Kwashiorkor: What Disease Happens When You Don't Eat Enough Protein?

Kwashiorkor, a severe form of protein-energy malnutrition, accounts for a significant percentage of deaths among children under five in poverty-stricken regions. This debilitating disease happens when you don't eat enough protein and is most often characterized by fluid retention and a swollen abdomen.

Quick Summary

Kwashiorkor is a disease caused by severe protein deficiency, primarily affecting children in developing countries. It leads to symptoms like fluid retention (edema), a distended belly, skin lesions, and hair discoloration. The condition weakens the immune system and can be fatal if not treated, but is reversible with increased protein intake.

Key Points

• Kwashiorkor is the result of severe protein deficiency, leading to malnutrition, most commonly seen in children in impoverished areas.

• Edema, or fluid retention, is a hallmark symptom, causing swelling in the extremities and a distended belly, masking the true extent of emaciation.

• Long-term deficiency can cause significant complications, including muscle wasting, weakened immunity, and stunted growth and development.

• Treatment requires careful and gradual refeeding, starting with calories and then reintroducing protein to avoid dangerous refeeding syndrome.

• Prevention is crucial and centers on nutrition education, access to diverse protein sources, and managing underlying infectious diseases.

Understanding the Most Common Disease from Protein Deficiency

Kwashiorkor is the most well-known disease resulting from a severe lack of protein in the diet. While a less severe form of low protein in the blood is called hypoproteinemia, kwashiorkor represents an advanced and life-threatening stage of malnutrition. It is particularly prevalent in developing countries where diets often consist of high-carbohydrate staples with very little protein. Protein is essential for virtually every function in the body, from building and repairing tissues to producing hormones and enzymes. A prolonged deficiency has widespread and devastating effects.

The Hallmark Signs and Symptoms of Kwashiorkor

The symptoms of kwashiorkor are distinct from other forms of malnutrition like marasmus. The most defining feature is the severe fluid retention, or edema, that masks the underlying muscle wasting.

• Edema: Swelling, especially in the ankles, feet, hands, and face, is caused by a low concentration of albumin in the blood. Albumin helps maintain oncotic pressure, preventing fluid from leaking out of blood vessels into tissues.
• Distended Abdomen: The swollen, protuberant belly is another visible sign, resulting from both edema and an enlarged liver due to fatty infiltration.
• Skin and Hair Changes: The skin can become dry, flaky, and develop rashes or lesions. Hair may lose its pigmentation (often turning a reddish or yellowish color), become brittle, and fall out easily.
• Muscle Wasting: Despite the swelling, there is significant loss of muscle mass. The body breaks down muscle tissue for protein and energy, leading to overall weakness and fatigue.
• Weakened Immune System: A lack of protein impairs the immune system's ability to produce antibodies and immune cells, leading to frequent and severe infections.
• Stunted Growth: In children, kwashiorkor leads to a failure to grow and gain weight. This can cause permanent physical and intellectual disabilities if not treated early.
• Fatigue and Apathy: Individuals, especially children, may exhibit extreme lethargy, irritability, and a general lack of interest in their surroundings.

The Complex Causes of Kwashiorkor

While inadequate protein intake is the direct trigger, the full etiology of kwashiorkor is multifactorial. It often arises in specific contexts.

• Poor Diet: The primary cause is a diet heavy in carbohydrates but severely lacking in protein. This is common in regions where staples like maize, cassava, or rice are plentiful but protein-rich foods are scarce.
• Weaning: The name "kwashiorkor" comes from a Ghanaian term meaning "the sickness the baby gets when the new baby comes". It often occurs in toddlers who are abruptly weaned from protein-rich breast milk and given a carbohydrate-heavy diet.
• Infections and Illnesses: Measles, malaria, HIV, and chronic diarrhea can exacerbate protein deficiency by increasing the body's need for nutrients and impairing absorption.
• Poor Sanitation: This contributes to infectious diseases, further straining the body's resources.
• Genetic Factors: Some research suggests that individual genetic variations may influence susceptibility to developing kwashiorkor versus marasmus.
• Aflatoxin Exposure: In some regions, exposure to aflatoxins from mold on crops is associated with higher rates of kwashiorkor, although the exact link is not fully understood.

Kwashiorkor vs. Marasmus: A Comparison

Feature	Kwashiorkor	Marasmus
Primary Deficiency	Predominantly protein deficiency, with relatively sufficient calorie intake.	Deficiency of all macronutrients: protein, carbohydrates, and fats.
Key Symptom	Edema (swelling) is the defining characteristic.	Severe muscle and fat wasting; no edema.
Appearance	Bloated or distended abdomen and puffy extremities, masking extreme emaciation.	Emaciated, skeletal appearance, with extreme loss of body fat and muscle.
Appetite	Often has a poor appetite.	Often hungry, sometimes ravenous.
Fatty Liver	Enlarged, fatty liver is a common finding.	Less common.
Skin/Hair	Changes in skin texture and color; brittle, discolored hair.	Dry, thin skin; hair is also often sparse and brittle.
Age	Most common in young children after weaning (1-3 years).	More common in infants under one year of age.

Treatment and Recovery

Early and careful treatment is crucial for a successful recovery from kwashiorkor. The World Health Organization has established a 10-step protocol to manage severely malnourished children.

1. Immediate Stabilization: Addressing life-threatening issues like hypoglycemia, hypothermia, and dehydration.
2. Cautious Feeding: Refeeding must be done slowly to avoid refeeding syndrome, a potentially fatal complication. Initially, a gradual increase of calories and nutrients is introduced, with protein added incrementally.
3. Correcting Deficiencies: Administering supplements to correct micronutrient deficiencies.
4. Managing Infections: Treating infections, as the immune system is severely compromised.
5. Achieving Catch-Up Growth: After stabilization, the child's diet is increased to promote rapid weight gain and growth.
6. Long-Term Support: Providing education and support to the family to prevent recurrence.

Full recovery is possible with early intervention, though long-term effects like stunted growth can remain. Kwashiorkor remains a significant global health issue, highlighting the critical importance of proper nutrition, especially for children. More information on global efforts can be found through organizations like the World Health Organization (WHO), a leading authority on combating malnutrition.

Conclusion

Kwashiorkor is a devastating disease that occurs when you don't eat enough protein, primarily affecting vulnerable children in low-income regions. Characterized by severe edema, muscle wasting, and a compromised immune system, it is a stark reminder of the profound impact of nutrient deficiencies. The good news is that with early and appropriate intervention, kwashiorkor is treatable. Prevention, however, is key, requiring improved access to diverse, protein-rich food sources and education on sound nutritional practices.

Frequently Asked Questions

What is the primary disease you get from not eating enough protein?

The primary disease resulting from a severe lack of protein is kwashiorkor, a form of severe protein-energy malnutrition.

How do you know if you have a protein deficiency?

Symptoms of protein deficiency can include fatigue, weakness, hair and nail issues, mood changes, increased hunger, and a weakened immune system.

Can adults get kwashiorkor?

While most common in children, adults can develop kwashiorkor in cases of severe illness, long-term restrictive diets, or other conditions that cause malnutrition.

What does a distended belly in kwashiorkor mean?

A distended belly is a classic symptom of kwashiorkor caused by edema, or fluid buildup, and an enlarged liver resulting from fatty infiltration.

Is protein deficiency common in developed countries?

Severe protein deficiency like kwashiorkor is rare in developed countries where food supply is stable. Milder deficiencies (hypoproteinemia) can occur due to restrictive diets, illness, or aging.

How can I increase my protein intake?

To increase protein intake, incorporate a variety of protein-rich foods such as lean meats, poultry, fish, eggs, dairy, beans, lentils, nuts, and seeds into your diet.

Is there a difference between kwashiorkor and marasmus?

Yes, kwashiorkor is primarily a protein deficiency marked by edema, while marasmus is a total energy deficiency (from protein, carbs, and fats) resulting in severe wasting without edema.