What is Kwashiorkor?
Kwashiorkor is a disease that results from a severe lack of protein in the diet, causing swelling in the legs and arms. This illness mostly affects young children, typically between the weaning phase and age 5. This condition is prevalent in regions plagued by extreme starvation and poverty across the world. The World Health Organization identified it as a significant health issue in the 1950s. However, the recognition was delayed as most child deaths were initially attributed to digestive system illnesses or infections.
As scientists researched more about the disease in children, they uncovered a significant pattern. Those children, who were diagnosed with “digestive system diseases” and exhibited symptoms like diarrhea, cough, runny nose and difficulty breathing, also showed signs of kwashiorkor, such as swelling due to fluid accumulation (pitting edema), loss of appetite, and skin changes. This observation raised a question: was kwashiorkor the primary cause of death, or was it secondary? The conclusion was that kwashiorkor is usually a secondary cause of death because many cases would not have occurred without other health issues like diarrhea, dehydration, or infectious diseases such as HIV and measles acting as triggering factors.
While kwashiorkor is a disease caused by severe malnutrition that results in swelling, there is a similar condition called marasmus, also known as wasting syndrome. In this condition, there’s malnutrition but without the swelling. Affected children tend over time to lose their body fat, appear shorter and lighter for their age, and have smaller upper-arms. Other signs of this disease include dry, thin skin, a head seeming larger compared to the body, a frail appearance, slower heart rate, low blood pressure, lower body temperature, and thin, shrunken arms, thighs, and buttocks with extra skin folds.
What Causes Kwashiorkor?
The exact cause of kwashiorkor, a form of malnutrition, isn’t fully understood. However, it’s often found in people who mainly consume foods like maize, cassava, or rice. It was previously thought to be a result of a protein deficiency or low levels of substances that combat harmful particles in our bodies, known as antioxidants, and toxins from molds, known as aflatoxins.
There is some evidence supporting these potential causes, but efforts to treat the disease by adding more protein and antioxidants to the diet have not been successful. Similarly, even though aflatoxins were originally believed to cause kwashiorkor, they are not always found in populations that have the disease.
Some factors that we do know are often linked to kwashiorkor include recent changes in diet such as weaning, recent infections (especially measles), and major disruptions in a child’s life such as the loss of a parent, living in temporary housing, or experiencing poverty.
Risk Factors and Frequency for Kwashiorkor
Kwashiorkor, a form of malnutrition, is pretty unusual in the United States but it is more common in other parts of the world. Locations that are particularly affected include Southeast Asia, Central America, Congo, Puerto Rico, Jamaica, South Africa, and Uganda. It often crops up during periods of starvation, particularly impacting rural and farming towns.
Signs and Symptoms of Kwashiorkor
Kwashiorkor is a form of severe malnutrition, and it has various symptoms, which often include:
- Swelling in the feet and legs that gradually moves upwards
- Severe muscle loss
- Bloating of the stomach, which can be accompanied by swollen bowel loops and an enlarged liver
- A round face, with puffed-out cheeks, often referred to as ‘moon facies’
- Skin that is thin, dry, peels easily and may have patches of discoloured scaling
- Dry hair, lighter in colour than usual, which falls out or can be easily plucked
- An enlarged liver due to fat build-up
- Stunted growth
- Changes in behaviour, like loss of appetite and lack of enthusiasm
- Skin rashes or inflammation, often on the areas around the groin, limbs, ears, and armpits
- Fat retained under the skin leading to saggy skin folds around the inner thigh region
Testing for Kwashiorkor
The World Health Organization (WHO) has a system for assessing how severe malnutrition is in a person and to determine if they have wasting or kwashiorkor, two types of severe malnutrition. They use three main checks:
The measurement of the middle upper part of the arm (MUAC), how the person’s weight relates to their height/length (Z score), and if there’s symmetrical pitting edema, which is swelling that leaves a dent when pressed.
A MUAC measurement of less than 110 mm, which is about the size of a regular highlighter pen, is usually linked to a high risk of death in babies under six months old. The WHO has specified certain cut-off values which, if reached or crossed, require immediate admission to the hospital for treatment. Evaluating a person’s nutrition history, past illnesses, vaccinations, and family health history is also crucial when malnutrition is suspected.
Treatment Options for Kwashiorkor
Kwashiorkor disease, a severe form of protein deficiency usually seen in children, involves a complex series of events within the body. Previously, it was thought that low levels of albumin (a protein in your blood) wasn’t the cause of swelling often seen in kwashiorkor, as the swelling disappeared before albumin levels rose during treatment. However, newer research shows that extremely low albumin levels are linked to the development of swelling, particularly in children with low blood volume.
Physicians follow ten primary steps when treating patients with kwashiorkor. These steps, which range from urgent stabilization to long-term recovery, include:
- Treatment or prevention of hypocalcemia (low calcium levels in the blood)
- Treatment or prevention of hypothermia (dangerously low body temperature)
- Treatment or prevention of dehydration
- Correction of electrolyte imbalance (an imbalance of minerals in the body)
- Treatment or prevention of infection
- Correction of micronutrient deficiencies (lack of vitamins and minerals essential for health)
- Beginning careful feeding
- Achieving catch-up growth (helping the child gain weight and grow rapidly to reach a healthier size)
- Providing emotional support and sensory stimulation
- Planning for follow-up care after the patient recovers.
Addressing fluid imbalance in children with kwashiorkor is critical. In the past, there was worry that treating dehydration too quickly might lead to heart failure, but this risk has been found to be overstated. Nonetheless, severe dehydration could lead to shock and death, so medical staff have to carefully manage fluid treatment. Normal saline, a standard treatment for dehydration, may have too much sodium and too little potassium for these patients.
What else can Kwashiorkor be?
When a medical professional is trying to diagnose kwashiorkor, a type of severe malnutrition, they may first consider other health conditions that show similar symptoms. These conditions include:
- Acrodermatitis enteropathica (a rare genetic disorder affecting the skin)
- Actinic prurigo (a condition causing itchy skin)
- Angio-neurotic edema (swelling under the skin)
- Atopic dermatitis (commonly known as eczema)
- Chronic kidney disease
- Cirrhosis (scarring of the liver)
- Depression
- Inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis)
- Malignancies (various types of cancer)
- Nephrotic syndrome (a kidney disorder causing your body to excrete too much protein in your urine)
What to expect with Kwashiorkor
Kwashiorkor is a condition that is less severe the older the age when it begins. Children suffering from this disease could have problems with growth or development, and they could even remain small in stature. Waiting too long to start treatment can lead to serious problems, including shock, coma, and permanent physical and mental disabilities. If kwashiorkor isn’t treated, it can become a life-threatening condition.
Possible Complications When Diagnosed with Kwashiorkor
Kwashiorkor, a form of severe malnutrition, can lead to many health issues:
- Hepatomegaly: This means the liver becomes large due to fatty deposits.
- Cardiovascular system collapse or hypovolemic shock: This is when the heart and circulatory system fail or a person loses too much blood or fluids.
- Urinary tract infections: These are infections that affect any part of your urinary system which includes your kidneys, bladder, ureters, and urethra.
- Abnormalities of the digestive system: This includes the shrinking of the pancreas leading to issues processing glucose, deterioration of the inner lining of the small intestine, inability to properly digest lactose, constipation, overgrowth of bacteria that can cause serious blood infections and potential death.
- Loss of immune function: This can lead to reduced ability to fight off illnesses, lower antioxidant function which protect our body from damage, increased vulnerability to infections, septic shock (a serious infection that spreads throughout the body) and potential death.
- Endocrine disorders: Where insulin levels are lower than usual, while growth hormone levels are high but without adequate amounts of insulin-like growth factors. This can cause your body to not respond properly to insulin.
- Metabolic disturbances and low body temperature.
- Impaired cellular functions: This includes issues with the inner lining of blood vessels which can lead to other health problems.
- Electrolyte abnormalities: These are common and occur when the balance of minerals in your body is disrupted.
Preventing Kwashiorkor
Talking to mothers about nutrition should begin before their babies are born. Eating healthy during pregnancy is crucial, not only for the moms themselves but also to meet their children’s nutritional needs. It’s essential to teach moms about how to properly feed their children for their overall health and development.
