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 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.
The signs and symptoms of Kwashiorkor
Change in skin and hair colour (to a rust colour) and texture
Loss of muscle mass
Failure to grow or gain weight
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
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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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.
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.
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:
Intellectual and physical disability
Urinary tract infections
Poor wound healing
Anemia (low red blood cell count)
Steatohepatitis (fatty liver)
Q1. How can Kwashiorkor be prevented?
Ans. The prevention of Kwashiorkor can be done by following a protein-rich diet. The diet should include food such as meat, fish, dairy products, eggs, soy, and beans. The treatment involves slow increases in calories from carbohydrates, sugars, and fats, followed by protein. The treatment also involves the correction of any fluid and electrolyte imbalances and treatment of any infections.
Q2. What are the symptoms of Lack of Protein?
Ans. Lack of protein can be the primary reason for kwashiorkor. On a metabolic aspect, the symptoms of protein deficiency in the child generally include mild to moderate villous blunting, increased mononuclear lymphocytes in the lamina propria, normal or mildly decreased mucosal width, cuboidal isolation of epithelial cells etc.
Electron microscopic studies of malnutrition reveal abnormalities in the microvilli brush border, decreased endoplasmic reticulum, dilated cytoplasmic vesicles, and phagocytic vacuoles as well.
All of this results in the physical symptoms of kwashiorkor which are diarrhoea, loss of muscle mass, fatigue etc.
Q3. What is Marasmus?
Ans. Marasmus is another type of malnutrition that can affect young children in regions of the world where there's an unstable food supply. The symptoms of marasmus include thinness and loss of fat and muscle without any tissue swelling (oedema) which is similar to kwashiorkor like deficiency diseases
Marasmus is caused by a lack of the right types of nutrients. Tests may need to be done to rule out other causes of thinness. The treatment for marasmus is more or less similar to that for kwashiorkor.
Q4. Write the differences between Marasmus and Kwashiorkor?
The main cause of severe protein deficiency.
The main cause of severe deficiency of all nutrients and inadequate calorie intake
Peripheral oedema is absent.
Peripheral oedema is present.
There is no change in hair.
Hair changes are common.
The patient’s skin is dry and wrinkled a bit so there is no dermatosis.
Dermatosis is observed.
Fatty liver is not seen.
Fatty liver is common.
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