Can a Grown Up Get Kwashiorkor?

December 13, 2025 •

4 min read

While traditionally associated with malnourished children in developing countries, kwashiorkor can and does occur in adults. This severe form of protein malnutrition is particularly seen in specific clinical scenarios and risk groups, debunking the common misconception that it is solely a pediatric illness.

Quick Summary

Kwashiorkor, a form of severe protein malnutrition, can affect adults, especially those with certain medical conditions, severe dietary restrictions, or older individuals in institutional care. Adult kwashiorkor is characterized by edema, muscle wasting, skin and hair changes, and other systemic issues caused by profound protein deficiency. Timely treatment is critical for recovery.

Key Points

Adults are Susceptible: A grown up can get kwashiorkor, although it is more commonly recognized in children.
Underlying Causes: In adults, kwashiorkor is often linked to underlying conditions like malabsorptive disorders, liver disease, chronic illness, and eating disorders.
Key Symptom is Edema: The defining feature of kwashiorkor is edema (fluid retention), which can mask significant muscle wasting.
Risks for Older Adults: Elderly individuals in care facilities are at a higher risk for protein-energy malnutrition, including kwashiorkor, due to various health and social factors.
Cautious Treatment is Vital: The treatment for adult kwashiorkor must involve a slow reintroduction of protein to prevent life-threatening refeeding syndrome.
Different from Marasmus: Kwashiorkor is primarily a protein deficiency, causing edema, whereas marasmus is a deficiency of both calories and protein, leading to severe wasting.

Understanding Kwashiorkor in the Adult Population

Kwashiorkor is a type of severe malnutrition resulting from a diet that lacks sufficient protein, even if caloric intake is adequate. This causes metabolic and osmotic disturbances, leading to fluid retention and swelling, known as edema. While most prevalent in children, particularly during weaning in regions with food scarcity, cases of adult kwashiorkor exist and are often linked to underlying health issues or extreme dietary habits.

Causes and Risk Factors for Adult Kwashiorkor

Several factors can contribute to kwashiorkor in adults, moving beyond the traditional image of famine-stricken populations. The etiology is complex and often multi-factorial, with a combination of nutritional and health-related issues playing a significant role.

Common causes include:

Chronic Illnesses: Conditions that impair nutrient absorption or increase the body's metabolic demands can lead to severe protein deficiencies. Examples include HIV/AIDS, liver cirrhosis, chronic renal failure, and some cancers.
Malabsorptive Disorders: Gastrointestinal conditions such as celiac disease, inflammatory bowel disease, or complications following bariatric surgery (e.g., Roux-en-Y gastric bypass) can significantly affect protein absorption.
Eating Disorders and Severe Dietary Restriction: Individuals with anorexia nervosa or those following extreme fad diets lacking sufficient protein are at risk.
Geriatric Malnutrition: Older adults, especially those in nursing homes or hospitalized, frequently suffer from protein-energy malnutrition due to poor appetite, chronic illness, and neglect.
Substance Abuse: Alcoholism and other forms of substance abuse can lead to severe malnutrition by displacing healthy food and causing liver damage.

Signs and Symptoms in Adults

While some symptoms, like a swollen belly, are common in pediatric cases, adult kwashiorkor presents with a broader range of signs that may be mistaken for other conditions.

Edema: The hallmark sign, characterized by swelling in the ankles, feet, hands, face, and abdomen due to fluid retention. This can mask severe muscle wasting.
Muscle Atrophy: A significant and noticeable loss of muscle mass, often most visible in the limbs.
Dermatological Changes: The skin may show patches of inflammation, cracking, peeling, or depigmentation, sometimes described as a “crazy pavement” dermatosis.
Hair Changes: Hair can become dry, brittle, and sparse, and may lose its color. A condition called the “flag sign,” where bands of different colored hair appear, indicates alternating periods of malnutrition and recovery.
Systemic Manifestations: Apathy, lethargy, fatigue, irritability, and diarrhea are also common. An enlarged liver (hepatomegaly) is a significant systemic finding.

Kwashiorkor vs. Marasmus in Adults: A Comparison

Kwashiorkor and marasmus are both forms of severe protein-energy malnutrition (PEM), but they differ in their primary deficiencies and clinical presentation. Adults can develop either, or a combination known as marasmic-kwashiorkor.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Severe protein deficiency with often adequate calorie intake.	Deficiency of both protein and total calories.
Physical Appearance	Edema (swelling) masks underlying muscle wasting, leading to a deceivingly plump or bloated look.	Emaciated and visibly wasted, with severe loss of muscle and subcutaneous fat.
Key Characteristic	Presence of pitting edema, especially in the limbs and abdomen.	Extreme wasting, giving an 'old man' appearance in severe cases.
Fluid Balance	Impaired due to low albumin levels, causing fluid retention.	Dehydration is a concern, but fluid retention is not a hallmark.
Appetite	Often poor or diminished.	Can sometimes be normal or even increased initially as the body attempts to compensate.

Treatment and Prognosis for Adult Patients

The management of adult kwashiorkor requires a cautious, multi-phase approach to prevent complications like refeeding syndrome.

Stabilization: Initial treatment focuses on correcting metabolic imbalances, such as hypoglycemia and electrolyte abnormalities. Infections, to which a malnourished individual is highly susceptible, must be treated with antibiotics.
Nutritional Rehabilitation: Food must be reintroduced slowly and carefully. Initially, the focus is on a high-carbohydrate and fat diet, with protein gradually added later to allow the body to adjust. Specially formulated therapeutic foods may be used.
Underlying Cause Treatment: To prevent recurrence, the root cause must be identified and addressed. This may involve managing a chronic illness, treating an eating disorder, or improving living conditions.
Long-Term Support: Ongoing nutritional counseling and support are essential for lasting recovery. Physical therapy may be needed to rebuild muscle strength and mobility.

The prognosis for adult kwashiorkor depends heavily on the timeliness of treatment and the severity of the underlying condition. Early intervention offers a better chance of full recovery, but if left untreated, the condition can be fatal due to organ failure, infection, or other complications. Some long-term effects may persist, especially with delayed treatment.

Prevention Strategies

Preventing kwashiorkor in adults involves ensuring adequate intake of protein and other essential nutrients, especially for those at high risk.

Education: Increasing nutritional knowledge is key, especially for high-risk populations and their caregivers.
Food Security: Addressing socioeconomic issues and improving access to nutritious food is crucial.
Regular Monitoring: For adults with chronic illnesses or those in care facilities, regular nutritional screening and monitoring can detect problems early.
Dietary Adjustments: Promoting diets rich in protein from sources like lean meat, eggs, dairy, beans, and nuts is essential for at-risk individuals.
Targeted Support: Community programs and social services can provide support for vulnerable populations, including the elderly or those with limited resources.

By understanding that a grown up can get kwashiorkor and recognizing its various causes and symptoms, healthcare providers and individuals can take steps to prevent and treat this dangerous form of malnutrition. The condition is a reminder that proper nutrition is vital at all stages of life, and that malnutrition can present in many forms beyond the classic image.

For more information on nutritional disorders and their treatment, consult the resources from the National Institutes of Health.

Frequently Asked Questions

The main difference is the type of nutrient deficiency. Kwashiorkor is primarily a severe protein deficiency, while marasmus is a severe deficiency of both calories and protein. This leads to the hallmark edema in kwashiorkor versus the extreme wasting in marasmus.

Yes, adults with eating disorders like anorexia nervosa are at risk of developing kwashiorkor, as their severely restricted intake of protein can cause the condition, as shown in case reports.

Treatment involves a carefully managed process that begins with stabilizing metabolic issues and treating infections, followed by a slow reintroduction of nutrients to prevent refeeding syndrome. Long-term nutritional rehabilitation and addressing the underlying cause are also essential.

The swollen abdomen, or edema, in kwashiorkor is caused by a lack of protein, specifically albumin, in the blood. This low protein level disrupts the fluid balance, causing fluid to leak into body tissues and the abdominal cavity.

Long-term complications can include liver damage, kidney problems, a weakened immune system, and persistent gastrointestinal issues. Prognosis depends heavily on how early and effectively treatment is initiated.

Yes, older adults are a significant risk group, especially in hospitals and nursing homes. Factors like poor appetite, chronic illness, and inadequate dietary intake can lead to severe protein-energy malnutrition.

Nutritional rehabilitation starts slowly with high-carbohydrate and fat formulas, with protein added gradually. Ultimately, a balanced diet rich in protein from sources like milk, eggs, lean meats, beans, and nuts is introduced.