What Is Kwashiorkor Its Causes Symptoms and Treatment
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 and Severe Protein Malnutrition
1. What is kwashiorkor?
Kwashiorkor is a severe form of protein-energy malnutrition caused primarily by inadequate dietary protein intake. It commonly affects young children after weaning when they receive enough calories from carbohydrates but insufficient protein. Key features include:
- Edema (swelling due to fluid retention)
- Enlarged fatty liver
- Stunted growth
- Skin and hair changes
2. What causes kwashiorkor?
Kwashiorkor is caused by a severe deficiency of dietary protein despite adequate or near-adequate calorie intake. The main causes include:
- Diets high in carbohydrates but low in protein (e.g., maize-based diets)
- Early weaning without proper protein replacement
- Chronic infections that increase protein demand
- Poverty and food insecurity
3. What are the symptoms of kwashiorkor?
The main symptoms of kwashiorkor include edema, fatty liver, and growth failure. Common clinical signs are:
- Swelling of feet, legs, and face due to low albumin
- Distended abdomen
- Skin depigmentation and peeling ("flaky paint" dermatosis)
- Hair discoloration and thinning
- Irritability and apathy
4. Why does edema occur in kwashiorkor?
Edema in kwashiorkor occurs due to low levels of plasma albumin, which reduces blood osmotic pressure and causes fluid to leak into tissues. The process involves:
- Protein deficiency → decreased albumin synthesis in the liver
- Reduced oncotic pressure in blood vessels
- Movement of fluid into interstitial spaces
5. What is the difference between kwashiorkor and marasmus?
Kwashiorkor is primarily due to protein deficiency, whereas marasmus results from overall calorie deficiency. Key differences include:
- Kwashiorkor: Edema present, fatty liver, some fat stores remain
- Marasmus: Severe wasting, no edema, extreme weight loss
- Kwashiorkor often has skin and hair changes
- Marasmus shows marked muscle and fat loss
6. How does kwashiorkor affect the liver?
Kwashiorkor causes fatty liver due to impaired synthesis of lipoproteins needed to transport fats. In protein deficiency:
- The liver cannot produce enough apolipoproteins
- Fat accumulates within liver cells
- The liver becomes enlarged (hepatomegaly)
7. Who is most at risk of developing kwashiorkor?
Kwashiorkor most commonly affects children under five years in low-income regions with limited protein intake. High-risk groups include:
- Recently weaned infants
- Children in areas of famine or food shortage
- Children with chronic infections (e.g., diarrhea, measles)
8. How is kwashiorkor diagnosed?
Kwashiorkor is diagnosed clinically based on bilateral pitting edema and signs of protein malnutrition. Diagnosis involves:
- Physical examination for edema and growth delay
- Observation of skin and hair changes
- Blood tests showing low serum albumin
9. How is kwashiorkor treated?
Kwashiorkor is treated by gradual nutritional rehabilitation with adequate protein and energy intake. Treatment steps include:
- Careful rehydration and correction of electrolyte imbalance
- Treatment of infections
- Gradual introduction of protein-rich therapeutic foods
- Vitamin and mineral supplementation
10. Can kwashiorkor be prevented?
Kwashiorkor can be prevented by ensuring adequate intake of dietary protein along with balanced nutrition. Preventive measures include:
- Breastfeeding during early infancy
- Introducing protein-rich complementary foods after weaning
- Nutrition education for caregivers
- Improving food security and public health measures
