Introduction

Kwashiorkor is a severe form of protein malnutrition that primarily affects children. This mainly occurs when infants and children under the age of 6 transition from breast milk or protein-rich food to highly starchy, low-protein foods, such as rice. Protein is one of the six essential food groups that humans require for a complete and balanced diet, and therefore plays a crucial role in the growth, function, and overall health of children. 

Protein malnutrition is characterised by fatty liver, skin and hair changes, swollen belly, lower limbs, and face due to accumulation of fluids known as oedema. Kwashiorkor is prevalent in low-income countries, especially in sub-Saharan Africa. There is high morbidity and mortality in undernourished children.^1,2,3,4

Cause of Kwashiorkor

Oxidative stress is a major factor in causing kwashiorkor, which occurs when harmful oxygen-containing molecules build up in the body. These reactive oxidative species (ROS) are byproducts of normal metabolism and can disrupt cellular processes when present in high levels, leading to damage in proteins, lipids, and nucleic acids. Antioxidants like certain enzymes and vitamins help protect cells from this damage. However, in poorly nourished individuals, especially children with kwashiorkor, the antioxidant system is often weak, resulting in higher oxidative stress and contributing to the illness's development.⁷

Clinical features

• Oedema: particularly in the face and lower limbs, is one of the defining characteristics of Kwashiorkor
• Fatty liver: may occur from oxidative damage, affecting lipid metabolism and detoxification in the liver⁸
• Skin and hair changes: skin becomes flaky and dark or light patches may appear. Hair may turn reddish or fall out. This can be due to oxidative damage to skin proteins and pigment cells. Lack of antioxidants like vitamin A and zinc worsens the problem⁹

The key role of glutathione

Glutathione is one of the most important antioxidants that the body makes. It helps cells stay healthy by neutralising ROS. The body needs specific amino acids to make glutathione.

Kids with kwashiorkor often eat a lot of carbs but very little protein. This means that their bodies lack the necessary building blocks to produce sufficient glutathione. Cells are left open to damage without this protective shield, and oxidative damage builds up.

Glutathione levels are markedly reduced in children with kwashiorkor relative to those with healthy counterparts. This supports the idea that oxidative stress has a greater impact.¹⁰ 

Micronutrients are important

Vitamins and minerals are also sources of antioxidants, in addition to amino acids. These essential nutrients are frequently absent in children with kwashiorkor:

• Vitamin E: helps protect fats in the body from being damaged
• Vitamin A: supports skin and immune function
• Zinc and selenium: help enzymes that detoxify harmful molecules
• Copper and iron: also play roles in oxidative reactions, and their imbalances can worsen oxidative damage

The body's capacity to manage oxidative stress declines when these nutrients are deficient.

Infections and the immune system

In addition to malnourishment, children with kwashiorkor are at a higher risk of infection. The immune system is weakened by oxidative stress. Antioxidants are essential for the healthy operation of immune cells. Their capacity to fend off bacteria or viruses is diminished in their absence.¹¹

When infections do occur, the immune system produces more ROS to get rid of the invaders. However, without antioxidants to counterbalance them, the body harms its own tissues. Oxidative stress brought on by malnutrition weakens immunity and exacerbates diseases and stress, resulting in a vicious cycle.

Treatment and upcoming plans

It takes more than just providing food to treat kwashiorkor. We now realise that it also involves reestablishing the equilibrium of the body. Current treatment includes the use of therapeutic meals, which are nutrient-dense pastes that are high in lipids, protein, and essential vitamins and minerals. While these help restore energy and minerals, there is increasing interest in tackling oxidative stress directly.

• Antioxidant supplements, like vitamin E or selenium
• Amino acid therapy, especially with sulfur-containing amino acids like cysteine 
• Restoring glutathione levels using compounds like N-acetylcysteine (NAC) 

These supplements may speed up healing, lower the chance of complications, and safeguard important organs.^12,13

FAQs

What is kwashiorkor, and what could cause the disease or illness?

Kwashiorkor is a disease that is caused by protein deficiency and malnutrition. This disease is mostly seen among children living in impoverished, marginalised and poor areas.

Who is most affected?

Infants and children under 6 years old have a weakened immune system and require protein for brain, muscle function, and growth.

What causes kwashiorkor?

Primarily protein deficiency, worsened by oxidative stress.

Symptoms or how they can be recognised?

Children with kwashiorkor predominantly suffer from a swollen belly, legs, head, lack of interest, fatty liver, etc.

Why do children with kwashiorkor swell?

Low protein (albumin) and damaged blood vessels cause fluid buildup.

What is oxidative stress?

An imbalance where harmful molecules (ROS) damage cells due to a lack of antioxidants.

Can kwashiorkor be cured?

Yes, with proper nutrition and potentially antioxidant support.

Can it be prevented?

Yes, through balanced, protein-rich diets and early feeding support.

Summary

Kwashiorkor is a disorder influenced by deeper biochemical imbalances, especially oxidative stress, rather than merely a protein deficiency. Damage accumulates when the body lacks the necessary nutrients to combat dangerous substances. This explains a lot of the symptoms of the disease, including skin and immune problems, liver problems, and swelling. Understanding how oxidative stress contributes to kwashiorkor enables us to go beyond outdated notions and provide better, more specialised care. We can provide children with the resources they require to recover, develop, and flourish by fusing healthy eating with techniques to strengthen the body's antioxidant defences.