound healing
Short stature
Anemia (low red blood cell count)
Coma
Shock
Steatohepatitis (fatty liver)
Electrolyte imbalance
FAQs on Kwashiorkor: Causes, Symptoms, and Prevention
1. What is Kwashiorkor and what is its primary cause?
Kwashiorkor is a severe form of malnutrition, specifically a type of protein-energy malnutrition (PEM). Its primary cause is an inadequate intake of protein in the diet, even when the intake of calories from carbohydrates might be sufficient. This condition often develops in young children who are weaned from protein-rich breast milk to a diet high in carbohydrates but low in essential proteins.
2. What are the most common symptoms of Kwashiorkor in children?
The most characteristic symptoms of Kwashiorkor are a direct result of protein deficiency. Key indicators include:
- Edema: Swelling caused by fluid retention, especially in the legs, feet, and face, and a characteristically swollen or 'pot' belly.
- Skin Lesions: Dermatosis that resembles flaky paint, with skin peeling off in patches.
- Hair Changes: Hair may become brittle, change colour to a reddish-orange or yellow (flag sign), and fall out easily.
- Lethargy and Irritability: Affected children often appear apathetic, listless, and easily irritable.
- Muscle Wasting: Despite the swelling, there is significant loss of muscle mass.
- Fatty Liver: An enlarged liver due to fat accumulation.
3. Why does Kwashiorkor cause a swollen 'pot belly' (edema) in a malnourished child?
The 'pot belly' in Kwashiorkor is a classic example of edema, which is swelling caused by excess fluid trapped in the body's tissues. This happens because of a severe lack of protein, particularly albumin, in the blood. Albumin is crucial for maintaining the correct osmotic pressure, which keeps fluid within the blood vessels. When albumin levels drop, the osmotic pressure decreases, causing fluid to leak out of the capillaries and accumulate in surrounding tissues, most noticeably in the abdomen and lower limbs.
4. How can Kwashiorkor be effectively prevented and treated?
Prevention and treatment both centre on nutrition.
- Prevention: The most effective prevention is ensuring a balanced diet rich in high-quality protein. This includes foods like eggs, meat, fish, milk, legumes (beans, lentils), and soy products, especially for children after weaning. Public health education on dietary needs is crucial.
- Treatment: Treatment must be gradual. It involves a phased approach starting with restoring fluid and electrolyte balance and treating any infections. Dietary rehabilitation begins with providing calories from carbohydrates and fats, followed by a slow and careful reintroduction of protein to avoid overwhelming the child's weakened metabolic system.
5. What is the main difference between Kwashiorkor and Marasmus?
While both are forms of severe malnutrition, their causes and primary symptoms differ significantly. The main difference lies in the specific nutrient deficiency.
- Kwashiorkor is caused primarily by a severe protein deficiency, while calorie intake may be adequate. Its defining symptom is edema (swelling), particularly a pot belly.
- Marasmus is caused by a severe deficiency of all major nutrients—proteins, carbohydrates, and fats—leading to an energy deficit. Its defining symptom is severe wasting of muscle and body fat, resulting in an emaciated, 'skin and bones' appearance, without edema.
6. Which age group is most commonly affected by Kwashiorkor and why?
Kwashiorkor most commonly affects children between the ages of 1 and 3 years. This is typically the period after a child is weaned from breastfeeding. Breast milk is a rich source of protein. If the child's new diet consists mainly of starchy, low-protein foods like rice, cassava, or yams, they may get enough calories but not enough protein to support growth and maintain bodily functions, leading to the onset of the disease.
7. Besides the visible symptoms, what are the long-term consequences of Kwashiorkor?
If left untreated, Kwashiorkor can have devastating and permanent consequences that go far beyond its visible symptoms. The long-term effects include stunted growth (both physical and cognitive), leading to permanent intellectual disabilities and poor school performance. It also causes a severely weakened immune system, making the child highly susceptible to life-threatening infections. Furthermore, it can lead to permanent damage to vital organs, such as the liver and pancreas.
8. Is it possible for a child to have symptoms of both Kwashiorkor and Marasmus at the same time?
Yes, it is possible. This condition is known as Marasmic-Kwashiorkor. A child with this condition exhibits a combination of symptoms from both disorders. They will show signs of severe muscle and fat wasting characteristic of Marasmus, but will also present with edema (swelling), which is the hallmark of Kwashiorkor. This represents a very severe and complex state of malnutrition that requires careful medical management.
