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Kwashiorkor

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Kwashiorkor chiefly affects children and young adults globally in developing countries and the tropics. Read the article to know more about kwashiorkor.

Medically reviewed by

Dr. Patel Bhavesh Ashokkumar

Published At February 18, 2022
Reviewed AtMay 16, 2024

What Is Kwashiorkor?

Kwashiorkor is a severe form of protein malnutrition that mainly affects children and young adults in developing countries. In the 1950s, the World Health Organization recognized it as a public health crisis. Dietary inadequacy of proteinaceous elements, lack of antioxidants, and possible attribution to aflatoxins (a mutagen) are the main causes of this protein-energy malnutrition (PEM) disease.

Apart from the edematous inflammation that is the notable feature of this disease, stunted growth or retarded growth like the failure of the child to grow in height, long-lasting infections, irritability, tiredness or generalized fatigue or malaise, cracked nails, and brittle hair follicles with color changes are other observable symptoms that may be present in a patient suffering from kwashiorkor. Though this condition may be uncommon in developed countries, long-term illness, negligence, or insufficient dietary nutrition can make children or young adults more prone to kwashiorkor.

What Are the Causes of Kwashiorkor?

The following are the main causes of kwashiorkor:

  • A diet high in carbohydrates. Among high-risk populations, especially in less developed parts of Africa, Central America, and Southeast Asia, carbohydrates such as rice, corn, or starchy vegetables are frequently the only dietary options. Particularly in rural locations where many people work as farmers, these products are typically more affordable and plentiful than those high in protein. Babies born to mothers who are low in protein may inherit this deficit.

  • Weaning with inadequate food replacement. A common situation is when a nursing toddler is quickly weaned so that a newborn can start nursing. The weaning toddler's nutrition decreases because they fail to get a suitable replacement meal because of a lack of resources, a lack of knowledge about nutrition, or both.

Other elements that could be included are:

  • Deficiency of vital vitamins and minerals.

  • Absence of antioxidants in food.

  • Toxins from a mold frequently growing on crops in hot, humid climates are called aflatoxins.

  • Infectious illnesses, including HIV, malaria, and measles in particular.

  • Severe life stressors include starvation, poverty, conflict, and natural catastrophes.

What Are the Clinical Features and Pathogenesis of Kwashiorkor?

The clinical features of kwashiorkor include;

  • Peripheral pitting edema or inflammatory swelling that begins in specific regions of the cranium.

  • Muscle weakness and fatigue (may be accompanied by muscle aches).

  • Abdominal bloating or swelling (abdominal distension).

  • Round face or moon face appearance.

  • Prominent cheeks.

  • Thin, dry, peeling skin with areas of scaling and hyperpigmentation.

  • Dry and hypopigmented hair that falls out or that can be easily plucked.

  • Hepatomegaly or enlarged liver tissue (from fatty liver infiltration).

  • Retarded or stunted growth.

  • Psychic changes (anorexia or apathy).

  • Skin lesions or dermatitis (can be observed in specific regions like the perineum, groin, limbs, ears, and armpits).

The development of kwashiorkor occurs due to inadequate dietary intake of essential nutrients in individuals, which can damage cell membranes, resulting in generalized edema or swelling and inflammation.

Environmental factors also play an important role in the pathogenesis of kwashiorkor. The gut flora constitutes a relatively uncontrolled metabolism capable of synthesizing toxic and beneficial compounds. Populations of gut flora change with changes in the diet and the individual's physiological state.

The gut microflora can work synergistically or antagonistically within the human host as they metabolically consume and process nutrients. Fat accumulates in the intracellular spaces of the liver tissues, mainly because of the inability to transport fat.

With understanding the etiology, a coherent understanding of the pathophysiology is easier. The unifying pathophysiological concept of kwashiorkor is that cell membranes are damaged throughout the body. This is why immunity is considerably low, putting the child at an increased risk for organ dysfunction and fatality.

Why Does Edema Occur in Kwashiorkor?

A potential mechanism by which peripheral edema occurs in kwashiorkor may be related to the glycosaminoglycans containing moieties subject to oxidation or reduction. They bind water mainly through cohesive forces (as observable in the "structural form of water"). Recent studies have shown that children with kwashiorkor have an abnormal renal (kidney) architecture that can be explained by gastrointestinal loss of glycosaminoglycans.

The other hypothesis, as per research, is also attributed to the increased sodium retention in kwashiorkor. According to this hypothesis, vanadate element insufficiency, being a potent inhibitor of the sodium pump at physiological concentration, can cause an imbalanced mechanism leading to sodium retention.

What Distinguishes Marasmus From Kwashiorkor?

The two primary forms of severe protein-energy malnutrition are kwashiorkor and marasmus. The primary distinction between the two is that marasmus is a shortage of all macronutrients, including carbohydrates, protein, and fats, whereas kwashiorkor is mostly a protein deficiency. People who have marasmus generally lack calories because they either consume too few, spend too much, or both. While they may not be completely calorie-deficient, those with kwashiorkor lack protein-rich foods.

How Is a Diagnosis of Kwashiorkor Made?

Medical professionals can typically identify kwashiorkor by physically examining the child and looking for the disease's distinctive physical symptoms. They will enquire regarding the child's nutrition and medical history for infections or diseases. The child's height-to-age and weight-to-height ratio may be measured, and scores based on different charts may be assigned. The weight-to-height score indicates the severity of the child's ailment. They can determine the extent to which the kid's development has been impacted by malnutrition by looking at their height-to-age score.

How to Manage Kwashiorkor?

Apart from the preliminary treatment of anemias, liver and kidney function tests also prove beneficial in determining if multi-organ disease possibilities exist. A complete blood count or a blood test and urine analysis, is an essential diagnosis for the physician to establish the treatment strategy. The physician may also collect a sample of the skin tissue or hair of the individual for biopsy to test the level of growth-related retardation. Body mass index or BMI also needs to be regularly monitored in these individuals until the symptoms of kwashiorkor subside.

Dietary Modifications - Management by regularly including small dietary proportions of vitamin-based food and a gradual increase in these proportions would be beneficial. Vitamin and mineral deficiencies can be eliminated in children by adopting the RUTF or ready-to-use therapeutic food strategy (a combination of vitamins, minerals, peanut butter, vegetable oils, milk powder, etc.).

Also, as these children or young adults may be intolerant of cold, providing them with accessories for adequate body heat is essential. Providing milk-based food supplements to these children is also beneficial in eliminating clinical symptoms of kwashiorkor within one to two months. However, these strategies usually work only when this malnutrition disorder is in its initial stages in the affected child. In the later stages of severe protein malnutrition, physical or intellectual disabilities would significantly impair the quality of life by making these children or young adults more susceptible to comorbidities, eventually increasing the mortality risk.

Oral and Systemic Management - Oral hygiene and dental visits are essential components to be added along with general hygiene and dietary supplements. These individuals will be more risk-prone than the average (poor oral immunity leads to systemic diseases). A dental surgeon's management of low calcium levels or hypocalcemia and low blood sugar management or hypoglycemia constitutes a major strategy for relieving kwashiorkor symptoms. The underlying infections need thorough assessment and management by the physician, and suitable micronutrient supplementation and electrolyte balancing are required.

Conclusion:

Kwashiorkor is a debilitating disease in children. Thus, following up by the physician is extremely crucial to ensure that the growth is not stunted or retarded. In these cases, emotional support with extended care for their physical needs is essential for long-term prognosis.

Frequently Asked Questions

1.

What Causes Kwashiorkor?

Kwashiorkor is a condition that occurs due to severe protein deficiency. Inadequate consumption of protein is the main reason for this condition. It mainly occurs in children. It is more common in areas affected by famine, economically backward communities, and lack of education can also contribute to this condition.

2.

What Are the Symptoms of Kwashiorkor?

Kwashiorkor is a condition that occurs due to severe malnutrition. It is quite common in underdeveloped and developing countries. The main symptoms of kwashiorkor include;
Swelling of feet, ankles, and stomach.
Change in skin and hair color.
- Fatigue.
- Diarrhea.
- Irritability.
- Loss of muscle mass.
- Growth failure.

3.

What Is the Reason for Enlarged Belly in the Case of Kwashiorkor?

Kwashiorkor is mainly due to protein deficiency. When there is an inadequate protein in the body, it can cause the accumulation of fluid in tissues as proteins are responsible for fluid balance. Due to fluid imbalance, it gets accumulated in tissues leading to enlargement of the belly in the case of kwashiorkor.

4.

What Are the Complications Associated With Kwashiorkor?

The complications associated with kwashiorkor include;
- Urinary tract infections.
- Fatty liver.
- Cardiovascular problems.
- Weakened immune system.
- Electrolyte imbalance.
- Metabolic disturbance.
- Growth failure.
- Hormone imbalances.

5.

What Is the Reason for Fatty Liver Associated With Kwashiorkor?

Fatty liver due to kwashiorkor occurs in severe cases. According to studies, it mainly occurs due to a lack of synthesis of beta lipoproteins. These are very important for the transport of lipids from the liver to other tissues. Due to the lack of this protein, fatty acids accumulate in the liver leading to fatty liver.

6.

What Is the Reason for the Moon Face in the Case of Kwashiorkor?

Kwashiorkor is mainly associated with protein deficiency. Proteins are essential for proper fluid and electrolyte balance. If there is a deficiency of proteins, it can cause fluid retention and edema, which is responsible for the moon face in kwashiorkor.

7.

What Type of Food Intake Can Cause Kwashiorkor?

Consumption of food rich only in carbohydrates and lack of proteins can cause kwashiorkor. Lack of dietary antioxidants in the diet can also contribute to kwashiorkor.

8.

What Type of Food Intake Is Recommended to Treat Kwashiorkor?

As the children are not taking protein-rich food for a longer period in the case of kwashiorkor, they may find it difficult to consume if suddenly introduced. Specially formulated foods are available to treat kwashiorkar. A gradual increase in dietary intake of protein is recommended. Fluid and electrolyte imbalance can be treated with intravenous fluids if required.

9.

What Is the Role of Antibiotics in Treating Kwashiorkor?

Kwashiorkor can lead to a weakened immune system. Due to a lack of immunity, affected children are more susceptible to infections. Antibiotics are recommended to treat infections in those conditions.
Source Article IclonSourcesSource Article Arrow
Dr. Patel Bhavesh Ashokkumar
Dr. Patel Bhavesh Ashokkumar

Pediatrics

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