What are the five causes of kwashiorkor? An in-depth look at protein malnutrition

October 10, 2025 •

3 min read

According to the World Health Organization, severe acute malnutrition, which includes kwashiorkor, accounts for a significant number of childhood deaths globally. Unpacking what are the five causes of kwashiorkor? reveals a complex interplay of dietary, environmental, and social factors that contribute to this serious nutritional disorder.

Quick Summary

Kwashiorkor is a severe malnutrition syndrome influenced by a complex interplay of factors, including protein deficiency, a carbohydrate-heavy diet, infectious diseases, and exposure to toxins.

Key Points

Protein Deficiency and Dietary Imbalance: Kwashiorkor is fundamentally caused by a severe lack of protein, often paired with a high-carbohydrate diet, leading to fluid retention (edema) and a swollen abdomen.
Infectious Diseases: Chronic or recurring infections like measles and diarrhea significantly worsen kwashiorkor by depleting the body's resources and impairing nutrient absorption.
Micronutrient Deficiencies: The absence of essential vitamins and minerals, particularly antioxidants like zinc and selenium, damages cellular function and contributes to the disease's development.
Environmental Toxins: Exposure to aflatoxins from moldy crops is strongly linked to kwashiorkor, potentially causing liver damage and other complications.
Socioeconomic Conditions: Underlying factors like poverty, food scarcity, poor sanitation, and lack of nutritional education are the root causes that create an environment ripe for kwashiorkor.
Fluid Retention vs. Wasting: Unlike marasmus, which causes visible wasting, kwashiorkor's edema can mask muscle loss, making its severity potentially deceptive.
Treatment Focus: Effective treatment involves a gradual reintroduction of nutrients, treatment of infections, and correcting micronutrient deficiencies to avoid refeeding syndrome.

Understanding the Five Core Factors Behind Kwashiorkor

Kwashiorkor is a severe form of malnutrition resulting from a combination of factors, not just a single deficiency. It is most prevalent in children in areas with limited resources and is influenced by environmental, dietary, and biological issues. The causes are diverse, encompassing nutritional imbalances, environmental toxins, and infectious diseases.

1. Inadequate Dietary Protein and Imbalance

A primary cause of kwashiorkor is a diet severely lacking in protein despite sufficient caloric intake from carbohydrates. The term “kwashiorkor” originates from a Ghanaian phrase describing the illness in a child after a younger sibling is born. This reflects the common scenario where an older child is weaned from protein-rich breast milk onto starchy, low-protein staple foods. This protein-to-energy imbalance is critical.

The lack of protein leads to low blood albumin levels (hypoalbuminemia), disrupting osmotic pressure and causing fluid to move into tissues, resulting in the characteristic edema and swollen abdomen. The body's reduced ability to synthesize new cells and repair tissues due to insufficient protein further worsens the condition.

2. Co-existing Infectious Diseases

Frequent infections significantly contribute to kwashiorkor. Diseases like measles, malaria, and diarrhea deplete the body's resources and hinder nutrient absorption. Malnourished individuals have weakened immune systems, making them more vulnerable to these infections, creating a cycle of illness and malnutrition. Diarrheal diseases can cause rapid dehydration and loss of electrolytes, worsening nutritional status. Infections increase the demand for nutrients, and in already deficient diets, this can trigger or intensify kwashiorkor.

3. Critical Micronutrient Deficiencies

Kwashiorkor typically involves deficiencies in essential micronutrients in addition to protein. A lack of vitamins and minerals like zinc, selenium, and antioxidants (Vitamins A and E) impacts metabolic functions and immune response. These deficiencies increase vulnerability to illness. Antioxidant deficiency, for example, leads to oxidative stress, contributing to the inflammation and cellular damage seen in kwashiorkor.

4. Exposure to Environmental Toxins

Aflatoxins, toxins produced by fungi in hot, humid conditions, are strongly linked to kwashiorkor. These fungi often contaminate crops like maize and groundnuts. Studies show higher levels of aflatoxins in children with kwashiorkor. These toxins can damage the liver, impairing protein synthesis and nutrient processing, which exacerbates malnutrition.

5. Underlying Socioeconomic and Environmental Factors

The fundamental causes of kwashiorkor lie in socioeconomic and environmental issues that affect food access and quality. Key contributing factors include:

Poverty and Food Insecurity: Financial limitations often restrict access to diverse, protein-rich foods.
Lack of Nutritional Knowledge: Limited education on proper feeding practices for infants and children can lead to inadequate diets.
Poor Sanitation and Hygiene: Unsanitary living conditions increase the risk of infectious diseases, a major trigger for kwashiorkor.
Political and Environmental Instability: Famine, conflict, and natural disasters cause food shortages and disrupt healthcare, putting vulnerable populations at high risk.

Kwashiorkor vs. Marasmus: A Key Comparison

Kwashiorkor differs from marasmus, another severe acute malnutrition (SAM) condition. Both are forms of protein-energy malnutrition (PEM) but present differently based on the balance of energy and protein deficiency.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Predominantly protein deficiency, though calories can be adequate.	Severe deficiency of both protein and calories.
Calories	Calorie intake may be adequate or relatively preserved from carbohydrates.	Calorie intake is severely deficient, leading to energy deficit.
Edema (Swelling)	Present. The defining feature is bilateral pitting edema in extremities and a distended belly.	Absent. No swelling or fluid retention.
Muscle Wasting	Significant muscle wasting, but it can be masked by edema.	Extreme muscle wasting is clearly visible, giving an emaciated appearance.
Subcutaneous Fat	Subcutaneous fat is often retained.	Fat stores are severely depleted or lost entirely.
Growth	Stunted growth and developmental delays are common.	Severe growth failure and wasting are prominent.

Combating Kwashiorkor: Prevention and Treatment

Addressing kwashiorkor requires immediate medical care and long-term public health strategies. Treatment involves managing immediate threats, therapeutic feeding with nutrient-dense foods like RUTF, micronutrient supplementation, infection control, nutritional education for caregivers, and improving food security.

Conclusion

Understanding what are the five causes of kwashiorkor? reveals that this severe malnutrition is a complex issue stemming from multiple factors. It results from a combination of severe protein and micronutrient deficiencies, worsened by chronic infections, exposure to toxins like aflatoxins, and underpinned by socioeconomic challenges. Effective management requires a comprehensive approach that treats acute medical issues while addressing root causes like food insecurity and poor sanitation. Early diagnosis and intervention, combined with sustained public health efforts, are essential for recovery and preventing long-term consequences. More information can be found through {Link: World Health Organization https://www.who.int/initiatives/behealthy/healthy-diet}.

Frequently Asked Questions

The primary dietary deficiency leading to kwashiorkor is a severe lack of protein. This often occurs when a child is weaned from protein-rich breast milk and given a diet composed mainly of carbohydrates.

Infections act as precipitating factors. They stress the body, weaken the immune system, and impair the absorption of nutrients, accelerating the onset and severity of malnutrition in an already vulnerable individual.

Edema, or fluid retention, is caused by very low levels of albumin protein in the blood (hypoalbuminemia). Albumin is crucial for regulating the fluid balance between blood vessels and tissues, and its deficiency causes fluid to leak into the tissues.

Yes, environmental toxins like aflatoxins from moldy crops have been linked to kwashiorkor. They can cause liver damage and contribute to metabolic disturbances, particularly in regions with high humidity.

The main difference is the presence of edema. Kwashiorkor is characterized by edema due to protein deficiency, while marasmus is a more general wasting syndrome caused by a severe deficiency of both calories and protein, and does not involve swelling.

Socioeconomic factors are the root cause, creating the conditions for malnutrition. Poverty leads to food insecurity and reliance on cheap, starchy, low-protein diets. Additionally, poor sanitation and lack of education increase the risk of infections.

If left untreated, kwashiorkor can be fatal. It can lead to severe long-term complications, including permanent physical and mental disabilities, impaired growth, liver failure, and increased susceptibility to life-threatening infections.