A childhood disease that is caused by protein deprivation. Early signs include apathy, drowsiness, and irritability. More advanced signs are poor growth, lack of stamina, loss of muscle mass, swelling, abnormal hair (sparse, thin, often streaky red or gray hair in dark-skinned children), and abnormal skin that darkens in irritated but not sun-exposed areas. An enlarged and protuberant belly is common. Kwashiorkor disables the immune system, rendering the affected individual susceptible to a host of infectious diseases. It is responsible for much illness and death among children worldwide. Also known as protein malnutrition and protein-calorie malnutrition (PCM).
Kwashiorkor is most common in areas where there is:
- Limited food supply
- Low levels of education (when people do not understand how to eat a proper diet)
This disease is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest. These conditions are responsible for a lack of food, which leads to malnutrition.
Kwashiorkor is very rare in children in the United States. There are only isolated cases. However, one government estimate suggests that as many as 50% of elderly people in nursing homes in the United States do not get enough protein in their diet.
When kwashiorkor does occur in the United States, it is usually a sign of child abuse and severe neglect.
In general, marasmus is an insufficient energy intake to match the body’s requirements. As a result, the body draws on its own stores, resulting in emaciation. In kwashiorkor, adequate carbohydrate consumption and decreased protein intake lead to decreased synthesis of visceral proteins. The resulting hypoalbuminemia contributes to extravascular fluid accumulation. Impaired synthesis of B-lipoprotein produces a fatty liver.
Protein-energy malnutrition also involves an inadequate intake of many essential nutrients. Low serum levels of zinc have been implicated as the cause of skin ulceration in many patients. In a 1979 study of 42 children with marasmus, investigators found that only those children with low serum levels of zinc developed skin ulceration. Serum levels of zinc correlated closely with the presence of edema, stunting of growth, and severe wasting. The classic “mosaic skin” and “flaky paint” dermatosis of kwashiorkor bears considerable resemblance to the skin changes of acrodermatitisenteropathica, the dermatosis of zinc deficiency.
- Changes in skin pigment
- Decreased muscle mass
- Failure to gain weight and grow
- Hair changes (change in color or texture)
- Increased and more severe infections due to damaged immune system
- Large belly that sticks out (protrudes)
- Lethargy or apathy
- Loss of muscle mass
- Rash (dermatitis)
- Shock (late stage)
- Swelling (edema)
The physical examination may show an enlarged liver (hepatomegaly) and general swelling.
Tests may include:
- Arterial blood gas
- Complete blood count (CBC)
- Creatinine clearance
- Serum creatinine
- Serum potassium
- Total protein levels
Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth.
Treatment depends on the severity of the condition. People who are in shock need immediate treatment to restore blood volume and maintain blood pressure.
Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.
Since the person will have been without much food for a long period of time, eating can cause problems, especially if the calories are too high at first. Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.
Many malnourished children will develop intolerance to milk sugar (lactose intolerance). They will need to be given supplements with the enzyme lactase so that they can tolerate milk products.