Nutrition Diet: Which Vitamin Deficiency Is Commonly Seen in Kwashiorkor?

October 28, 2025 •

4 min read

According to the World Health Organization, millions of children in impoverished countries are affected by severe malnutrition, leading to conditions like kwashiorkor. While a protein deficit is the hallmark, understanding which vitamin deficiency is commonly seen in kwashiorkor is vital for effective treatment.

Quick Summary

Kwashiorkor is a form of malnutrition characterized by edema due to severe protein deficiency, often compounded by critical deficiencies in vitamins A, E, and folic acid. These deficiencies impact immune function, vision, blood health, and overall recovery.

Key Points

Protein is the Primary Deficiency: Kwashiorkor's defining symptom of edema is caused by low albumin levels resulting from a severe protein deficit.
Vitamin A Deficiency is Critically Common: VAD is strongly associated with kwashiorkor, causing impaired immune function and potentially permanent blindness.
Folic Acid Deficiency Contributes to Anemia: Insufficient folic acid (vitamin B9) is a major contributor to the megaloblastic anemia frequently observed in patients.
Low Vitamin E Levels are Tied to Oxidative Stress: Kwashiorkor patients often have low levels of the antioxidant Vitamin E, linked to the high oxidative stress seen in the condition.
Multiple Deficiencies Exacerbate the Condition: Kwashiorkor is not a single deficiency but a complex condition where a lack of multiple nutrients, including key vitamins, worsens the overall health outcome.
Treatment Must be Comprehensive: Effective therapy requires addressing protein, calorie, and all identified micronutrient deficiencies in a phased and careful manner.

Kwashiorkor: An Edematous Malnutrition

Kwashiorkor is a severe form of protein-energy malnutrition (PEM) that is particularly prevalent in children in developing countries. It is classically distinguished from marasmus by the presence of edema, which is fluid retention causing swelling in the hands, feet, face, and abdomen. The core cause of kwashiorkor's edema is the severe deficiency of protein, which leads to hypoalbuminemia, or low levels of albumin in the blood. Albumin helps regulate the fluid balance between tissues and blood vessels; without enough protein to produce it, fluid leaks out and causes swelling. While a protein deficit is the primary driver, the diets leading to kwashiorkor are typically high in carbohydrates but severely lacking in protein and other essential nutrients, including vitamins. This makes it crucial to address not only protein but also the accompanying vitamin deficiencies.

The Critical Role of Vitamin Deficiencies

Malnutrition is a systemic problem, and a diet lacking sufficient protein is almost guaranteed to also lack vital micronutrients. The associated vitamin deficiencies in kwashiorkor play a significant role in exacerbating symptoms and complicating treatment. A comprehensive approach that includes vitamin supplementation is therefore essential for recovery.

Vitamin A (Retinol) Deficiency

Vitamin A deficiency (VAD) is one of the most commonly seen vitamin deficiencies in kwashiorkor.

Impaired absorption: The lack of protein impairs the synthesis of retinol-binding protein (RBP), a crucial protein for transporting vitamin A throughout the body. This means that even if some vitamin A is present in the diet, its absorption and transport are severely hindered.
Immune system compromise: Vitamin A is vital for maintaining a healthy immune system, and its deficiency leads to profoundly impaired innate and adaptive immune responses. This increases the child's susceptibility to serious infections, like measles, which further worsens their malnourished state.
Ocular issues: VAD is a leading cause of preventable blindness in children. Symptoms include night blindness and, in severe cases, xerophthalmia and keratomalacia, which can lead to permanent vision loss.

Folic Acid (Vitamin B9) Deficiency

Anemia is a common feature of kwashiorkor, and folic acid deficiency is a frequent contributing factor.

Megaloblastic anemia: Folic acid is essential for the production of red blood cells. A deficiency can lead to megaloblastic anemia, where red blood cells are larger than normal and fewer in number.
Dietary source: Diets consisting primarily of carbohydrate staples like maize or cassava are often low in folic acid, compounding the issue.

Vitamin E Deficiency

Kwashiorkor is characterized by high levels of oxidative stress, an imbalance between free radical production and the body's ability to counteract their harmful effects.

Role as an antioxidant: Vitamin E is a fat-soluble antioxidant that protects cells from damage. Its deficiency is commonly noted in children with kwashiorkor due to inadequate dietary intake and impaired absorption of fat-soluble vitamins.
Consequence or cause?: While deficiency is clearly present, some studies suggest that low antioxidant levels, including vitamin E, may be a consequence of the illness rather than a direct cause, resulting from the body's systemic response to severe malnutrition and oxidative stress.

Kwashiorkor vs. Marasmus: A Comparative Look

Kwashiorkor and marasmus are both forms of severe acute malnutrition (SAM), but they present with distinct characteristics related to the nature of their nutritional deficits.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Protein deficiency, with generally adequate or even excess calories.	Overall energy and calorie deficit (protein, fat, carbohydrates).
Key Clinical Sign	Presence of bilateral pitting edema (swelling).	Severe wasting and emaciation, with a 'skin and bones' appearance and no edema.
Abdominal Appearance	Distended abdomen due to edema and fatty liver.	Wrinkled skin and loss of subcutaneous fat.
Psychological State	Apathetic, irritable, and withdrawn.	Appears alert and hungry, but can be irritable.
Micronutrients	Often has profound deficiencies in vitamins and antioxidants, such as Vitamin A and E.	Also has micronutrient deficiencies, but the oxidative stress profile can differ.

The Multi-Pronged Approach to Treatment

Treating kwashiorkor requires more than just reintroducing protein; a careful, multi-phased approach is critical to prevent potentially fatal complications, such as refeeding syndrome. The World Health Organization outlines a structured treatment plan that addresses both macro- and micronutrient needs.

Phases of Treatment

Initial Stabilization: In the first phase, the immediate life-threatening issues such as hypoglycemia (low blood sugar), hypothermia, and dehydration must be addressed. This involves careful rehydration and introduction of a low-protein, low-sodium therapeutic formula (F-75).
Addressing Micronutrient Deficiencies: Before full-scale nutritional rehabilitation begins, it is vital to correct severe micronutrient deficiencies. This includes providing supplements of key vitamins and minerals like Vitamin A, folic acid, and zinc. Vitamin A is often administered to prevent vision damage.
Catch-Up Growth: Once stable, the child can transition to higher-calorie, higher-protein therapeutic foods (like F-100 or ready-to-use therapeutic foods, RUTF) to promote rapid weight gain and muscle mass recovery.

Prevention and Long-Term Care

Long-term prevention of kwashiorkor requires addressing the root causes of malnutrition, including food scarcity and access to diverse, nutrient-dense foods. Education on proper nutrition and food preparation is also essential. Early intervention and appropriate dietary management are crucial for minimizing permanent physical and mental disabilities. Outbound link to WHO guidelines on severe malnutrition treatment: WHO Vitamin A supplementation guidance.

Conclusion

While the striking edema of kwashiorkor is caused by severe protein deficiency, the illness is fundamentally a multifaceted nutritional disorder. The answer to 'which vitamin deficiency is commonly seen in kwashiorkor?' is not singular; rather, deficiencies in Vitamin A, folic acid, and Vitamin E are frequently observed alongside the primary protein deficit. Treating kwashiorkor successfully necessitates a holistic approach that corrects both protein and all associated micronutrient deficits, highlighting the intricate and interconnected nature of nutritional health.

Frequently Asked Questions

The main nutritional cause of kwashiorkor is a severe deficiency of protein, which is essential for many bodily functions, including fluid regulation.

Severe protein deficiency causes a lack of albumin, a protein that helps maintain fluid balance in the blood. This results in fluid leaking from the blood vessels into surrounding tissues, causing swelling or edema.

Vitamin A deficiency is particularly dangerous because it can lead to severe and irreversible consequences, such as vision problems and permanent blindness.

Folic acid deficiency is common because the carbohydrate-heavy diets often associated with kwashiorkor are poor sources of this B vitamin. This deficiency contributes to megaloblastic anemia.

Yes, kwashiorkor is associated with deficiencies in other micronutrients, including minerals like zinc, selenium, and iron, which further compromise immune function and overall health.

The main difference is the primary deficiency and the resulting symptoms. Kwashiorkor is a protein deficiency causing edema, while marasmus is an overall calorie and energy deficiency causing severe wasting and emaciation.

Treatment involves a multi-phase approach, starting with stabilizing life-threatening conditions. Once stable, doctors correct micronutrient deficiencies with supplements before initiating a diet rich in calories and protein for catch-up growth.