What is the diet for kwashiorkor?

October 26, 2025 •

4 min read

Kwashiorkor, a severe form of malnutrition caused by protein deficiency, affects millions of children globally. The correct diet for kwashiorkor is not as simple as increasing protein intake; it involves a careful, phased approach to avoid dangerous complications like refeeding syndrome.

Quick Summary

A kwashiorkor diet focuses on a gradual nutritional rehabilitation process, starting with cautious energy repletion and advancing to protein-rich, high-calorie foods. Treatment is divided into stabilization and rehabilitation phases to prevent life-threatening complications and promote catch-up growth.

Key Points

Gradual Reintroduction of Food: A diet for kwashiorkor must be introduced slowly in distinct phases to prevent refeeding syndrome, a dangerous metabolic shift.
Initial Focus on Stabilization: The first phase prioritizes correcting life-threatening issues like hypoglycemia and dehydration using specialized formulas, with limited protein intake.
High-Calorie, High-Protein Diet for Recovery: The rehabilitation phase uses energy-dense foods rich in protein, such as milk, legumes, and therapeutic pastes, to support rapid growth and tissue repair.
Essential Micronutrient Supplementation: Vitamin and mineral supplements are a crucial part of the treatment, added slowly to correct deficiencies.
Preventing Complications: Avoiding rapid refeeding and managing infections are critical steps to prevent severe complications like electrolyte imbalances, organ failure, and shock.
Emphasis on Local Foods and Education: For long-term prevention, utilizing locally available, nutritious crops and educating caregivers on proper feeding are vital strategies.

The Phased Approach to Nutritional Rehabilitation

Treating kwashiorkor requires a delicate and multi-step dietary approach to safely restore nutritional balance. The World Health Organization (WHO) outlines a phased treatment plan to manage the severe metabolic and electrolyte imbalances common in malnourished individuals. This systematic approach is crucial for preventing complications, particularly refeeding syndrome, a potentially fatal condition caused by rapid re-feeding after prolonged starvation.

Phase 1: Stabilization (1–7 days)

During the initial stabilization phase, the primary goals are to correct life-threatening conditions. These include treating hypoglycemia, hypothermia, dehydration, and infections. Feeding is introduced cautiously to avoid overwhelming the compromised metabolic system. The focus is on providing simple sugars, carbohydrates, and fats to restore energy levels gradually. Proteins are limited initially to prevent metabolic shock. Specialized milk-based formulas, often diluted, are used for feeding.

Initial energy intake: 30 to 60 calories per kilogram of body weight per day.
Initial protein intake: 1 to 2 grams per kilogram of body weight per day.
Micronutrient supplementation: Administration of vitamins and minerals, excluding iron, which is delayed to prevent harm to the liver.
Rehydration: Uses special oral rehydration solutions, like RESOMAL, to correct electrolyte imbalances carefully.

Phase 2: Rehabilitation (weeks 2–6)

Once the patient is stabilized, and their appetite returns, the diet is gradually increased in both calories and protein. This phase aims for "catch-up growth," addressing the stunted growth and muscle mass loss. The goal is to provide a dense, energy-rich diet to support rapid growth and tissue repair. Protein sources are slowly introduced, prioritizing those with high biological value.

Increased energy intake: Progresses to 130 to 150 calories per kilogram of body weight per day.
Increased protein intake: Rises to 5 to 7 grams per kilogram of body weight per day.
Introducing solid foods: Foods like meat, fish, eggs, legumes, and bananas are gradually incorporated into the diet.
Ready-to-use therapeutic food (RUTF): These pastes, often made from peanuts, milk powder, sugar, and oil, are highly effective during this stage.

Comparison of Kwashiorkor vs. Marasmus Diets

Kwashiorkor and marasmus are both forms of severe acute malnutrition (SAM) but have different underlying causes and dietary needs. The key distinction lies in the primary deficiency: protein for kwashiorkor and overall calories and protein for marasmus. This difference dictates the specific nutritional interventions required.


Feature	Kwashiorkor Diet	Marasmus Diet
Primary Deficiency	Severe protein deficiency, often with relatively normal calorie intake.	General lack of all macronutrients (protein, calories, and fat).
Initial Focus	Correcting edema, electrolyte imbalances, and metabolic issues.	Reversing severe wasting and dehydration.
Initial Feeding	Cautious introduction of calories from carbohydrates and fats, with low protein.	Gradual increase of total caloric intake from all macronutrients.
Protein Introduction	Delayed and carefully increased to prevent metabolic shock.	Gradually increased alongside calories from the start.
Risk Factor	Refeeding syndrome due to electrolyte shifts caused by rapid feeding.	Dehydration and electrolyte disturbances, similar to kwashiorkor.

Recommended Foods for Recovery

The recovery diet should focus on nutrient-dense foods that provide high-quality protein, calories, vitamins, and minerals.

High-Protein Foods

Milk and dairy products: Skimmed milk powder is frequently used in therapeutic feeds.
Legumes: Beans, peas, and lentils are excellent plant-based protein sources.
Eggs: A complete protein source rich in vitamins and minerals.
Meat and fish: Lean meat and seafood offer high-quality animal protein.
Nuts and seeds: Peanut butter and other nut/seed products are energy-dense and nutritious.

High-Calorie Foods

Ready-to-use therapeutic food (RUTF): A peanut-based paste with added milk powder, sugar, and vegetable oil.
Energy-dense starches: Foods like bananas, cereals, and sweet potatoes provide necessary carbohydrates for energy.
Fortified foods: Foods enriched with essential vitamins and minerals help correct micronutrient deficiencies.

Practical Dietary Considerations

Successful treatment also relies on practical factors. Local availability and cost of food must be considered, which is why organizations like WHO develop formulas from regionally accessible ingredients. For example, studies in Malawi have highlighted the use of indigenous crops like pigeon peas and millet to enhance nutritional diversity. The treatment plan also includes education for caregivers on proper nutrition, food hygiene, and meal preparation to prevent recurrence. The process requires careful medical supervision, especially during the initial stages.

Conclusion

The dietary treatment for kwashiorkor is a methodical process of nutritional rehabilitation, not a simple, rapid fix. It begins with a careful stabilization phase focused on addressing immediate, life-threatening symptoms and correcting severe electrolyte imbalances. This is followed by a rehabilitation phase designed for catch-up growth, involving a controlled increase in protein and calorie intake using nutrient-dense foods. Given the complexities, including the risk of refeeding syndrome, medical supervision is essential throughout the entire recovery process. Ensuring access to varied and nutrient-rich food sources, potentially utilizing locally available crops and fortified products, is key to preventing and effectively managing this severe form of malnutrition. For more information, the World Health Organization provides guidelines on managing severe malnutrition in children (link to WHO guidelines could be here).

Frequently Asked Questions

Kwashiorkor is primarily caused by a severe deficiency of protein in the diet, even if the person is consuming enough calories from carbohydrates.

A rapid increase in protein and calories can cause refeeding syndrome, a potentially fatal condition involving sudden shifts in fluids and electrolytes. This can lead to cardiac, respiratory, and neurological problems.

Kwashiorkor is mainly a protein deficiency with edema (swelling), while marasmus is a deficiency of both protein and calories, resulting in severe wasting and no edema.

RUTF, or Ready-to-Use Therapeutic Food, is a nutrient-dense paste, often peanut-based, used to provide a high-calorie, high-protein diet during the recovery phase of kwashiorkor.

Iron supplementation is typically delayed for the first week or so because a patient's liver is compromised, and excessive iron can increase the risk of infection and oxidative stress.

Recommended foods include milk products, eggs, lean meats, fish, beans, lentils, and energy-dense starches like bananas to provide the necessary proteins and calories.

While kwashiorkor is most commonly associated with young children, adults can also suffer from severe protein malnutrition under conditions of famine, illness, or extreme poverty.