Talk:Kwashiorkor

This article was the subject of a Wiki Education Foundation-supported course assignment, between 1 July 2019 and 23 August 2019. Further details are available on the course page. Student editor(s): Alexuang, Dannymrowr (article contribs).

Not a protein-deficiency at all

I will not edit medical pages, but think quick quick review on http://nutritionfacts.org/video/the-great-protein-fiasco/ contains a lot of references to research debunking that protein deficiency is the cause of Kwashiorkor. Please change. — Preceding unsigned comment added by 2001:980:93A5:1:4D3B:55D3:2103:7F5D (talk) 12:30, 27 June 2016 (UTC)

second

I will second this. Most research now points to complex interaction between microbiome, infection and malnutrition. The association with weaning is likely not linked to the lack of protein, just the lack of calories in general. If/when I have more time will find some sources and edit.

Also the image is NOT a child with kwashiorkor. The child is predominantly marasmic with maybe a touch of edema (combined picture). Ibrmrn (talk) 14:07, 26 October 2016 (UTC)

third

Very much agree that this the picture is not a good example of kwashiorkor.

There is also a large body of evidence building that, while kwashiorkor may not be due to a deficiency of protein per se, it may be due to a deficiency in particular amino acids. Sulfur amino acids are one of the most promising culprits currently being investigated.

Roediger WEW, Waterlow JP. New Views on the Pathogenesis of Kwashiorkor: Methionine and Other Amino Acids. Journal of Pediatric Gastroenterology & Nutrition. 1995;21(2):130-6. Phadke MA, Khedkar VA, Pashankar D, Kate SL, Mokashi GD, Gambhir PS, Bhate SM. Serum Amino Acids and Genesis of Protein Energy Malnutrition. Indian Pediatrics. 1995;32:301-6. Jahoor F. Effects of decreased availability of sulfur amino acids in severe childhood undernutrition. Nutrition Reviews. 2012;70(3):176-87. Jahoor F, Badaloo A, Reid M, Forrester T. Protein kinetic differences between children with edematous and nonedematous severe childhood undernutrition in the fed and postabsorptive states. The American Journal of Clinical Nutrition. 2005;82(4):792-800. Jahoor F, Badaloo A, Reid M, Forrester T. Sulfur amino acid metabolism in children with severe childhood undernutrition: cysteine kinetics. The American Journal of Clinical Nutrition. 2006;84(6):1393-9. Badaloo A, Hsu JW, Taylor-Bryan C, Green C, Reid M, Forrester T, Jahoor F. Dietary cysteine is used more efficiently by children with severe acute malnutrition with edema compared with those without edema. The American Journal of Clinical Nutrition. 2012;95(1):84-90. Badaloo A, Reid M, Forrester T, Heird WC, Jahoor F. Cysteine supplementation improves the erythrocyte glutathione synthesis rate in children with severe edematous malnutrition. The American Journal of Clinical Nutrition. 2002;76(3):646-52. — Preceding unsigned comment added by 130.64.25.58 (talk) 17:11, 4 May 2017 (UTC)

Please read: https://www.ncbi.nlm.nih.gov/m/pubmed/23363771/ Jbulleit (talk) 15:39, 11 April 2019 (UTC)

fourth

Here are links to some of the references that discuss the cause of kwashiorkor: "The cause of kwashiorkor remains obscure," (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667500/), "there is no real evidence of dietary protein deficiency," (Kwashiorcor revisited: https://academic.oup.com/trstmh/article-abstract/78/4/436/1893691?redirectedFrom=PDF), and "The mechanisms responsible for oedema formation in kwashiorkor remain obscure," (https://adc.bmj.com/content/76/1/54).

I would appreciate if someone qualified in the field would edit the article to remove its inaccuracies regarding the cause of kwashiorkor. — Preceding unsigned comment added by Thomaswayneriddle (talk • contribs) 15:27, 12 April 2019 (UTC)

Do

Do you have any pictures of people with kwashiorkor? [[User:NazismIsntCool|{{NazismIsntCool/sig}} Nazism isn't cool]] 05:41, 2 September 2005 (UTC)

What is the other name for kwashiorkor? gay

another mechanism for Kwashiorkor

A professor gave me a math problem concerning the hypoosmotic effects of reduced serum albumin (which has colligative properties, as any other molecule would) due to reduced protein intake/production. This would lead to an overall decrease in oncotic pressure in the capillaries, in turn increasing the osmotic flux through the capillary wall, resulting in edema. —The preceding unsigned comment was added by Raleightodd (talk • contribs) 01:43, 28 February 2007 (UTC).

The edema of kwashiokor gets better after the first phase of treatment BEFORE the albumin levels are corrected by the liver. —Preceding unsigned comment added by 167.206.17.116 (talk) 19:02, 29 May 2010 (UTC)

Meaning (derivation)

French & English Wikipedia conflict on derivation.

Here it is said:

The name is derived from one of the Kwa languages of coastal Ghana and means "the one who is displaced"

And in wp:fr they say:

Le terme, qui signifie enfant (kwashi) rouge (orkor) dans la langue des Ashanti du Ghana

So they mention the concrete language and give a completely different meaning... Which one is right? --83.32.66.149 19:49, 20 May 2007 (UTC)

(What it actually says here is:

...Jamaican pediatrician Dr. Cicely D. Williams introduced the name into the medical community in her 1935 Lancet article.[3] The name is derived from the Ga language of coastal Ghana, translated literally "first-second"[4][citation needed], and reflecting the development of the condition in an older child who has been weaned from the breast when a younger sibling comes.[5] Breast milk contains proteins and amino acids vital to a child's growth. In at-risk populations, kwashiorkor may develop after a mother weans her child from breast milk and replaces the diet with foods high in starches and carbohydrates and deficient in protein. )

The cited Lancet article is listed as

3. "Williams CD (1935). "Kwashiorkor: a nutritional disease of children associated with a maize diet". Lancet 226: 1151–2. doi:10.1016/S0140-6736(00)94666-X."

This is a bona fide Lancet article found in PubMed and cited by other recent PubMed abstracts of studies of Kwashiorkor.

Some additional evidence of derivation appears in footnote 4 of the English WP article:

4. ^ "Jamaica Gleaner : Pieces of the Past: A Pioneer, A Survivor: Dr. Cicely Williams". "... she asked an African nurse if it had a name. She learned it was called "kwashiorkor" meaning the sickness the older child gets when the next baby is born. Cicely surmised that this meant that weanling children were not receiving enough to eat". http://www.jamaica-gleaner.com/pages/history/story0037.htm. Retrieved 2009-12-27.

Can anyone reference the Lancet article referenced in footnote 3 as the source and give us a short fair-use quote?

If the Lancet article is correctly cited as the source, the French Wikipedia article may need to be corrected. Ga is the particular member of the Kwa language family suggested in the footnoted sources. A Ga/Kwa/Ashanti linguistic scholar might shed more light, but the suggested "red child" meaning does not match the syndrome actually observed in Kwashiorkor. Meanwhile, the the Ga language meaning is closely tailored to the most common presentation.

The very rare cases found in developed countries almost invariably occur when an infant is weaned off of breast milk after only a few months, but the needed protein and plethora of other breast milk nutrients (EFAs, etc., etc. -- the list of know benefits of nursing and mother's milk is very long and growing) is not replaced. Rather than willing neglectfulness, the parents are generally well-educated, know that the protein needs of adults can be amply satisfied by a purely vegan diet, but tragically lack the information that developing children need the protein and other ingredients in breast milk for normal health and development. A vegan mother may be able to supply these nutrients in her breast milk while the mother continues to consume a purely vegan diet, but an infant or toddler cannot do the same during the several years that breast feeding is recommendable. (Actually, a nursing mother who supplements her own vegan diet with fish oil and fish may provide her milk with more of the DHA needed for optimal brain development). If anything, vegans should breast-feed longer than meat-eaters, and this information is tragically not everywhere available, even to the well-educated, leading to very rare prosecutions for abuse or neglect if the Kwashiorkor is not diagnosed in time to save the child's life and health. Occasionally in the absence of breast feeding or other protein sources, fears of allergy to cow's milk, may also lead to Kwashiorkor's.

If the mother is severely malnourished, or has a second pregnancy while nursing, her milk dries up. If this happens while the first child still needs nursing and other protein sources (particularly fish sources) are not available (but starch sources are) the result is Kwashiorkor.

Humor: "Queasy-Kosher" When they won't eat it because they think it's "gross" leading to malnutrition. — Preceding unsigned comment added by KarlHegbloom (talk • contribs) 13:28, 2 December 2013 (UTC)

Pathophysiology

I removed the following paragraph:

The swollen abdomen is generally attributed to two causes: First, the appearance of ascites due to increased capillary permeability from the increased production of cysteinyl leukotrienes (LTC4 and LTE4) as a result of generalized intracellular deficiency of glutathione. Tolga is 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(cholesterol) from the liver to tissues throughout the body.

The first assertion, that children w/ kwashiorkor have ascites is incorrect; they abdominal distention is NOT caused by ascites. Since the rest of the paragraph is unsourced, I removed it; if you can find a reliable source, please reintroduce this information. This article needs some serious work. --Wawot1 (talk) 15:43, 5 April 2009 (UTC)

A useful source

Management of acute moderate and severe childhood malnutrition. http://www.bmj.com/cgi/content/full/337/nov13_1/a2180?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=kwashiorkor&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT#REF2

--Wawot1 (talk) 15:43, 5 April 2009 (UTC)

Is it allowed to use the WHO guidelines? http://www.who.int/nutrition/publications/guide_inpatient_text.pdf — Preceding unsigned comment added by Szadeh4 (talk • contribs) 03:50, 17 February 2016 (UTC)

Can it be said to be "virulent"?

"Kwashiorkor is a virulent form of childhood malnutrition" would seem to indicate that it is caused by a virus and is infectious. Could that be the case?

--alagahd (talk) 11:13, 22 May 2009 (UTC)

"Virulent" can mean "deadly" or "serious" but as you recognize, it connotes contagion. Replacement with "deadly" or "extremely serious" would avoid this ambiguity by specifying the meaning intended.

Micronutrients

I am going to edit the sections about the reason for Kwashiorkor being "micronutrients" and antioxidants. There is no mention of that in the literature. Only Zink deficiency (Acrodermatitis enteropathica) shows a similar picture but is a diagnosis on it's own. I am also deleting the part about aflatoxin because alfatoxin is not the cause for Kwashiorkor as written in the article. Higher alfatoxin levels are the consequence of impaired liver function due to Kwashiorkor. (Sources: peer reviewed journals: Pediatrics. 1991 Aug;88(2):376-9. Kwashiorkor: the hypothesis that incriminates aflatoxins., Hendrickse RG. Aflatoxin Exposure and its Relationship to Kwashiorkor in African Children K. C. Househam and H. K. L. Hundt, J Trop Pediatr (1991) 37 (6): 300-302. doi: 10.1093/tropej/37.6.300 Ann Trop Paediatr. 1992;12(3):241-7, Aflatoxins and kwashiorkor in Durban, South Africa. Ramjee G, Berjak P, Adhikari M, Dutton MF.) I will expand the section about sign and symptoms — Preceding unsigned comment added by Jadram2011 (talk • contribs) 18:45, 26 July 2012 (UTC)

I was just trying to edit the Kwashiorkor article to include micronutrients and antioxidants. Protein deficiency in children is rare. Children at 1-2yrs only need 5-6% of calories from protein. The symptoms of kwashiorkor (e.g. edema) are not cured by high protein diets. WHO guidelines stated that for the first week you give micronutrients (except iron), a diet with 5-6% protein calories, and you treat infections, hypoglycemia, dehydration. After the first week the child's edema will lessen (before any change in plasma albumin) and their appetite should return. That's when you give them high protein diets for catch up growth. Diets consumed by 1-2yr olds in most of the affected regions have about 6.4-8.8% protein calories. — Preceding unsigned comment added by Szadeh4 (talk • contribs) 03:47, 17 February 2016 (UTC)

Reader feedback: This article can be improved...

112.205.39.127 posted this comment on 11 July 2012 (view all feedback).

This article can be improved by adding more explanation on symptoms and other signs of kwashiorkor.

Also add pictures of people with kwashiorkor in front view.

There have also been many other feedback requests for more pictures and about how the disease is treated.

Puffin ^{Let's talk!} 21:06, 26 January 2014 (UTC)

Literal translation

There are conflicting sources on the web (none referenced here, however). Some agree with the Wikipedia translation, but others claim that while this may be the most meaningful translation, the literal one is "red-haired boy". If they are in fact different, the Wikipedia article needs both. 72.200.151.13 (talk) 14:18, 11 July 2014 (UTC)

Foundations 2 2019, Group 3b goals

This article is being edited as part of the Foundations II course at UCSF

Proposed edits:

1. Expand "diagnosis" section to include specific labs and diagnostic algorithms, definition of muscle wasting
2. Add section on Treatment
3. add information about prevalence/epidemiology
4. literature for up-to-date information on pathophysiology

-insufficient protein intake / amino acids / hypoalbuminemia

-kidney dysfunction

-dysadaptation to a low protein high carbohydrate diet

-aflatoxins

-oxidative stress (free radicals)

-gut microbiota

//current references

Oedema in kwashiorkor is caused by hypoalbuminaemia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462841/

Kwashiorkor - Statpearls https://www.ncbi.nlm.nih.gov/books/NBK507876/

Management of complicated severe acute malnutrition in children in resource-limited countries https://www.uptodate.com/contents/management-of-complicated-severe-acute-malnutrition-in-children-in-resource-limited-countries

Malnutrition in children in resource-limited countries: Clinical assessment https://www.uptodate.com/contents/malnutrition-in-children-in-resource-limited-countries-clinical-assessment#H4

Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.12452

The Immune System in Children with Malnutrition—A Systematic Review https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105017

--Alexuang (talk) 21:41, 29 July 2019 (UTC)

FYI, check editing tags I used for future reference, in particular the citation added (use "Cite" dropdown). Some of the suggested sources appear to be good reviews while others are quite specific; as noted summary articles are better, where available (but they may not be!) Health policy (talk) 04:38, 31 July 2019 (UTC)