Kwashiorkor
Severe malnutrition from a lack of dietary protein
Quick Facts
- Type: Severe protein-energy malnutrition
- Main cause: Inadequate protein intake
- Hallmark sign: Body swelling (edema)
- Most affected: Young children in food-insecure settings
Overview
Kwashiorkor is a severe form of malnutrition that results mainly from a serious lack of protein in the diet, often when overall food, especially protein-rich food, is scarce. It is most common in young children in regions affected by poverty, food insecurity, or famine, particularly after weaning when a child's diet may become low in protein.
A defining feature of kwashiorkor is swelling (edema), especially of the legs, feet, and face, along with a swollen belly. This swelling can hide weight loss, so an affected child may not look thin at first glance. Kwashiorkor is a serious, potentially life-threatening condition, but with careful, gradual nutritional treatment many children recover.
Symptoms
Kwashiorkor produces a range of signs related to severe protein deficiency:
- Swelling (edema) of the legs, feet, and face, and a swollen, distended belly
- Failure to grow or gain weight, or loss of muscle, sometimes masked by swelling
- Changes to the hair, which may become thin, dry, and lighter in color
- Dry, flaky, or peeling skin and skin changes or sores
- Irritability, tiredness, and loss of appetite
- Increased vulnerability to infections
Because kwashiorkor is severe and can become life-threatening, a child with these signs needs urgent medical assessment and carefully supervised treatment.
Causes
Kwashiorkor is caused by a serious lack of protein, often together with insufficient overall nutrition. Contributing factors include:
- Diets very low in protein: Often based mainly on starchy staples with little protein-rich food.
- Food insecurity: Poverty, famine, and limited access to varied, nutritious food.
- Disruption after weaning: When a child moves from breast milk to a protein-poor diet.
- Illness: Infections and digestive illnesses that increase the body's needs or reduce nutrient absorption.
The exact way protein deficiency leads to the swelling of kwashiorkor is complex, but the central problem is inadequate protein for the body's needs.
Risk Factors
- Living in an area affected by famine, poverty, or food insecurity
- Young age, particularly after weaning
- A diet dominated by starchy staples and low in protein
- Frequent infections or digestive illnesses
- Disruption of food supply due to conflict or disaster
Diagnosis
Kwashiorkor is diagnosed through examination and assessment of nutrition:
- Physical examination: Recognizing the characteristic swelling, belly distension, and skin and hair changes.
- Growth and nutrition assessment: Measuring weight, height, and other indicators of nutritional status.
- Blood tests: May show low protein levels and other changes, and help guide safe treatment.
- Checking for infection and other deficiencies: Since these often occur alongside severe malnutrition.
Treatment
Treatment of kwashiorkor must be careful and gradual, because reintroducing food too quickly can be dangerous. It is best done under medical supervision and includes:
- Stabilization: Treating dehydration, infections, and any life-threatening problems first, and correcting salt and mineral imbalances cautiously.
- Gradual feeding: Slowly reintroducing calories and protein, often with specially formulated therapeutic foods, to avoid the dangerous shifts that can occur with rapid refeeding.
- Vitamins and minerals: Replacing deficiencies that accompany severe malnutrition.
- Treating infections: With appropriate medicines.
- Ongoing nutritional support: Continuing balanced nutrition and monitoring growth during recovery.
With timely, well-managed treatment, many children recover, although severe or delayed cases can have lasting effects.
Prevention
Preventing kwashiorkor depends largely on access to adequate, balanced nutrition:
- Ensuring children have enough protein-containing food in a varied diet
- Supporting breastfeeding and safe, nutritious complementary foods after weaning
- Treating infections and digestive illnesses that worsen nutrition
- Community and public health measures to address food insecurity
When to See a Doctor
Seek medical care urgently if a child has:
- Swelling of the legs, feet, or face, or a swollen belly with poor growth
- Failure to grow or gain weight, or loss of muscle
- Skin and hair changes with tiredness and loss of appetite
- Signs of infection or dehydration alongside poor nutrition
Kwashiorkor is a medical emergency in its severe forms. A child with these signs should be assessed promptly, as treatment must be started carefully and under supervision.
Frequently Asked Questions
What is the main cause of kwashiorkor?
Kwashiorkor is caused mainly by a serious lack of protein in the diet, often when food in general, and protein-rich food in particular, is scarce. It is most common in young children in settings affected by poverty, famine, or food insecurity.
How is kwashiorkor different from marasmus?
Both are severe malnutrition. Kwashiorkor results mainly from too little protein and is marked by swelling and a distended belly, while marasmus results from an overall lack of calories and causes severe wasting and a very thin appearance. Some children have features of both.
Why does kwashiorkor cause swelling?
A central feature of kwashiorkor is body swelling (edema), particularly of the legs, feet, and face, linked to severe protein deficiency and other changes. This swelling can mask weight loss, so an affected child may not appear thin.
Can kwashiorkor be cured?
With timely, carefully supervised treatment, many children recover. Treatment must reintroduce food gradually, because feeding too quickly can be dangerous. Severe or long-standing cases can have lasting effects, so early care is important.
Why must refeeding be done slowly?
After severe malnutrition, reintroducing food too quickly can cause dangerous shifts in the body's salts and minerals, known as refeeding syndrome. For this reason, treatment starts cautiously under medical supervision, often using specially formulated therapeutic foods.
References
- World Health Organization (WHO). Malnutrition.
- MedlinePlus, U.S. National Library of Medicine. Kwashiorkor.
- UNICEF. Severe acute malnutrition.
- Centers for Disease Control and Prevention (CDC). Malnutrition.