Author: Vanessa Ngan, Staff Writer, 2005.
What is kwashiorkor?
Kwashiorkor is a form of protein-energy malnutrition caused by the inadequate intake of protein with reasonable caloric (energy) intake. The other form of protein-energy malnutrition is the condition known as marasmus. Marasmus involves inadequate intake of both protein and calories. Hence, protein-calorie malnutrition encompasses a group of related disorders that include kwashiorkor, marasmus, and intermediate or mixed states of kwashiorkor and marasmus.
Kwashiorkor is also known as protein malnutrition, protein-energy (calorie) malnutrition and malignant malnutrition.
Early signs of kwashiorkor present as general symptoms of malnutrition and include fatigue, irritability and lethargy. As protein deprivation continues the following abnormalities become apparent.
Characteristic skin and hair changes occur in kwashiorkor and develop over a few days.
Kwashiorkor is the commonest and most widespread nutritional disorders in developing countries. It occurs in areas of famine or areas of limited food supply, and particularly in those countries where the diet consists mainly of corn, rice and beans. It has also been reported in children following very restricted diets for cultural reasons or in the context of presumed food allergy.
It is more common in children than in adults. The onset in infancy is during the weaning or post-weaning period where protein intake has not been sufficiently replaced.
Physical examination may show an enlarged liver and generalised swelling (oedema). Laboratory tests usually show the following significant findings in kwashiorkor.
Other tests include, detailed dietary history, growth measurements, body mass index (BMI) and complete physical examination. Skin biopsy and hair-pull analysis may also be performed.
Treatment should start with correcting fluid and electrolyte imbalances. Any infections should also be treated appropriately. Once the patient is stabilised, usually within 48 hours, small amounts of food should be introduced. Food must be reintroduced slowly, carbohydrates first to provide energy, followed by protein foods. Vitamin and mineral supplements may also be given. The reintroduction of food may take over a week by which time the intake rates should approach 175kcal/kg and 4g/kg of protein for children and 60kcal/kg and 2g/kg of protein for adults.
The outlook for patients with kwashiorkor is dependent on the stage of the disease at the time it is first treated.
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