What Gives You Kwashiorkor? A Deep Dive into Causes and Risk Factors

November 7, 2025 •

4 min read

Kwashiorkor is a severe form of malnutrition that primarily affects children and was first medically described in 1933. So, what gives you kwashiorkor? It is fundamentally caused by a lack of protein in the diet, but several complex and interconnected factors contribute to its development, extending beyond a simple food shortage.

Quick Summary

Kwashiorkor stems from severe protein malnutrition, often combined with a carbohydrate-rich diet and other micronutrient deficiencies. Key factors include improper weaning, persistent infections, poverty, and other environmental stressors.

Key Points

Primary Cause: Kwashiorkor is fundamentally caused by a severe deficiency of protein in the diet, often alongside enough calories from starches.
Defining Symptom: The hallmark of kwashiorkor is edema, or fluid retention, which causes characteristic swelling in the belly, feet, and face.
Vulnerable Population: The condition most commonly affects children aged 1-5, frequently triggered during weaning when a child's diet shifts from breast milk to low-protein, bulky foods.
Contributory Factors: Beyond diet, chronic infections, micronutrient deficiencies, poor sanitation, and environmental toxins can all precipitate or worsen the disease.
Distinguishing Feature: Unlike marasmus, which involves general starvation and severe wasting, kwashiorkor's edema can obscure the underlying muscle loss, creating a misleadingly plump appearance.
Treatment Urgency: Early, cautious refeeding is critical for recovery and to prevent complications like refeeding syndrome. Untreated kwashiorkor can be fatal.
Prevention Strategy: Effective prevention relies on a combination of nutritional support, health education, access to clean water, and addressing systemic socioeconomic issues.

The Core Nutritional Deficiency: Lack of Protein

At its most basic level, the core nutritional trigger that gives you kwashiorkor is an insufficient intake of protein. Unlike marasmus, which involves a general lack of calories, kwashiorkor occurs when there is a severe protein deficiency despite a diet that may contain sufficient calories, often from starchy, carbohydrate-heavy sources like cassava, maize, or rice. Protein is a vital macronutrient composed of amino acids, the building blocks for every cell, tissue, and organ in the body. When the body lacks adequate protein, several critical biological processes fail.

Protein's Role in Edema

One of the most striking and characteristic symptoms of kwashiorkor is edema, the fluid retention that causes swelling in the belly, feet, and ankles. This is directly linked to low protein levels. Proteins, particularly albumin, maintain the oncotic pressure in the bloodstream, which is essential for regulating fluid balance. When protein levels plummet, the body's ability to draw fluid back into the blood vessels from surrounding tissues is compromised, leading to fluid accumulation and the distinctive swollen appearance.

Beyond Protein: The Multifactorial Causes

While protein deficiency is the main feature, the actual development of kwashiorkor is often far more complex, involving a perfect storm of biological, social, and environmental factors.

Inadequate Weaning Practices

The name "kwashiorkor" originates from the Ga language of Ghana, meaning "the sickness the baby gets when the new baby comes". This perfectly illustrates a common scenario: an older child is prematurely weaned from protein-rich breast milk to make way for a new infant. Their new diet often consists of low-protein, bulky starchy foods, leading to a sudden and severe protein deficit.

Chronic Infections and Illness

Persistent infections, such as measles, diarrhea, and malaria, significantly contribute to the risk of kwashiorkor. Infections increase the body's metabolic demand and nutrient requirements while simultaneously causing loss of appetite, vomiting, and diarrhea. The body's weakened immune system from malnutrition makes it harder to fight off illness, creating a vicious cycle of infection and nutritional decline.

Micronutrient Deficiencies and Antioxidant Depletion

Research indicates that kwashiorkor is not solely about protein, but also involves severe deficiencies in essential micronutrients like zinc, potassium, and magnesium, as well as antioxidants like glutathione. The depletion of antioxidants can lead to oxidative stress, further damaging the body's cells and exacerbating the symptoms.

Environmental Toxins (Aflatoxins)

Some studies have found a correlation between kwashiorkor and exposure to aflatoxins, toxic compounds produced by mold that can grow on staple crops like maize and peanuts in hot, humid climates. While conflicting evidence exists, liver damage from these toxins is a plausible contributing factor.

Socioeconomic and Political Factors

The root causes of widespread kwashiorkor are deeply entwined with larger social and economic issues. Poverty, food insecurity, lack of nutritional education, political unrest, war, and natural disasters are all major drivers that limit access to diverse, nutritious food and clean water.

Kwashiorkor vs. Marasmus: A Key Distinction

Understanding the difference between the two main types of severe malnutrition is crucial for proper diagnosis and treatment. Both fall under the umbrella of protein-energy malnutrition (PEM), but their primary nutritional deficits differ significantly.


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Predominantly protein deficiency, with relatively adequate calories.	Deficiency of all macronutrients: calories, protein, and fat.
Key Symptom	Edema (swelling) is the defining characteristic due to fluid retention.	Severe wasting and emaciation, with visible loss of fat and muscle.
Appearance	A swollen, distended belly, face, and ankles. The bloating can mask underlying muscle atrophy.	An extremely thin, shriveled appearance, often described as an "old man" face in children.
Appetite	Poor or lost appetite (anorexia) is common.	Often presents with increased hunger and food-seeking behavior.
Hair/Skin	Hair may become dry, brittle, and discolored (e.g., reddish or orange). Skin can become flaky and have patchy lesions.	Hair and skin changes are less pronounced than in kwashiorkor, though skin can be dry.
Liver	Often associated with a fatty, enlarged liver.	Fatty liver is typically not present.

Recognizing the Signs and Symptoms

The clinical presentation of kwashiorkor includes numerous distinct features:

Edema: The bilateral swelling of the ankles and feet is the defining sign, which can progress to the legs, face, and abdomen.
Skin and Hair Changes: The skin can develop a rash, peel, or become dry and scaly. Hair may lose its color or change to a reddish-brown, become sparse, and brittle.
Fatigue and Irritability: Affected children often experience extreme fatigue, apathy, and irritability.
Abdominal Distension: A bloated or "pot belly" appearance is common due to a combination of ascites (fluid buildup) and a fatty, enlarged liver.
Growth Failure and Muscle Wasting: Though hidden by edema, there is significant muscle mass depletion and stunted growth.
Compromised Immunity: A damaged immune system leads to more frequent and severe infections.

Conclusion: A Complex Public Health Challenge

In summary, the complex answer to "what gives you kwashiorkor?" goes far beyond just a lack of protein. It is an intricate health issue stemming from a critical protein deficit that is often compounded by inadequate micronutrients, chronic infections, and devastating socioeconomic factors like poverty and food insecurity. The most significant risk group remains young children in developing nations, particularly during weaning periods. Addressing kwashiorkor requires a multifaceted public health approach that includes nutritional education, adequate food provision, improved sanitation, and prompt treatment of underlying infections. Early diagnosis and careful management are essential for improving outcomes and preventing long-term physical and developmental consequences.

For additional information on the recognition and management of severe acute malnutrition, consult authoritative health resources, such as this overview from the National Institutes of Health: Recognition and Management of Marasmus and Kwashiorkor.

Frequently Asked Questions

The main cause of kwashiorkor is a severe deficiency of protein in the diet. This often occurs even when a person's caloric intake is relatively adequate, typically from starchy foods lacking sufficient protein.

The key difference is the nutritional deficit and resulting symptoms. Kwashiorkor is primarily a protein deficiency causing edema (swelling), whereas marasmus is a deficiency of all macronutrients (protein, calories, fat) leading to extreme emaciation and visible wasting.

The swelling, known as edema, is caused by low levels of albumin in the blood due to protein deficiency. Albumin helps maintain oncotic pressure, which keeps fluid within blood vessels. When albumin is low, fluid leaks into surrounding tissues, causing swelling in the abdomen and limbs.

Yes, chronic or frequent infections like measles, diarrhea, and malaria are major contributing factors. Infections increase the body's metabolic needs and can cause loss of appetite, making it harder for an already malnourished body to recover.

Kwashiorkor is most common in young children between the ages of 1 and 5 in developing countries. This is often during the weaning process, when a child transitions from nutrient-rich breast milk to a less adequate, carbohydrate-based diet.

Treatment involves a cautious, gradual approach to refeeding with a balanced diet containing protein and calories, as well as vitamin and mineral supplements. Medical care also focuses on treating underlying infections, dehydration, and electrolyte imbalances.

If left untreated, kwashiorkor can be fatal. Survivors may experience permanent long-term effects, including growth stunting, developmental delays, impaired cognitive function, and damage to internal organs such as the liver.