Kwashiorkor

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