Kwashiorkor
| Kwashiorkor | |
|---|---|
| Specialty | Endocrinology  |
Kwashiorkor is a type of childhood malnutrition caused by inadequate protein intake in the presence of fairly good total calorie intake. British pediatrician Cicely D. Williams introduced the name into international scientific circles in her 1935 Lancet article[1]. The name is derived from one of the Kwa languages of coastal Ghana and means "the one who is displaced" reflecting the development of the condition in the older child who has been weaned from the breast once a new sibling is born.
When a child is nursing, it receives certain amino acids vital to growth from its mother's milk. When the child is weaned, if the diet that replaces the milk is high in starches and carbohydrates, and deficient in protein (as is common in parts of the world where the bulk of the diet consists of starchy vegetables, or where famine has struck), the child may develop kwashiorkor.
Symptoms of kwashiorkor include a swollen abdomen, reddish discoloration of the hair and depigmented skin. The swollen abdomen is generally attributed to two causes: ascites due to altered oncotic pressure as a result of hypoalbuminemia (low albumin in the blood) and 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. Additionally, the child has a miserable appearance with a "bull-dog" face. 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.
There are various explanations for the development of kwashiorkor, and the topic remains controversial[2]. 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 I nutrients (e.g. iron, folic acid, iodine, selenium, vitamin C), particularly those involved with anti-oxidant protection. Important anti-oxidants in the body that are reduced in children with kwashiorkor include glutathione, albumin, vitamin E and polyunsaturated fatty acids. Therefore, if a child with reduced type I nutrients or anti-oxidants is exposed to stress (e.g. an infection or toxin) he/she is more liable to develop kwashiorkor.
Other malnutrition syndromes include marasmus and cachexia, although the latter is often caused by an underlying illness.