Kwashiorkor

Name

The name is derived from one of the languages of coastal Ghana and means "rejected one" reflecting the development of the condition in the older child who has been weaned from the breast.

Symptoms

Symptoms of kwashiorkor include a swollen abdomen known as a pot belly, as well as reddish discoloration of the hair and depigmented skin. The swollen abdomen is generally attributed to two causes: First, the observation of ascites due to increased capillary permeability from the increased production of cysteinyl glutathione. It is also thought to be attributed to the effect of malnutrition on reducing plasma proteins (discussed below), resulting in a reduced oncotic pressure and therefore increased osmotic flux through the capillary wall. A second cause may be due to a grossly enlarged liver due to fatty liver. This fatty change occurs because of the lack of apolipoproteins which transport lipids from the liver to tissues throughout the body. Victims of kwashiorkor fail to produce antibodies following vaccination against diseases including diphtheria and typhoid.[1] Generally, the disease can be treated by adding food energy and protein to the diet; however, mortality can be as high as 60% and it can have a long-term impact on a child's physical growth and, in severe cases, affect mental development.

Possible causes

There are various explanations for the development of kwashiorkor, and the topic remains controversial^[3]. It is now accepted that protein deficiency, in combination with energy and micronutrient deficiency, is certainly important but may not be the key factor. The condition is likely to be due to deficiency of one of several type one nutrients (e.g. polyunsaturated fatty acids. Therefore, if a child with reduced type one nutrients or anti-oxidants is exposed to stress (e.g. an infection or toxin) he/she is more liable to develop kwashiorkor.

Ignorance of nutrition can be a cause. Dr. Latham, director of the Program in International Nutrition at Cornell University cited a case where parents who fed their child cassava failed to recognize malnutrition because of the edema caused by the syndrome and insisted the child was well-nourished despite the lack of dietary protein.

One important factor in the development of kwashiorkor is urea cycle, which is located in the liver and can easily overwhelm the capacity of an already damaged organ. The resulting liver failure can be fatal.

Other malnutrition syndromes include marasmus and cachexia, although the latter is often caused by underlying illnesses.

References

1. ^ Williams CD. (1935) Kwashiorkor: a nutritional disease of children associated with a maize diet. Lancet 229:1151-2.
2. ^ Jamaica Gleaner : Pieces of the Past: A Pioneer, A Survivor: Dr. Cicely Williams. Retrieved on 2007-09-18.
3. ^ Krawinkel M. (2003) Kwashiorkor is still not fully understood. Bull World Health Organ, vol.81, no.12, p.910-911.

• Malnutrition in Third World Countries