Kwashiorkor: Symptoms, Causes, Diagnosis & Treatment

 

A type of malnutrition known as kwashiorkor is characterized by severe deficiency of protein. It results in a swollen, distended abdomen and fluid retention. Children are most frequently impacted by kwashiorkor, especially in developing nations where poverty and food insecurity are prevalent. Although they may eat food, people with kwashiorkor may not consume enough protein.

Kwashiorkor. KWOSH-ee-OR-kor, -⁠kər, is also KWASH-, is severe protein malnutrition condition marked by fatty infiltrates in the liver and edema. It is believed to be caused by eating enough calories but not enough protein (or not enough high-quality protein), which sets it apart from marasmus. According to recent research, the disease may develop due to aflatoxins and a deficiency in antioxidant micronutrients like β-carotene, lycopene, other carotenoids, and vitamin C. The precise cause of kwashiorkor is still unknown, though. Kwashiorkor is associated with inadequate food supplies; it is uncommon in high-income nations. It happens to kids who are weaning until they are around five years old.

Also Read: ESSENTIAL NUTRIENT OF LIFE

What is kwashiorkor?

One of the two primary forms of severe protein-energy undernutrition is kwashiorkor. Protein and certain essential micronutrients are particularly lacking in people with kwashiorkor. What sets kwashiorkor apart from other types of malnutrition is the severe protein deficiency that results in edema, or fluid retention in the tissues. Individuals who have kwashiorkor may appear to have emaciated limbs but swollen hands, feet, face, and abdomen. People who are truly severely malnourished may appear to have kwashiorkor's characteristic enlarged abdomen.

What distinguishes Marasmus from Kwashiorkor?

The two primary forms of severe protein-energy undernutrition identified by medical professionals worldwide are kwashiorkor and marasmus. The primary distinction between them is that whereas marasmus is a deficiency of all macronutrients, including protein, carbohydrates, and fats, kwashiorkor is primarily a protein deficiency. Due to either eating too little, spending too much, or both, people with marasmus generally experience calorie deprivation. Although they may not be deficient in calories overall, people with kwashiorkor are deficient in high protein food.

Which symptoms are indicative of kwashiorkor?

Edema is fluid-induced swelling, particularly in the ankles and feet.
Stomach that is bloated and has ascites, or an accumulation of fluid in the abdominal cavity.

• Hair loss, brittleness, dryness, and color loss

• Red, scaly, or dry skin that peels is called dermatitis

• Fatty liver disease manifests as an enlarged liver

• Decreased muscle mass but retained fat beneath the skin

• Dehydration

•  Loss of appetite (anorexia)

• Fatigue and irritability

• Childhood growth retardation

Causes:

The primary characteristic of kwashiorkor is protein deficiency, which many researchers think is the cause, though not all agree. There have been instances reported where dietary protein was unable to prevent or improve kwashiorkor. This suggests that protein deficiency might not be the only factor at play.

The following are the main causes of kwashiorkor:

• Primarily carbohydrate-based diet. Rice, corn, or starchy vegetables are frequently the only foods available to populations deemed high-risk, especially in less developed parts of Africa, Central America, and Southeast Asia. Particularly in rural areas where many people are farmers, these crops are typically more plentiful and less expensive than foods high in protein. Children of mothers who are protein deficient may also be affected.

• Weaning with inadequate nutrition replacement. According to the Ga language of Ghana, Africa, the term "kwashiorkor" means "the sickness the baby gets when the new baby comes." This refers to a common situation where a nursing toddler is quickly weaned to make room for a newborn to start nursing. The weaning toddler's nutrition deteriorates because they don't receive a suitable replacement diet due to a lack of resources, a lack of knowledge about nutrition, or both.

Other elements that could be involved are:

• Lack of vital minerals and vitamins

• Lack of antioxidants in the diet

• Toxins from a mold that frequently grows on crops in hot, humid climates are known as aflatoxins

• Parasites and infectious diseases, especially HIV, malaria, and measles

• Severe stressors in life, such as famine, hunger, war, and disasters from nature

What other complications might arise from kwashiorkor?

• Low blood sugar, or hypoglycemia

• Low body temperature, or hypothermia

• Hypovolemic shock and hypovolemia (low blood volume)

• Electrolyte abnormalities brought on by dehydration

• Immune system dysfunction, which results in slow wound healing and recurrent infections

• Liver failure and liver cirrhosis

• Pancreatic atrophy, which causes digestive problems

• Gastrointestinal mucosal atrophy, which could result in an overabundance of small intestinal bacteria

• Delays in children's growth and development

• Death and starvation

How does one diagnose kwashiorkor?

By physically inspecting the child and noting its telltale physical symptoms, medical professionals can frequently diagnose kwashiorkor. They will inquire about the child's diet and any past infections or illnesses. They might calculate the child's height-to-age and weight-to-height ratio and assign a score based on a variety of charts. The severity of the child's condition is indicated by the weight-to-height ratio. They can determine how much malnutrition has impacted the child's growth by looking at their height-to-age score.

What is the treatment for Kwashiorkor?

When treating severe undernutrition, the World Health Organization has established ten steps to follow:

• Treat or prevent hypoglycemia. The introduction of calories can cause hypoglycemia. Glucose is included in the malnourished person's rehydration formula to aid in reestablishing equilibrium. In the initial hours of treatment, it is administered gradually.

• Treat or prevent hypothermia. Malnourished bodies need to be kept warm because they struggle to control their body temperature.

• Treat or prevent dehydration. To treat dehydration in Kwashiorkor, a unique formula known as RESOMAL (REhydration SOlution for MALnutrition) is administered. It is intended to preserve and repair the body's sodium/fluid equilibrium. It can be administered via tube or orally.

• Correct imbalances in electrolytes. When a malnourished person starts refeeding, electrolyte imbalances can have major, even fatal, consequences. Usually, in their rehydration formula, healthcare providers attempt to address these first.

• Treat or prevent infection. All infections pose a significant risk to recovery because kwashiorkor results in a weakened immune system. Antibiotics are used to treat infections.

• Correct deficiencies in micronutrients. If certain vitamin and mineral deficiencies are severe enough, they can have detrimental consequences. Before refeeding, healthcare professionals attempt to address these.

• Begin feeding with caution. The metabolism of undernourished bodies is changed. Their metabolism will alter once more when they are refed. However, this can lead to potentially fatal complications (refeeding syndrome) if it occurs too quickly. Slowly, under careful observation, feeding starts. In kwashiorkor, protein in particular needs to be gradually restored.

• Make catch-up growth. The child's calorie intake can rise to up to 140% of the age-appropriate recommendations once they have stabilized and seem to be handling refeeding well. If required, the WHO offers premade liquid formulas that can be administered orally or through a tube. This is the phase of treatment known as nutritional rehabilitation. It could go on for six weeks.

• Offer emotional support as well as sensory stimulation. Kids with kwashiorkor may have been apathetic for a while. Their social, neurological, and intellectual development may have been hampered by their malnutrition. Their treatment plan includes stimulating their development to reboot. The mother of the child should ideally be involved in this project with the healthcare providers.

After you recover, get ready for  a follow-up. Healthcare professionals educate and counsel the mother on nutrition, breastfeeding, food and water hygiene, and disease prevention before releasing the child from their care. If necessary, they might administer vaccinations. They ought to assist in ensuring access to a constant supply of nutritious food, if at all possible.

How can one prevent kwashiorkor?

 Instruction.  Basic nutrition, the benefits of breastfeeding, and the nutritional requirements of both mothers and children are simply unknown to certain populations.

 Nutritional assistance.  In impacted nations, the WHO and other groups are attempting to reintroduce indigenous crops that provide sources of micronutrients and protein.  They have created nutritious formulas using ingredients that are readily available in the area, like peanuts and skim milk.

 Control of disease. High-risk populations' immunity is weakened by widespread diseases and infections.  In addition to requiring more nutritional resources, diseased bodies may expend calories through persistent diarrhea.  A community's material resources are also depleted by diseases, which leads to poverty.  Malnutrition can be significantly reduced with improved immunizations and sanitation.

References:

• NHS. Kwashiorkor (https://www.nhs.uk/conditions/kwashiorkor/). Accessed 5/19/2022.

• Benjamin O, Lappin SL. Kwashiorkor (https://www.ncbi.nlm.nih.gov/books/NBK507876/). [Updated 2021 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 5/19/2022.

• https://en.wikipedia.org/wiki/Kwashiorkor

• MedlinePlus. Kwashiorkor (https://medlineplus.gov/ency/article/001604.htm). Accessed 5/19/2022.