Understanding Kwashiorkor: The Disorder When a Person Has a Deficiency in Protein

October 27, 2025 •

4 min read

Affecting over 149 million children globally in 2020 with stunted growth, kwashiorkor is a severe form of protein-energy malnutrition. It is the most well-known disorder when a person has a deficiency in protein, leading to tell-tale symptoms like fluid retention and a distended abdomen.

Quick Summary

This article explores kwashiorkor, the severe protein deficiency disorder, detailing its common occurrence in children in developing nations and the factors contributing to it. It outlines the specific symptoms of kwashiorkor and differentiates it from marasmus, another form of malnutrition, and explains diagnostic methods and crucial treatment steps.

Key Points

Definition of Kwashiorkor: A severe form of protein-energy malnutrition caused primarily by insufficient protein intake, often accompanied by relatively normal carbohydrate consumption.
Distinguishing Symptoms: The most notable symptom is edema (swelling) of the extremities and abdomen, which can mask the severe underlying muscle wasting.
Key Difference from Marasmus: Unlike marasmus, which involves a general deficit of all macronutrients, kwashiorkor is predominantly a protein deficiency and is defined by the presence of edema.
Underlying Causes: While dietary protein deficiency is central, other factors like micronutrient shortages, oxidative stress, and infections also play a role in its development.
Critical Treatment Phases: Effective treatment involves stabilizing the patient by addressing fluid and electrolyte imbalances and infections before a gradual and cautious reintroduction of nutrient-dense food to prevent refeeding syndrome.
Risk Factors and Long-term Effects: Most prevalent in children in developing countries, kwashiorkor can lead to permanent physical and mental developmental delays if not treated in a timely manner.

What is Kwashiorkor?

Kwashiorkor is a severe form of protein-energy malnutrition (PEM) that is primarily characterized by a severe lack of protein in the diet, often alongside adequate calorie intake from carbohydrates. The name originates from a Ghanaian language and translates to "the sickness the baby gets when the new baby comes," referring to the time when a toddler is weaned from protein-rich breast milk and given a diet of high-carbohydrate, low-protein foods. While a pure protein deficiency is the main characteristic, some research indicates that the underlying causes are more complex, potentially involving micronutrient deficiencies, oxidative stress, and environmental toxins like aflatoxins.

The Physiological Impact of Protein Deficiency

Protein is crucial for countless bodily functions, from building and repairing tissues to producing hormones and enzymes. In kwashiorkor, the lack of dietary protein leads to systemic failure. One of the most visible effects is the significant reduction in albumin, a protein that maintains osmotic pressure and keeps fluid within blood vessels. When albumin levels drop, fluid leaks into the tissues, causing the characteristic swelling, or edema, seen in the hands, feet, and face. This fluid buildup can also cause the abdomen to appear distended, masking the underlying malnutrition.

In addition, a protein deficit forces the body to break down its own tissues to get the necessary amino acids. While muscle mass is lost, the presence of carbohydrates can spare fat, leading to the misleading appearance of retaining body fat under the skin. This metabolic disturbance also significantly impairs the immune system, making individuals highly vulnerable to infections.

Signs and Symptoms of Kwashiorkor

Edema (Swelling): The most defining sign is bilateral pitting edema, particularly in the lower extremities, face, and abdomen.
Fatty Liver: Liver enlargement due to fatty infiltration is common because the body cannot produce enough lipoproteins to transport fats out of the liver.
Skin and Hair Changes: The skin may become dry, scaly, and hyperpigmented, with peeling patches. Hair can become brittle, sparse, and lose its color, sometimes described as a “flag sign”.
Muscle Wasting: While edema can hide it, muscle mass is depleted as the body breaks down its own protein stores.
Growth Failure: Children with kwashiorkor often experience stunted growth and weight loss (though it may be masked by swelling).
Apathy and Irritability: Behavioral changes, including listlessness, sadness, and irritability, are frequently observed.
Compromised Immunity: The weakened immune system makes the body susceptible to infections, which can be life-threatening.
Diarrhea: Persistent diarrhea is a common symptom that can worsen dehydration and nutrient malabsorption.

Diagnosis and Treatment

Diagnosis of kwashiorkor is typically made through physical examination, where characteristic signs like edema are noted. Blood tests revealing low serum albumin and other micronutrient deficiencies, as well as body measurements like weight-for-height and height-for-age, help confirm the diagnosis and severity.

Treating severe malnutrition requires a careful, staged approach to avoid complications like refeeding syndrome. The World Health Organization (WHO) outlines a multi-step process:

Immediate Stabilization: Addressing life-threatening issues such as hypoglycemia, hypothermia, dehydration, and infection is the first priority. Special rehydration formulas (like ReSoMal) are used to correct electrolyte imbalances and fluid levels.
Nutritional Rehabilitation: Once stable, cautious feeding is started, gradually reintroducing nutrient-dense, high-protein formulas. This prevents the shock to the system known as refeeding syndrome.
Catch-up Growth: Calories are increased to promote rapid recovery and catch-up growth.
Long-term Follow-up: Education for caregivers on proper nutrition, hygiene, and disease prevention is essential to prevent recurrence.

The Difference Between Kwashiorkor and Marasmus


Feature	Kwashiorkor	Marasmus	Marasmic-Kwashiorkor
Primary Deficiency	Severe protein deficiency, often with relatively normal calorie intake from carbohydrates.	Severe deficiency of all macronutrients, including protein, carbohydrates, and fats.	Combination of both severe protein and calorie deficiencies.
Physical Appearance	Edema (swelling) of the face, abdomen, and limbs, often masking the underlying muscle wasting.	Emaciated and withered appearance with severe muscle and fat wasting, and skin hanging in loose folds.	Features of both, including edema and significant muscle wasting.
Abdomen	Distended (swollen) due to ascites (fluid accumulation) and an enlarged fatty liver.	Often appears sunken or 'gaunt' due to extreme tissue loss.	Distended abdomen with overall wasting.
Weight	May appear less underweight than they are due to edema.	Significantly low body weight for age.	Very low body weight for age.
Behavior	Apathetic and irritable.	May be active and hungry initially, but become apathetic later.	Displays characteristics of both.

The Global Impact and Prognosis

Kwashiorkor remains a significant health concern in developing regions affected by poverty, food insecurity, and infectious diseases. While it is rare in developed countries, it can occur in cases of eating disorders, severe neglect, or specific gastrointestinal conditions. If left untreated, kwashiorkor can be fatal due to complications like infection, dehydration, or liver failure. With early intervention and proper treatment, a strong recovery is possible, though some children may experience lasting effects on their physical and cognitive development. Prevention is key and involves improving nutritional education, access to nutritious foods, proper sanitation, and addressing underlying socioeconomic factors.

Conclusion

Kwashiorkor is a complex and dangerous form of malnutrition resulting from a severe protein deficiency. Its defining symptoms, particularly edema, differentiate it from other forms of protein-energy malnutrition like marasmus. While the most severe cases are linked to food scarcity in developing countries, an understanding of the condition is vital for identifying underlying risks and ensuring timely intervention. Treatment, when administered carefully and early, can lead to a full recovery, highlighting the importance of nutritional awareness and comprehensive public health strategies. The persistent global prevalence of this disorder underscores the ongoing need for efforts to combat food insecurity and improve nutritional health worldwide.

World Health Organization

Frequently Asked Questions

The primary disorder is kwashiorkor, a severe form of protein-energy malnutrition (PEM) characterized by a pronounced deficiency in protein intake, often accompanied by edema and a distended abdomen.

Kwashiorkor is defined by a severe protein deficiency with resulting edema, while marasmus is a deficiency of all macronutrients (protein, carbohydrates, and fats) and results in extreme emaciation without edema.

Common symptoms include bilateral pitting edema (swelling) in the feet, hands, and face, a bloated abdomen, skin and hair color changes, muscle wasting, and stunted growth in children.

Kwashiorkor most commonly affects young children in developing countries, particularly after they are weaned from breast milk and moved to a low-protein, high-carbohydrate diet.

Yes, while less common, adults can develop kwashiorkor due to underlying medical conditions like eating disorders, severe gastrointestinal issues, or certain wasting diseases.

Diagnosis is based on a physical examination for clinical signs like edema, as well as blood tests to measure low serum albumin levels. Anthropometric measurements also help confirm the severity.

Yes, kwashiorkor is treatable, but requires careful medical supervision, especially during the initial stages to prevent refeeding syndrome. Early and sustained nutritional intervention can lead to recovery.

Untreated kwashiorkor can lead to severe and potentially fatal complications, including infection, dehydration, and liver failure. Long-term effects for survivors can include permanent intellectual and physical developmental delays.