Nutrition Diet: What is the disease called kwashiorkor?

Kwashiorkor is a serious form of protein-energy malnutrition (PEM) that disproportionately affects young children in impoverished regions. A diet severely lacking in protein leads to the condition known as what is the disease called kwashiorkor?, which is characterized by prominent fluid retention and metabolic dysfunction. This debilitating disease, sometimes mistaken for a well-fed state due to bloating, is a critical issue that requires urgent intervention.

Quick Summary

Kwashiorkor is a severe malnutrition disorder caused by extreme protein deficiency, primarily affecting children. It is marked by edema, a distended belly, and other metabolic and physical symptoms resulting from nutritional imbalance.

Key Points

• Protein Deficiency: The central feature of kwashiorkor is a severe lack of protein in the diet, often coupled with sufficient or high carbohydrate intake.

• Edema is a Hallmark Sign: Kwashiorkor causes bilateral pitting edema (fluid swelling) in the ankles, feet, and face, often masking the underlying severe muscle wasting.

• Distinct from Marasmus: Unlike marasmus, which involves a total energy deficit and extreme emaciation, kwashiorkor is defined by the presence of edema.

• Multifactorial Causes: The disease is triggered by a combination of dietary imbalance, infections, micronutrient deficiencies, and socioeconomic factors like poverty and food scarcity.

• Gradual Treatment and Rehabilitation: Treatment follows a cautious, staged approach to address complications like refeeding syndrome before increasing protein and calories to aid catch-up growth.

• Long-term Consequences: If not treated early, kwashiorkor can lead to permanent physical and mental disabilities, including stunted growth.

• Preventable: Effective prevention hinges on improving food security, promoting proper nutrition education, and ensuring access to healthcare and clean water.

Understanding the Disease Called Kwashiorkor

Kwashiorkor, derived from the Ga language of Ghana, translates to "the sickness the baby gets when the new baby comes". This name vividly describes a common scenario where the disorder emerges in an older child who is abruptly weaned from protein-rich breast milk to make way for a new sibling, receiving a diet predominantly composed of low-protein starches like maize or cassava. The fundamental characteristic of kwashiorkor is severe protein malnutrition, which causes a significant fluid imbalance and distinguishes it from other forms of malnutrition.

The core causes of kwashiorkor

The etiology of kwashiorkor is complex and not solely attributed to low protein intake, although it is the main feature. Multiple interconnected factors contribute to its development:

• Dietary Imbalance: The most significant factor is a diet high in carbohydrates but severely deficient in protein. This occurs in areas with limited food resources and reliance on starchy staple crops.
• Inadequate Weaning Practices: The transition from breast milk to nutrient-poor complementary foods is a critical period when kwashiorkor can manifest, especially if caregivers lack nutritional knowledge.
• Infections and Illnesses: Frequent infectious diseases, such as measles, malaria, and chronic diarrhea, exacerbate malnutrition. These illnesses increase the body's nutrient requirements and hinder absorption, precipitating the disease.
• Micronutrient Deficiencies: Concurrent deficiencies in essential vitamins (like A) and minerals (like zinc and iron) are common and contribute to the severity and complications of kwashiorkor.
• Environmental Toxins: Exposure to toxins like aflatoxins, which contaminate food crops in hot, humid climates, has been linked to kwashiorkor in some regions. These toxins can damage the liver, a key organ affected by the disease.

Recognising the signs and symptoms

The clinical presentation of kwashiorkor is distinctive, though the visible swelling can misleadingly hide severe muscle wasting. Key symptoms include:

• Edema: The defining symptom, a characteristic swelling of the ankles, feet, hands, and face due to fluid retention.
• Distended Abdomen: The belly appears bloated and swollen due to the buildup of fluid (ascites) and an enlarged, fatty liver.
• Hair and Skin Changes: Hair can become dry, brittle, and sparse, sometimes changing to a rust or reddish color. The skin often develops a characteristic flaky, peeling rash, sometimes described as 'flaky paint' dermatosis.
• Muscle Atrophy: Despite the outward swelling, there is a significant loss of muscle mass, which becomes visible as the edema resolves with treatment.
• Behavioral Changes: Children with kwashiorkor are typically irritable, lethargic, and apathetic.
• Other Manifestations: Fatigue, diarrhea, and a weakened immune system leading to frequent infections are also common.

Kwashiorkor vs. Marasmus: A Comparative Look

Kwashiorkor and marasmus are both forms of severe acute malnutrition (SAM), but they manifest differently. While kwashiorkor is a protein-centric deficiency with edema, marasmus is a general calorie deficiency leading to extreme emaciation.

Feature	Kwashiorkor	Marasmus
Primary Deficiency	Protein-dominant	All macronutrients (protein, carbs, fats)
Appearance	Edema (swelling) masks underlying muscle wasting, leading to a swollen abdomen and limbs.	Emaciated, wasted, and shriveled appearance with visible bones and loose skin folds.
Edema	Present; bilateral pitting edema is a diagnostic sign.	Absent.
Fat and Muscle	Retained some subcutaneous fat, but muscle mass is depleted.	Significant loss of both muscle and fat stores.
Behavior	Apathetic, irritable, and lethargic.	Apathetic, but often more alert and interested in food.
Liver	Enlarged and fatty liver (hepatomegaly) is a common feature.	Liver is typically not fatty and is reduced in size.
Onset	Often occurs after weaning onto a starchy diet.	Can occur in younger infants due to general starvation.

Diagnosing and Treating Kwashiorkor

Diagnosing kwashiorkor involves a physical examination and reviewing the child's dietary history. Blood and urine tests measure protein levels and overall health markers. The World Health Organization (WHO) has established a 10-step protocol for treating severely malnourished children, which is crucial for managing kwashiorkor.

The treatment process follows these critical stages:

1. Initial Stabilisation: Address life-threatening issues like hypoglycemia, hypothermia, dehydration, and electrolyte imbalances. Special rehydration solutions are used.
2. Cautious Feeding: Refeeding must be done slowly to avoid refeeding syndrome, a dangerous condition caused by rapid metabolic shifts. Protein is introduced gradually after initial calories from carbs and fats.
3. Micronutrient Supplementation: Supplementation with vitamins and minerals like Vitamin A, zinc, and iron corrects deficiencies and boosts immune function.
4. Achieve Catch-Up Growth: Once stabilized, the child's caloric and protein intake is increased to facilitate rapid growth. Ready-to-use therapeutic foods (RUTFs) are effective at this stage.
5. Manage Infections: Prophylactic antibiotics are often administered due to the child's compromised immune system.
6. Provide Emotional Support: Stimulating emotional and intellectual development is part of the rehabilitation process, as kwashiorkor can cause developmental delays.
7. Follow-Up Care: Before discharge, caregivers receive counseling on nutrition and hygiene to prevent recurrence.

Prevention Strategies

Prevention is the most effective approach to combating kwashiorkor and relies on a multi-pronged strategy to address the root causes of malnutrition.

• Promoting Proper Nutrition Education: Informing parents and caregivers about nutritional needs, especially during and after pregnancy, is vital.
• Improving Food Security: Ensuring access to affordable and nutritious foods, particularly protein-rich options like legumes, eggs, and fish, can prevent dietary imbalances.
• Encouraging Breastfeeding: Exclusive breastfeeding for the first six months provides essential nutrients and antibodies. Introducing nutrient-rich complementary foods after six months is key.
• Enhancing Healthcare Access: Regular check-ups, growth monitoring, and access to sanitation and clean water can reduce the risk of infections that contribute to malnutrition.

The Long-Term Outlook

The prognosis for kwashiorkor is heavily dependent on the timing and quality of treatment. Early intervention can lead to a full recovery, but if treatment is delayed, it can result in permanent physical and mental disabilities, including stunted growth. Children who have recovered may also be predisposed to future liver or pancreatic issues. Without treatment, kwashiorkor can be fatal, often due to infection, liver failure, or shock. Therefore, prompt and appropriate medical care is essential to mitigate the devastating consequences of this disease. For further reading on global malnutrition, explore the World Health Organization's resources.

Conclusion

Kwashiorkor is a severe form of protein malnutrition that tragically affects many children in resource-poor areas, presenting with distinctive fluid retention and metabolic complications. The name what is the disease called kwashiorkor? underscores its link to poor weaning practices, but its causes also involve broader issues like poverty, infection, and micronutrient deficiencies. Timely diagnosis and careful, multi-stage treatment following WHO guidelines are crucial for recovery, while comprehensive prevention strategies focusing on nutrition education and food security are the most effective long-term solutions. The potential for lasting physical and mental health issues highlights the need for continued public health efforts to address this critical form of malnutrition.

Frequently Asked Questions

What is the primary cause of kwashiorkor?

The primary cause of kwashiorkor is a diet that is severely deficient in protein, even if the person consumes enough calories from carbohydrates.

How is kwashiorkor different from marasmus?

Kwashiorkor is distinguished from marasmus by the presence of edema (fluid retention). Marasmus is caused by a general lack of all macronutrients and is characterized by extreme emaciation without swelling.

What are the most visible symptoms of kwashiorkor?

The most visible symptoms include a swollen, distended abdomen, fluid retention in the ankles, feet, and hands (edema), and changes in the color and texture of hair and skin.

Can kwashiorkor cause permanent damage?

Yes, if treatment is not administered early, kwashiorkor can lead to permanent physical and mental disabilities, including stunted growth. It can be fatal if left untreated.

How is kwashiorkor diagnosed?

Diagnosis typically involves a physical examination for signs like edema and an enlarged liver. Doctors will also use blood and urine tests to check protein and other nutrient levels.

What is the main challenge in treating kwashiorkor?

A major challenge is the risk of refeeding syndrome, a potentially fatal complication that can occur when severely malnourished individuals are fed too rapidly. Treatment must start slowly and cautiously.

How can kwashiorkor be prevented?

Prevention strategies include ensuring access to protein-rich foods, promoting proper weaning practices, providing nutritional education, and improving overall food security and healthcare.

Does kwashiorkor only affect children?

While most common in children, kwashiorkor can affect all ages, especially during times of famine or severe food scarcity. It can also be found in elderly individuals or those with certain medical conditions.