What are the main causes of kwashiorkor?

November 30, 2025 •

2 min read

Kwashiorkor, a serious form of protein-energy malnutrition, is most prevalent among children in developing countries where food security is low. While inadequate protein intake is the defining feature, research suggests a combination of dietary, environmental, and infectious factors contributes to its development.

Quick Summary

Kwashiorkor is primarily caused by severe protein deficiency, often triggered by weaning to a low-protein diet. Environmental factors, infectious diseases, and nutrient deficiencies exacerbate the condition, particularly in impoverished regions.

Key Points

Severe Protein Deficiency: The defining feature of kwashiorkor is a diet severely lacking in protein, which leads to fluid imbalances and other systemic issues.
Inadequate Weaning: The disease often emerges when children are weaned from breast milk onto a starchy, low-protein diet, particularly in resource-poor regions.
Chronic Infections: Frequent bouts of infectious diseases, like diarrhea, malaria, and measles, exacerbate kwashiorkor by increasing the body's nutrient needs and impairing absorption.
Environmental and Socioeconomic Factors: Poverty, poor sanitation, and food insecurity are significant risk factors that contribute to the dietary deficiencies and increased disease exposure associated with kwashiorkor.
Associated Micronutrient Deficiencies: Kwashiorkor is typically accompanied by a lack of essential vitamins and minerals, which further complicates the condition and hinders recovery.
Fluid Retention and Edema: The low level of blood albumin, a protein, causes a decrease in oncotic pressure, leading to the characteristic fluid retention and swelling.

Kwashiorkor is a form of severe acute malnutrition (SAM) characterized by edema, or swelling, caused by fluid retention. Although traditionally attributed to insufficient protein, recent findings highlight a more complex etiology involving multiple factors that disproportionately affect vulnerable populations, especially children.

The Central Role of Protein Deficiency

Kwashiorkor primarily results from an inadequate intake of dietary protein, essential for numerous bodily functions including cell repair, growth, and fluid balance. When protein is severely limited, normal body functions decline, leading to kwashiorkor. This protein deficit often leads to edema. Proteins, like albumin, maintain oncotic pressure which draws fluid from tissues back into capillaries. Low protein levels (hypoalbuminemia) disrupt this process, causing fluid accumulation and characteristic swelling in the ankles, feet, face, and abdomen.

Inadequate Weaning Practices

A common trigger for kwashiorkor is improper weaning, often when a child is switched from nutrient-rich breast milk to a low-protein diet of staples like maize or rice to make way for a new sibling. This sudden dietary shift in protein-deficient communities is a key cause.

Environmental and Infectious Factors

Environmental issues also significantly contribute to kwashiorkor, highlighting its link with poverty.

Chronic and recurrent infections: Illnesses such as diarrhea, measles, and HIV deplete nutrients. Diarrhea hinders nutrient absorption. Malnutrition also weakens the immune system, creating a cycle of infection and poor health.
Poor sanitation and hygiene: Unhygienic conditions increase infectious diseases, making children more vulnerable to malnutrition.
Aflatoxin exposure: Aflatoxins from moldy crops in hot climates may be linked to liver damage in kwashiorkor.
Limited access to food: Food insecurity due to famine, conflict, or economic issues restricts access to adequate, quality food.

Micronutrient Deficiencies and Oxidative Stress

Beyond protein, kwashiorkor often involves severe deficiencies in vitamins and minerals like vitamin A and zinc.

Comparison of Kwashiorkor and Marasmus

Kwashiorkor is distinct from marasmus, another form of severe malnutrition.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Protein (often with sufficient calories)	Protein, carbohydrates, and fat (overall calories)
Characteristic Sign	Edema (swelling due to fluid retention)	Severe muscle wasting and emaciation
Appearance	Bloated belly and rounded face, but emaciated limbs	Shrunken, "old man" appearance due to fat and muscle loss
Subcutaneous Fat	Retained subcutaneous fat	Significant loss of subcutaneous fat
Appetite	Often poor appetite	Usually has a good, or ravenous, appetite
Liver	Enlarged and fatty liver (hepatomegaly)	Liver may be normal or slightly enlarged

Conclusion

Kwashiorkor results from a complex mix of protein deficiency, weaning practices, infections, and environmental factors. Poverty, poor nutrition knowledge, and limited resources contribute significantly. Prevention needs to tackle dietary issues, health education, food security, and sanitation. More information on pediatric nutrition can be found through the World Health Organization (WHO).

Correcting Misconceptions about Kwashiorkor

Refeeding kwashiorkor patients too quickly with protein and calories can be dangerous, causing refeeding syndrome. Treatment requires careful medical supervision. The swollen belly does not mean a child is well-fed; it's a sign of dangerous fluid retention masking severe malnutrition.

Frequently Asked Questions

The primary dietary cause is a severe deficiency of protein, often occurring when a child transitions from breastfeeding to a diet high in carbohydrates but low in protein.

The swelling, known as edema, is caused by a severe lack of albumin protein in the blood. This disrupts the balance of fluids, causing fluid to leak into body tissues and accumulate in the abdomen and limbs.

Infections, such as chronic diarrhea, can trigger or worsen kwashiorkor. They increase the body's nutritional demands, decrease appetite, and impair the absorption of vital nutrients.

No, while both are forms of severe malnutrition, they are distinct. Kwashiorkor is a protein deficiency characterized by edema, whereas marasmus is a deficiency of both protein and total calories, leading to extreme muscle wasting without edema.

While it is most common in young children, particularly after weaning, kwashiorkor can also affect adults with underlying conditions or those following extreme diets. Cases in developed countries are rare but have been linked to eating disorders.

Yes, prevention involves ensuring a balanced diet rich in proteins, providing nutritional education, promoting good hygiene and sanitation, and addressing underlying issues like poverty and food insecurity.

If not treated promptly, kwashiorkor can lead to long-term physical and mental disabilities, including stunted growth and impaired cognitive development. Early intervention improves the prognosis significantly.

Yes, sudden or aggressive refeeding can cause a dangerous condition called refeeding syndrome, which involves life-threatening electrolyte shifts. Feeding must be done slowly and cautiously under medical supervision.