Understanding Kwashiorkor: Which vitamin deficiency leads to kwashiorkor, and what is the real cause?

October 25, 2025 •

3 min read

According to the World Health Organization (WHO), malnutrition remains a significant public health concern, particularly in children under five. A common misconception asks: 'Which vitamin deficiency leads to kwashiakor?' The truth is that while several vitamin deficiencies are associated with this severe condition, the underlying cause is severe protein malnutrition.

Quick Summary

Kwashiorkor is a severe form of protein-energy malnutrition, not a singular vitamin deficiency. It is characterized by protein and micronutrient shortages, particularly vitamin A, folic acid, and zinc. Symptoms include edema, skin lesions, and hair changes.

Key Points

Protein is the Primary Deficiency: Kwashiorkor's defining features, especially the edema, stem from severe protein malnutrition, not a single vitamin deficiency.
Vitamin Deficiencies are Comorbidities: Deficiencies in vitamins, such as A, E, C, and folic acid, frequently accompany kwashiorkor but are secondary complications, not the core cause.
Edema is a Hallmark Sign: Swelling, or edema, in the extremities and abdomen is the key diagnostic feature that distinguishes kwashiorkor from other forms of severe malnutrition.
Diagnosis is Clinical and Multi-faceted: A diagnosis is made based on clinical signs like edema and physical examination, often complemented by laboratory tests for protein and electrolyte levels.
Treatment is Cautious and Phased: Nutritional rehabilitation starts slowly with high-energy, low-protein feeds to prevent refeeding syndrome, with protein and micronutrients added gradually.
Prevention Focuses on Food Security: Preventing kwashiorkor requires addressing underlying issues like poverty and food insecurity, ensuring access to diverse and protein-rich diets.

Demystifying the Cause of Kwashiorkor

Kwashiorkor is a severe form of malnutrition rooted in a lack of protein, often occurring when a child transitions from breast milk to a protein-poor diet, a scenario captured by the Ga language term 'kwashiorkor,' meaning 'the sickness the baby gets when the new baby comes'. This protein deficiency significantly lowers serum albumin levels, disrupting osmotic pressure and causing the characteristic edema (swelling) seen in patients. This edema can hide severe muscle wasting. The underlying cause is not a single vitamin deficiency, but rather a severe lack of protein coupled with insufficient intake of vital vitamins and minerals.

The Role of Associated Vitamin Deficiencies

While not the primary cause of kwashiorkor's defining symptoms like edema, concurrent deficiencies in vitamins and minerals exacerbate the condition. For example, Vitamin A deficiency is commonly associated, leading to eye issues such as keratomalacia and Bitot spots. Anemia is also frequently seen due to deficiencies in folic acid and iron. Low levels of antioxidants like Vitamin E contribute to increased oxidative stress.

Core Symptoms of Kwashiorkor

Key symptoms of kwashiorkor, which differentiate it from other types of malnutrition, include:

Edema: Swelling, particularly in the ankles, feet, and abdomen.
Hair Changes: Hair can become brittle, sparse, and may change color.
Skin Lesions: Dermatitis and peeling skin that can resemble flaky paint.
Apathy and Lethargy: Children often display irritability and a lack of interest.
Enlarged Liver: Caused by impaired fat transport due to protein deficiency.
Impaired Growth: Significant stunting is evident after edema subsides.
Compromised Immunity: Increased susceptibility to infections.

Kwashiorkor vs. Marasmus: A Comparative Look

Kwashiorkor and marasmus are both forms of severe acute malnutrition but differ in their primary cause and presentation.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Severe protein.	Severe protein and calories.
Key Clinical Sign	Edema (swelling).	Severe muscle wasting and emaciation.
Appearance	Often appears bloated or puffy due to fluid retention.	Presents with a visibly emaciated, shriveled look.
Appetite	Loss of appetite is common.	Often have a ravenous hunger.
Hair/Skin Changes	Common, including brittle, discolored hair and dermatitis.	Less frequent or prominent.
Fatty Liver	Characteristic.	Rare.

Treatment and Prevention

Treatment, guided by WHO protocols, focuses on stabilizing the child and addressing complications like infections. This involves cautious refeeding with high-energy, low-protein formulas to prevent refeeding syndrome, gradually introducing higher protein content and supplementing with micronutrients like vitamin A, zinc, and iron. Prevention centers on combating food insecurity and poverty, promoting breastfeeding, and ensuring access to nutrient-rich foods.

Conclusion

In summary, kwashiorkor is fundamentally a consequence of severe protein malnutrition, not a single vitamin deficiency. The characteristic edema is a result of low protein levels affecting blood osmotic pressure. While specific vitamin deficiencies, notably Vitamin A and E, are common and serious complications requiring supplementation, they are not the underlying cause. Effective management requires a comprehensive approach addressing both protein and micronutrient deficiencies, alongside long-term strategies to improve dietary quality and food security. For more information on the management of severe acute malnutrition, consult resources from the National Institutes of Health.

Frequently Asked Questions

The primary cause of kwashiorkor is a severe deficiency of protein in the diet, which often occurs alongside an adequate or high intake of carbohydrates.

No, kwashiorkor is not directly caused by a single vitamin deficiency. It is a form of severe protein-energy malnutrition, though patients often also suffer from concurrent deficiencies of vitamins like A and E.

Severe protein deficiency causes a decrease in blood albumin levels (hypoalbuminemia). This reduces the blood's osmotic pressure, leading to fluid leaking from the blood vessels into the tissues and causing edema.

Kwashiorkor is primarily a protein deficiency characterized by edema, while marasmus is a deficiency of both protein and calories, characterized by severe muscle wasting and emaciation.

Commonly associated deficiencies include Vitamin A, Vitamin E, and folic acid. These shortages contribute to specific symptoms, such as eye problems from a lack of vitamin A and anemia from a lack of folic acid and iron.

Treatment involves a gradual refeeding process, starting with high-energy, low-protein foods and progressing to higher protein content. This is combined with antibiotic treatment for infections and supplementation of vital micronutrients like vitamins and minerals.

Yes, if left untreated, kwashiorkor can be life-threatening. Complications can include severe infections due to a weakened immune system, cardiovascular issues, and shock, which can lead to death.