Kwashiorkor is a pathological protein-energy malnutrition. It manifests itself primarily in children in developing countries.

What is Kwashiorkor?

Reason for the appearance of kwashiorkor is the lack of food and protein in regions where there is famine. Harvest failures, natural disasters, political unrest or wars can be responsible for this. See AbbreviationFinder for abbreviations related to Kwashiorkor.

Kwashiorkor is a protein deficiency disease. It occurs in children in developing countries and is associated with a protein disorder. In earlier years, kwashiorkor was also widespread in Central Europe. In Germany, the disease was known as flour nutritional damage.

The name Kwashiorkor comes from Jamaican pediatrician Cicely D. Williams. She introduced the term in 1935 as part of a technical paper. Kwashiorkor is a Ghanaian term. It means something like “that the disease gives birth to a child when a new child is born”. In the course of the disease, the emergence of cachexia, which is associated with severe organic disorders, is revealed. These disorders can be life-threatening.

Causes

Reason for the appearance of kwashiorkor is the lack of food and protein in regions where there is famine. Harvest failures, natural disasters, political unrest or wars can be responsible for this. Not infrequently, however, an unbalanced diet is the reason for the development of the deficiency disease. The affected children are primarily fed on maize. Although calorie intake is adequate, kwashiorkor symptoms appear.

The essential amino acids lysine and tryptophan are not present in corn. However, the human organism needs this in order to be able to build up its own protein. For this reason, kwashiorkor is common in areas of Africa where corn is the main staple food. In countries where enough protein is consumed, the disease hardly ever occurs.

Due to the lack of the essential amino acids, the albumins in the blood decrease. At the same time, the colloid osmotic pressure is reduced. As a result, the tissue fluid in the abdominal region can no longer get into the venous capillaries. However, not all children are affected.

Symptoms, Ailments & Signs

Kwashiorkor can make itself felt in the sick children in different ways. The symptoms are similar to the signs of celiac disease (native sprue). This inhibits cell growth and cell regeneration. In addition, there is a weakness in hormone production.

A typical symptom is the feeling of hunger. This is caused by the retention of water all over the body. The abdomen is particularly affected. There is also enlargement of the liver. The skin of the sick is also affected. Other possible symptoms are diarrhea, loss of weight to the point of emaciation, muscle wasting, discoloration of the hair, apathy and an immune deficiency. Since the organ functions also decrease, there is a risk of liver failure, cardiac insufficiency or encephalopathy. The mental development of the child also suffers.

Diagnosis & course of disease

If kwashiorkor is suspected, a medical examination must be carried out. Typical signs of the disease are edema and an enlarged liver. In addition, the affected children make an emaciated and apathetic impression. Another indication is the occurrence of a bulging abdomen due to ascites. Fluid accumulates in the abdominal cavity.

Laboratory tests play an important role in the diagnosis. In this context, the protein content of the patient is determined in a blood or urine test. Other tests may be done to determine liver function or muscle breakdown. The most important examinations are a blood-urine nitrogen test, determining the arterial blood gases, measuring the potassium and creatinine levels in the blood, and creating a complete blood count.

The laboratory values ​​can be used to detect a wide range of defects. The course of kwashiorkor depends on when appropriate medical treatment is given. There is a risk of permanent physical and mental damage if therapy is too late. Without treatment, the sick child faces a coma or even death. However, if the therapy starts in the early stages, recovery is usually possible.

Complications

In most cases of kwashiorkor, there are disturbances in development and growth. Children in particular are affected by this disorder, so that further consequential damage occurs in the adulthood of the patient. This damage is usually irreversible and can no longer be fully treated. The patients suffer from water retention, which can occur anywhere on the body.

Kwashiorkor also enlarges the liver, causing pain. Those affected lose weight and also suffer from malnutrition. Furthermore, poor nutrition leads to cardiac insufficiency or liver insufficiency. In the worst case, both complaints can lead to death. Other internal organs can also be damaged.

The treatment of kwashiorkor usually takes place with the help of a diet. In this way, the symptoms can be largely limited and in most cases there is a positive course of the disease if treatment begins at an early stage. There are no particular complications. Successful treatment of kwashiorkor does not result in a reduction in life expectancy for those affected.

When should you go to the doctor?

If symptoms such as weight loss and weakness are noticed, kwashiorkor may be underlying. The disease occurs primarily in developing countries, but can also occur in connection with fasting or dieting. People who belong to these risk groups must consult their family doctor at the first warning sign of malnutrition. If serious symptoms such as apathy or circulatory problems become noticeable, it is best to speak to the doctor directly.

Complications such as cardiac arrhythmia or signs of liver failure should be treated by an emergency doctor. Ideally, parents who notice the corresponding warning signs in their children should call the emergency services immediately or take the child to a clinic where the symptoms can be clarified. In the case of Kwashiorkor, a stay in the hospital is necessary in any case. The initial treatment is carried out by the general practitioner, while various specialists are called in for further therapy. Any muscle atrophy must be treated with physiotherapy, while cardiac insufficiency must be treated by a cardiologist or internist.

Treatment & Therapy

For a successful treatment of kwashiorkor, it is extremely important to start the therapeutic measures as soon as possible. The core of the treatment is a high-energy diet. To this end, the children are provided with small but regular portions. In this way, the basic physiological processes of the organism can be maintained. However, care must be taken not to overtax the limited metabolism.

Too much protein can have negative effects. In addition, the body must first adjust to the new conditions. Milk, which is usually supplied with the help of a tube, is considered to be well suited for nutrition. In the further course, the milk feed can be enriched. Later, the milk is replaced by a grain porridge that contains important minerals and vitamins. Fat, carbohydrates and sugar also play an important role.

In addition, the administration of dietary supplements can be useful. This diet continues until the child has reached about 80 percent of its normal weight. Then it gets normal food again. Kwashiorkor is said to be at an end when the body’s normal weight is 85 percent. However, despite the treatment, physical and mental damage can sometimes remain.

Outlook & Forecast

Third-world children with kwashiorkor have a poor prognosis without expert treatment. In the case of hunger edema or persistent protein-energy malnutrition, those affected lack sufficient protein-rich food after weaning. The children often only get one bowl of white rice, corn or millet porridge a day.

Kwashiorkor suffers from a chronic deficiency in the most important building blocks of life – the amino acids. The organism cannot produce essential amino acids itself. He is dependent on their supply through food. If this is low in nutrients and one-sided, starvation edema occurs. A swollen abdomen is characteristic of this. This suggests a catastrophic condition of the intestinal flora. The immune system also depends on the intestinal biome. Whether kwashiorkor is causally related to aflatoxins remains to be proven.

Children with starvation edema and an enlarged liver have a poor prognosis unless protein-rich food and medical attention are promptly available. The first food intake after the kwashiorkor diagnosis must take into account the sluggish metabolism. This can no longer process larger amounts of proteins.

Those affected can recover completely with medical nutritional treatment. However, those affected may suffer from kwashiorkor sequelae later in life. This forecast sounds more optimistic. However, steps must be taken to ensure that those affected by the kwashiorkor continue to do well in the future. You need to get enough high-protein food on a consistent basis.

Prevent

Preventing kwashiorkor is entirely possible. For this purpose, a child must be given sufficient protein foods. According to the CDC (Center for Disease Control and Prevention), the recommended amount of protein per day is between 10 and 35 percent of calorie intake.

Aftercare

For kwashiorkor, follow-up measures are usually unavailable or severely limited. First and foremost, a doctor should be consulted quickly and the malnutrition should be interrupted so that the symptoms do not worsen further or other complications occur. As a rule, kwashiorkor cannot heal on its own, and in the worst case the disease can lead to the death of the affected person.

In the case of this disease, the child’s undersupply must be stopped first and foremost. The child has to adapt to the usual diet and get used to it. A doctor can also draw up a nutrition plan, which should be followed in any case. Above all, the child’s parents must observe this plan and support the child in eating.

At the same time, the trigger for malnutrition or underweight should continue to be prevented. Psychological support may therefore be necessary for Kwashiorkor, whereby loving and intensive conversations can also have a positive effect on the further course of the disease. The life expectancy of those affected may also be reduced due to the disease.

You can do that yourself

Individuals diagnosed with kwashiorkor should seek immediate medical attention. Therapy focuses primarily on changing your diet. The affected children must eat a healthy and balanced diet and should also eat more small but regular portions. This allows the physiological processes of the organism to be regulated.

However, the limited metabolism must not be stressed too much. For example, not too much protein should be included in the daily diet. Milk and milk products are more suitable. During the course of the disease, the formula can be enriched with cereal porridge and fruit. In addition, dietary supplements usually have to be administered. In severe cases, it may be necessary to infuse the sick child with the missing nutrients.

Treatment must be continued until the child has reached about 80 percent of normal body weight. After the treatment, it must be ensured that the child consumes sufficient protein-containing foods in the future. The Center for Disease Control and Prevention (CDC) recommends a daily protein intake of 10 to 35 percent of your daily caloric intake, supplemented with the necessary vitamins and minerals.