Kwashiorkor, also known as “edematous malnutrition” because of its association with edema (fluid retention), is a nutritional disorder most often seen in regions experiencing famine. It is a form of malnutrition caused by a lack of protein in the diet. People suffering from kwashiorkor typically have an extremely emaciated appearance in all body parts except their ankles, feet, and belly, which swell with fluid.
Kwashiorkor is rarely found in the United States and other countries with a generally steady food supply. It’s most common in sub-Saharan Africa and other countries where people routinely have a limited supply of food.
Most people who are affected by kwashiorkor recover fully if they are treated early. Treatment involves introducing extra calories and protein into the diet. Children who develop kwashiorkor may not grow or develop properly and may remain stunted for the rest of their lives. There can be serious complications when treatment is delayed, including coma, shock, and permanent mental and physical disabilities. Kwashiorkor can be life-threatening if it’s left untreated. It can cause major organ failure and eventually death.
Kwashiorkor is caused by a lack of protein in the diet. Every cell in your body contains protein. You need protein in your diet for your body to repair cells and make new cells. A healthy human body regenerates cells in this way constantly. Protein is also especially important for growth during childhood and pregnancy. If the body lacks protein, growth and normal body functions will begin to shut down, and kwashiorkor may develop.
Kwashiorkor is most common in countries where there is a limited supply or lack of food. It is mostly found in children and infants in sub-Saharan Africa, Southeast Asia, and Central America. A limited supply or lack of food is common in these countries during times of famine caused by natural disasters — such as droughts or floods — or political unrest. A lack of nutritional knowledge and regional dependence on low-protein diets, such the maize-based diets of many South American countries, can also cause people to develop this condition.
This condition is rare in countries where most people have access to enough food and are able to eat adequate amounts of protein. If kwashiorkor does occur in the United States, it can be a sign of abuse, neglect, fad diets, or a perceived milk allergy, found mostly in children or older adults. It can also be a sign of an underlying condition, such as HIV.
The symptoms of kwashiorkor include:
- change in skin and hair color (to a rust color) and texture
- loss of muscle mass
- failure to grow or gain weight
- edema (swelling) of ankles, feet, and belly
- damaged immune system, which can lead to more frequent and severe infections
- flaky rash
If kwashiorkor is suspected, your doctor will first examine you to check for an enlarged liver (hepatomegaly) and swelling. Next, blood and urine tests may be ordered to measure the level of protein and sugar in your blood.
Other tests may be performed on your blood and urine to measure signs of malnutrition and lack of protein. These tests may look for muscle breakdown and assess kidney function, overall health, and growth. These tests include:
- arterial blood gas
- blood urea nitrogen (BUN)
- blood levels of creatinine
- blood levels of potassium
- complete blood count (CBC)
Kwashiorkor can be corrected by eating more protein and more calories overall, especially if treatment is started early.
You may first be given more calories in the form of carbohydrates, sugars, and fats. Once these calories provide energy, you will be given foods with proteins. Foods must be introduced and calories should be increased slowly because you have been without proper nutrition for a long period. Your body may need to adjust to the increased intake.
Your doctor will also recommend long-term vitamin and mineral supplementation to your diet.
Even with treatment, children who have had kwashiorkor may never reach their full growth and height potential. If treatment comes too late, a child may have permanent physical and mental disabilities.
If left untreated, the condition can lead to coma, shock, or death.
The condition can be prevented by making sure you eat enough calories and protein-rich foods. Dietary guidelines from the Institute of Medicine recommend that 10 to 35 percent of adults’ daily calories come from protein. Five to 20 percent of young children’s and 10 to 30 percent of older children and teenagers’ daily calories should come from protein.
Protein can be found in foods like:
- lean meat
Children and older adults, the two groups who most commonly suffer from kwashiorkor as a result of abuse or neglect, will display typical symptoms of the condition. The most visible symptoms are swelling of the ankles, feet, and belly. In some cases of abuse or neglect, these symptoms may also accompany other signs of mistreatment, such as bruising and broken bones.
If you suspect a person is in immediate danger because of abuse or neglect, call 911 right away. Cases of abuse and neglect that don’t appear immediately life-threatening should be reported to your state’s abuse hotline. Child abuse cases may also be reported to the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD.