What Is Kwashiorkor?

Overview

We have often heard about a balanced diet and how we must incorporate the right amount of carbohydrates, protein, and fats in our daily intake to keep our bodies functioning the proper way. If the consumption of any of these decreases rapidly, it can result in serious conditions. Keeping this in mind, if an infant or a child is a victim of severe protein deficiency, it can result in a disease called kwashiorkor or oedematous malnutrition.¹ The World Health Organisation (WHO) during the 1950s recognised it as a public health crisis. Proteins are essential compounds that have many key roles in our bodies, such as the transportation of oxygen (haemoglobin), muscle movement (actin and myosin), and blood clotting (thrombin). The word “kwashiorkor” belongs to a language called Ga from Ghana, a country situated in West Africa, which means “the contraction of sickness in a newly born baby”. Kwashiorkor, if neglected, can turn out to be life-threatening as well.

Causes of kwashiorkor

Kwashiorkor is the result of severe protein deficiency caused by severe acute malnutrition.¹ This disease is prevalent in tropical regions; it is ubiquitous in sub-Saharan Africa, while a fair number of cases have been noted in Southeast Asia.²

• Dietary intake: The disease targets the young, especially weaning infants and children till age 5. The dietary intake of protein per day for children aged 4-8 is 19 grams.² Since weaning is the transition from a breast milk diet to that of solid food, it is essential for a weaning diet to be wholesome and nourishing to the individual as the food consumed would decide the future health of the individual
• Geographical location: If we talk about sub-Saharan Africa, the most popular crops grown there are maize and cassava, which are excellent sources of carbohydrates. The weather conditions and the soil being unsuitable for a wide variety of crops also play a role in the local diet. Attempts are being taken to improve these conditions to build a comprehensive diet for the people of Africa
• Other causes: The outcome of kwashiorkor depends on a dietary deficiency caused by socio-political issues such as political agitations and a lack of education and awareness towards maintaining good health. Maintaining an unhygienic environment generates a niche for infectious diseases and supplements malnutrition. Sometimes natural disasters supplement food shortage, which results in famines

While this is a prevailing issue in developing countries, kwashiorkor is quite rare in the developed world and is the conclusion of child abuse and neglect. 

Signs and symptoms of kwashiorkor

What are proteins made of?

As mentioned earlier, proteins are mandatory for the proper functioning of the body. The products of protein breakdown give the smallest component called amino acids, which are responsible for the construction of many such protein polymers. In humans, there are twenty-one amino acids (including selenocysteine) that are primarily needed for the body to operate. Out of the twenty-one amino acids, nine are essential (those that the body cannot make and must be derived from the diet), six are conditionally essential, and six are non-essential.

1. For example, keratin is an important structural protein that is present in the skin, hair, and nails. In the case of protein deficiency diseases like kwashiorkor, hair colour and texture change, along with alterations in skin colour, is a key symptom.^7,8
2. There is a protein in the blood called albumin that aids in the retention of salts and water in the blood vessels and prevents leakage.³ If the albumin levels decrease, then the fluid leaks out into the tissues and causes fluid retention called oedema, which is the distinguishing feature of kwashiorkor. This eventually leads to the protrusion of the abdomen forwards.²
3. Proteins are required for the working of muscles as well. Symptoms of kwashiorkor include reduced or loss of muscle mass. This leads to the child gaining weight and growing slowly.

Some other symptoms include fatigue, fatty liver, anaemia, diarrhoea, rashes, and shocks. Thin, dry, and peeling skin is also noted.^4,8

Management and treatment for kwashiorkor

The target of treatment mainly includes the integration of more protein in the diet for calories.^4,7 As aforementioned, a carbohydrate-majority diet leads to protein deficiencies, so first, the energy in the form of calories is exhausted by the child, and then proteins are gradually introduced into the child’s diet. 

Along with this, some vitamins and minerals are also given as supplements. Reversing malnutrition takes some time, but it is not impossible. 

Diagnosis

The first step of diagnosis is:

• To draw out the patient’s blood and urine to evaluate how much protein and blood sugar are present through a blood and urine test.⁵ This would tell us the status of the liver and kidney functioning
• Physical tests such as measuring height and weight and calculation of body mass index are also carried out
• Since the amount of fluid retained in the body is in the form of oedema, a simple pitting test is done. Keratin tests are done through a biopsy of the hair or skin. Creatinine, a byproduct of muscle activity, is also evaluated

Complications

Some complications associated with this condition are outlined below.⁶

• The first complication would be hindered cellular functions
• One of the symptoms of kwashiorkor is a fatty liver, and from this, a condition called hepatomegaly arises
• Loss of immune function and septic shocks are also complications along with gastrointestinal co-morbidities such as atrophy (thinning of a body part) of the pancreas and the mucosa of the small intestine
• Endocrine disorders are also noted as hormones are proteins, too 
• Urinary tract infections and the impaired functioning of the cardiovascular system may be seen

FAQs

How can I prevent kwashiorkor?

Kwashiorkor is a severe protein deficiency caused by malnutrition or a disease caused by protein malnutrition that can be prevented by incorporating the concept of a balanced diet that includes the right amount of each nutrient. According to the dietary intake chart, the amount of proteins to be consumed is 19 grams per day for children between the ages of 4 and 8 and 13 grams per day for toddlers.

How common is kwashiorkor?

Kwahiorkor is very rare in developed countries. It is seen widespread in Sub-Saharan Africa, Southeast Asia and Central America due to food insecurity.²

Who is at risk of kwashiorkor?

Infants and children at the brink of the weaning stage who belong to countries with food insecurity, like sub-Saharan Africa, are very prone to Kwashiorkor. Any child with some amount of protein deficiency can also be considered.² 

What can I expect if I have kwashiorkor?

Symptoms such as oedema, forward protrusion of the abdomen, change in colour and texture of hair and skin, weight loss, abnormally decreased muscle mass and activity, fatty liver, and fatigue are some of the symptoms seen.²

When should I see a doctor?

If the child shows the presence of oedema and is growing very slowly and does not gain weight or is losing weight rapidly, it is advised to visit the doctor immediately.

Summary

Proteins are important macronutrients for the proper functioning of the body. Kwashiorkor is the outcome of severe protein malnutrition. It is very common in food-insecure countries of sub-Saharan Africa. It is quite rare in developed countries but does occur as a result of child abuse and neglect. Infants and children at the brink of the weaning stage who belong to food-insecure countries of sub-Saharan Africa are very prone to kwashiorkor. Any child with some amount of protein deficiency can be considered as well. Symptoms include oedema, forward protrusion of the abdomen, change in colour and texture of hair and skin, weight loss, and abnormally decreased muscle mass. Treatment includes diet revision in which nutritious food is enriched and fortified with proteins, vitamins, and minerals.