Kwashiorkor

• ALSO KNOWN AS: Edematous malnutrition, protein-calorie malnutrition, protein energy malnutrition, Mehlhschaden (German, meaning “flour damage”)
• ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, immune system, muscles, skin
• CAUSES: Protein deprivation
• SYMPTOMS: Fatigue, irritability, lethargy, poor growth, apathy, edema, decreased muscle mass, large belly, diarrhea, dermatitis, loss of skin pigmentation, changes in color and texture of hair, infections; may progress to shock, coma, and death
• DURATION: Progressive if untreated
• TREATMENTS: Depends on degree of malnutrition; may include treatment for shock and increased calorie intake (first as carbohydrates, simple sugars, and fats, then proteins)

DEFINITION: A form of malnutrition caused by inadequate protein intake

Causes and Symptoms

Kwashiorkor occurs most commonly in areas of famine, limited food supply, and low levels of education, which can lead to inadequate knowledge of diet and appropriate dietary intakes. Early symptoms are general and include fatigue, irritability, and lethargy. As protein deprivation continues, symptoms include failure to gain weight and linear growth. Other progressed symptoms include apathy, decreased muscle mass, edema, a large protuberant belly (resulting from decreased albumin in the blood), diarrhea, and dermatitis. Skin may lose pigment where it has peeled away or darken where it has been irritated or traumatized. Hair may become thin and brittle and may change color, becoming lighter or reddish. As a result of immune system damage, patients experience an increased risk of infection and increased severity of what normally might be mild infections. In the final stages, shock and/or coma usually precede death.

Treatment and Therapy

A physical examination may show an enlarged liver and generalized edema. Treatment varies depending on the degree of malnutrition. Patients in shock will require immediate treatment. Often, calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other caloric sources have provided increased energy. Vitamin and mineral supplements are essential. Many children will have developed intolerance to milk lactose (sugar intolerance) and will need to be supplemented with lactase (an enzyme) if they are to benefit from milk products. Adequate diet with appropriate amounts of carbohydrates, fat, and protein will prevent kwashiorkor.

Perspective and Prospects

Kwashiorkor means “deposed child” in a West African dialect, referring to a child “deposed” from the mother’s breast by a newborn sibling. Kwashiorkor is found largely in tropical and subtropical regions where the diet is high in starch (such as cereal grains or plantains) and low in protein. Treatment early in the course of kwashiorkor generally produces positive results. Treatment in later stages will improve a child’s general health, but the child may be left with permanent physical ailments and mental disabilities. With delayed or no treatment, the condition is fatal.

Bibliography

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"Kwashiorkor ." Cleveland Clinic, 18 May 2022, my.clevelandclinic.org/health/diseases/23099-kwashiorkor. Accessed 14 Aug. 2025.

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May, Thaddaeus, et al. "The Neglect of Kwashiorkor." The Lancet Child & Adolescent Health, vol. 7, no. 11, 2023, pp. 751-53, doi:10.1016/S2352-4642(23)00214-6. Accessed 2 Apr. 2024.