What Is Kwashiorkor?
Kwashiorkor is a severe form of protein malnutrition disease that mainly affects children and young adults in developing countries. In the 1950s, it was recognized as a public health crisis by the world health organization. Dietary inadequacy of proteinaceous elements, lack of antioxidants, and possible attribution to aflatoxins (kind of mutagens) are the main causatives resulting in this protein-energy malnutrition or PEM disease.
Apart from 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 Clinical Features and Pathogenesis of Kwashiorkor?
The clinical features of kwashiorkor include;
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Peripheral pitting edema or inflammatory swelling begins in specific regions of the cranium.
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Muscle weakness and fatigue (may be accompanied by muscle aches).
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Abdominal bloating or swelling (abdominal distension).
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Round face or moon face appearance.
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Prominent cheeks.
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Thin, dry, peeling skin with areas of scaling and hyperpigmentation.
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Dry and hypopigmented hair that falls out or that can be easily plucked.
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Hepatomegaly or enlarged liver tissue (from fatty liver infiltration).
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Retarded or stunted growth.
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Psychic changes (anorexia or apathy).
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Skin lesions or dermatitis (can be observed in specific regions like perineum, groin, limbs, ears, 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 both 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.
Without understanding the etiology, a coherent understanding of the pathophysiology is difficult. The unifying pathophysiological concept of kwashiorkor is that cell membranes are damaged throughout the body. The damage results in excess potassium and water from the cell structure, causing dysfunction in all organ systems. This is why immunity is considerably low, making 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 well 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 that occurs in kwashiorkor. According to this hypothesis, the vanadate element insufficiency being a potent inhibitor of the sodium pump at physiological concentration can cause an imbalanced mechanism leading to sodium retention.
How to Manage Kwashiorkor?
Apart from the preliminary treatment of anemias, liver, and kidney function tests also prove beneficial to see if multi-organ disease possibility exists. 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 the 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 to 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 timespan. But these strategies usually work only when this malnutrition disorder is in the 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 riskier 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 individual (poor oral immunity leading to systemic diseases). The management of low calcium levels or hypocalcemia and low blood sugar management or hypoglycemia by a dental surgeon 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. Emotional support with extended care for their physical needs in these cases is essential for long-term prognosis.
