Is kwashiorkor common in adults? Understanding the Causes and Risks

October 27, 2025 •

4 min read

While famously associated with children in developing countries, research indicates that kwashiorkor can occur in adults, especially those with severe protein-energy malnutrition. So, is kwashiorkor common in adults? The answer is complex, involving underlying health conditions, restrictive diets, and specific clinical scenarios that are distinct from its presentation in children.

Quick Summary

Kwashiorkor, a severe protein deficiency, is uncommon but can affect adults with pre-existing medical issues, restrictive diets, or other risk factors. It is distinguished by edema and requires prompt, careful nutritional and medical management to avoid serious complications.

Key Points

Rarity in Adults: While kwashiorkor is commonly associated with children in developing regions, it is rare but possible in adults, often linked to complex medical and lifestyle issues, not just food scarcity.
Causes Beyond Diet: Adult kwashiorkor is often triggered by underlying conditions like gastrointestinal disorders, alcoholism, post-bariatric surgery complications, and severe chronic illnesses, rather than simple dietary neglect.
Hallmark Symptom is Edema: The presence of bilateral pitting edema (swelling) in the feet, ankles, and face is the defining characteristic of kwashiorkor, and can mask the patient's true weight loss.
Different from Marasmus: Kwashiorkor differs from marasmus primarily due to edema caused by protein deficiency, while marasmus results from a general lack of calories and is characterized by extreme emaciation.
Careful Treatment is Crucial: Management of adult kwashiorkor requires slow, controlled nutritional rehabilitation to prevent refeeding syndrome, and addressing any underlying medical or psychiatric conditions.
Complex Diagnostic Picture: Diagnosing kwashiorkor in adults can be difficult due to confounding symptoms and a low clinical suspicion. A thorough history and specific lab tests are required.

The Adult Kwashiorkor Paradox: Rare but Present

Kwashiorkor is a severe form of protein-energy malnutrition (PEM) traditionally seen in young children in regions of famine and food scarcity. It is characterized by protein deficiency, which leads to fluid retention, causing edema (swelling) in the ankles, feet, and abdomen. This causes a paradox, as the bloating can mask the severe underlying malnourishment. While cases in developed countries are uncommon, they are not unheard of and often occur due to underlying health issues rather than simply a lack of food.

Causes and Risk Factors for Adult-Onset Kwashiorkor

Unlike the typical scenario in children caused by diets high in carbohydrates and low in protein, the causes of adult kwashiorkor are more varied and complex. The primary risk factors are typically related to pre-existing medical conditions that impair nutrient intake or absorption, or severe lifestyle-related issues.

Key causes include:

Chronic Medical Conditions: Diseases that disrupt protein absorption or metabolism, such as severe malabsorptive disorders, inflammatory bowel disease, or significant liver disease, can lead to kwashiorkor.
Post-Bariatric Surgery: Some patients who undergo procedures like Roux-en-Y gastric bypass are at risk, especially if complications like short gut syndrome arise, impairing nutrient absorption.
Alcohol Dependence: Severe alcoholism can lead to malnutrition by replacing nutritious food with alcohol and causing damage to the liver and digestive system.
Severe Dietary Restrictions: Extreme or unorthodox diets, including self-imposed, severely limited eating patterns or those caused by untreated psychiatric disorders like anorexia nervosa, can induce kwashiorkor. In developing nations, monotonous, low-protein diets of rice, maize, or cassava are a known cause.
Hospitalization: Protein malnutrition is a frequent issue among hospitalized patients, and prolonged hospital stays can sometimes result in severe deficiencies.
HIV/AIDS: As a condition that impacts immune function and increases metabolic demands, HIV can be a contributing factor to severe malnutrition.

Symptoms of Kwashiorkor in Adults

While sharing the hallmark edema with children, adults may present with different or more subtle signs. The symptoms can often be mistaken for other underlying diseases, making a diagnosis difficult without a thorough dietary and medical history.

Common signs and symptoms include:

Edema: Swelling, typically pitting, of the ankles, feet, and face. A distended, bloated belly due to ascites (fluid accumulation in the abdomen) is also common.
Skin and Hair Changes: Dermatosis, or flaky, peeling, and discolored skin, particularly in areas of pressure, is a classic sign. Hair may become brittle, sparse, and change color.
Fatigue and Weakness: Severe muscle wasting and loss of muscle mass leads to extreme fatigue, irritability, and apathy.
Enlarged Liver: Known as hepatomegaly, a fatty liver is a common physiological sign of kwashiorkor due to impaired lipid transport.
Compromised Immune System: A weakened immune response makes adults more susceptible to infections.
Electrolyte Imbalances: Severe electrolyte disturbances are common and can lead to cardiac complications.

Diagnosis and Treatment for Adult Kwashiorkor

Due to its rarity, diagnosis in adults often requires a high degree of clinical suspicion. A doctor will begin with a physical examination, checking for edema and other physical signs, and taking a detailed dietary history.

Diagnostic Tools:

Blood Tests: Used to measure low levels of serum albumin and other proteins, electrolytes, and micronutrients like zinc and iron.
Anthropometric Measurements: While BMI may be low, it can also be misleading if edema is present. Other measurements may be used in diagnosis.
Imaging Studies: Scans like a CT can help evaluate for complications like ascites or hepatomegaly.

Treatment for adult kwashiorkor must be initiated carefully under medical supervision to avoid refeeding syndrome, a potentially fatal electrolyte imbalance that can occur with rapid nutritional repletion. The process typically involves:

Gradual Nutritional Rehabilitation: Starting with carbohydrates and slowly introducing protein and other micronutrients. Ready-to-use therapeutic foods (RUTFs) may be used.
Electrolyte and Fluid Management: Correcting imbalances in potassium, phosphate, and magnesium.
Treatment of Underlying Issues: Addressing the root cause, whether it is a chronic illness, alcoholism, or psychiatric condition.
Supplementation: Administering vitamin and mineral supplements long-term to correct deficiencies.

Comparison: Kwashiorkor vs. Marasmus in Adults

Kwashiorkor and marasmus are both forms of severe protein-energy malnutrition, but they present with distinct characteristics. In adults, the distinction can help guide treatment and management of the underlying condition.


Feature	Kwashiorkor (Edematous Malnutrition)	Marasmus (Wasting Malnutrition)
Primary Deficiency	Predominantly protein deficiency, with adequate or near-adequate caloric intake.	Deficiency of all macronutrients: protein, carbohydrates, and fats.
Physical Appearance	Edema (swelling) of the limbs and face, often a distended belly due to ascites. Muscle wasting is present but may be masked by fluid retention.	Severe emaciation and muscle wasting. A skeletal, wasted appearance with loose, wrinkled skin.
Weight Loss	Significant weight loss is often masked by fluid buildup.	Extreme, visible weight loss and depletion of fat stores.
Appetite	Poor appetite, irritability, and lethargy are common.	Hunger and a strong food-seeking response may be present initially, though appetite can eventually decline.
Liver Status	Often characterized by a fatty, enlarged liver due to impaired protein transport.	Liver is typically reduced in size, but normal in function.

Conclusion

While a diagnosis of kwashiorkor in an adult is relatively rare, its occurrence is a serious indicator of severe underlying nutritional or medical issues. Unlike in children, where food scarcity is often the primary driver, adult cases are frequently linked to chronic diseases, extreme diets, or surgical complications. The distinctive edema is a critical sign, differentiating it from marasmus, another form of malnutrition. Prompt recognition and careful, medically supervised nutritional rehabilitation are essential for recovery and preventing life-threatening complications. Increased awareness among healthcare professionals regarding the potential for adult-onset kwashiorkor is vital, especially when dealing with at-risk populations like hospitalized patients, the elderly, or those with chronic illnesses.

For more information on the complexities of protein-energy malnutrition, the Medscape reference offers a comprehensive overview.(https://emedicine.medscape.com/article/1104623-overview)

Frequently Asked Questions

Kwashiorkor is more common in young children because they have higher protein and energy requirements for their rapid growth and development. The abrupt transition from protein-rich breast milk to a low-protein, high-carbohydrate diet, often after a new sibling is born, is a significant risk factor in resource-limited settings.

Yes, although it is rare. In developed countries, adult kwashiorkor is typically not due to simple food scarcity but is a complication of chronic conditions, substance abuse (especially alcoholism), severe dietary restrictions from psychiatric disorders like anorexia, or post-surgical malabsorption issues.

The most prominent symptom is edema, or fluid retention, causing swelling in the legs, feet, and belly. Other symptoms include skin and hair changes, muscle wasting, fatigue, a compromised immune system, and an enlarged liver.

Diagnosis involves a physical examination to check for edema and other signs, a detailed dietary history, and lab tests to measure low serum protein and albumin levels, as well as checking for electrolyte imbalances.

The key difference is the presence of edema. Kwashiorkor is a protein deficiency that causes fluid retention and swelling, while marasmus is an overall calorie deficiency that leads to severe, visible wasting and emaciation without edema.

Treatment requires a medically supervised, gradual nutritional rehabilitation to prevent refeeding syndrome. It involves slowly introducing calories and protein, correcting electrolyte imbalances, providing vitamin and mineral supplements, and addressing the underlying cause of the malnutrition.

Long-term effects can include lasting organ damage (especially to the liver), persistent cognitive or neurological impairment, and an increased risk for subsequent illnesses due to a weakened immune system, particularly if treatment is delayed.