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Kwashiorkor is most widespread in rural locations, particularly in Sub-Saharan Africa. Nowadays, most children are sick due to a malnutrition disease called Kwashiorkor. The disease is caused by deficiencies of proteins in the body. Kwashiorkor is often referred to as "edematous malnutrition" since it relates to edema. People who suffer from this disease have emaciated marks all over their bodies. Different body parts, like arms, legs, and feet, swell up and get filled with liquid. Famine-stricken places or locations with a scarcity of food are particularly vulnerable to this illness. There are also higher incidences of Kwashiorkor in places where individuals are uninformed about healthy food and nutrition.
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Key Terms: Kwashiorkor, marasmus, protein deficiency, antioxidants, measles, diarrhea, edema, edematous malnutrition
Causes of Kwashiorkor
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The cause of Kwashiorkor is uncertain. However, diets high in maize, cassava, or rice are usually linked to the disorder. It was formerly thought to be caused by a lack of protein and a lack of antioxidants, and aflatoxins. Although there is proof of these relationships, attempts to fill meals with increased proteins and antioxidants were ineffective. Aflatoxin, formerly assumed to be the cause of Kwashiorkor, is not consistently linked to the condition in certain groups. Early lactation, current illness (especially measles), and childhood disturbances are reliably linked to the condition (death of parents, frequent changes in the environment of the house, poverty).
Symptoms of Kwashiorkor
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Following are the symptoms of Kwashiorkor disease: -
- Diarrhea
- Weight loss
- Irritation
- Fatigue
- Changes occur in the skin color, hair texture, and the color of hair.
- Failure to gain muscle mass
- Weakened immune system
- Edema in ankles, feet, and arms
Effect of Kwashiorkor on the Physiology
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Kwashiorkor is characterized by peripheral edema in a starving individual. The lack of fluid equilibrium between hydrostatic pressure and oncotic pressure across capillary blood vessel walls causes edema. The quantity of albumin increases the oncotic pressure, which allows the body to maintain fluids inside the vasculature. Kids with Kwashiorkor had incredibly low amounts of albumin, causing them to become intravascularly deficient, and hence, antidiuretic hormone (ADH) rises in reaction to hypovolemia, causing edema. Plasma renin reacts vigorously as well, increasing salt retention. These variables all lead to edema.
Low glutathione (antioxidant) levels are also a feature of Kwashiorkor. It is assumed to be due to the impoverished child's elevated levels of oxidant stress. Increased oxidant amounts are frequent during fasting and have even been observed in situations of chronic inflammation. Better nutritional status and sulfur-containing antioxidants would've been one indicator of reversion.
Clinical Demonstration of Kwashiorkor
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Kwashiorkor can be analyzed and demonstrated in the following ways:
- Distension of the abdomen
- Scalp that is dry, full, and hypopigmented and that comes out or is readily plucked.
- Pitting edema that originates in the dependent areas and progresses cranially
- Muscle loss is noticeable.
- Psychic shifts (anorexia, apathy)
- Skin that is weak, rough, and cracking, with confluent patches of scales and hyperpigmentation
- Dermatitis/skin lesions
- Development stifling
- Spherical face (cheek prominence)
- Hepatomegaly
Treatment of Kwashiorkor
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The ten fundamental concepts listed below are widely employed to manage patients hospitalized for Kwashiorkor. These concepts are implemented in stages, beginning with emergency stabilization and progressing to final rehabilitation.
- Thirst treatment/prevention
- Begin eating with caution.
- Making preparations for a follow-up appointment following recuperation.
- Hypothermia Treatment and prevention
- Hypocalcemia treatment/prevention
- Offering sensory input as well as psychological support
- Infections treatment/prevention
- Micronutrient deficiency correction
- Obtaining catch-up growth
- Restoring electrolyte balance
- The entire course of therapy takes between 2 and 6 weeks.
Different Diagnoses of Kwashiorkor
The major diagnosis of Kwashiorkor is given as follows:
- Malignancies
- Acrodermatitis enteropathica
- Chronic kidney disease
- Nephrotic syndrome
- Actinic prurigo
- Inflammatory bowel disease
- Angio-neurotic edema
- Depression
- Atopic dermatitis
- Cirrhosis
Courses for Kwashiorkor
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The mortality rate in Kwashiorkor decreases with increasing age of onset. Stunted children may not develop or function normally. If treatment is not gone early in the disease's course, serious effects such as shock, coma, and irreparable mental and physical incapacity may ensue. Kwashiorkor can be lethal if left undiagnosed.
Complications involved with Kwashiorkor
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Complications of undiagnosed or poorly managed Kwashiorkor can be significant, even fatal, in certain individuals, particularly babies and children. The danger can be reduced by adhering to the planned treatment plan.
Kwashiorkor complications include
- Malformations of the gastrointestinal system, such as pancreatic atrophy with consequent glucose intolerance, shrinkage of the small intestine mucosa, lactase deficiency, ileus, and bacterial translocation, which can lead to bacterial septicemia and mortality
- Electrolyte imbalances are prevalent
- Hepatomegaly
- Hypothermia and metabolic abnormalities
- Cardiovascular collapse and hypovolemic shock
- In Endocrinopathies, insulin levels are low; growth hormone levels are high, but insulin-like growth factor levels are low. It results in insulin resistance.
- Infections of the urinary tract
- Cellular dysfunction, including endothelial dysfunction
- Immune dysfunction, antioxidant dysfunction, secondary infestations, septic shock, and death
Prevention from Kwashiorkor
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To successfully reduce childhood malnutrition rates, public health measures such as improved agriculture and improved access to healthcare are required. Individuals of reproductive age may supply suitable nutrients to their children from a young age by teaching them about optimal nutrition and health during and after pregnancy. Caretakers and newborns are in better health because they are provided with the necessary information and resources, eventually reducing childhood malnutrition.
Because edema can conceal reduced muscle mass, diagnosing Kwashiorkor in early infants can be difficult; nonetheless, kids become much more vulnerable to infections if instances are neglected, which can eventually lead to morbidity and mortality. To avoid this, parents may be taught about good nutrition and the necessity of nursing children to ensure they get all of the nutrients they require. A meal rich in carbs, lipids that account for 10% of overall calorie demands, and proteins that account for 15% of total caloric needs can help avoid Kwashiorkor.
Foods that can help avoid Kwashiorkor are:
- Eggs
- Peas
- Meat
- Seafood
- Nuts
- Beans
- Seeds
Marasmus versus Kwashiorkor
Acute malnutrition may be classified into three types:
- Marasmus is characterized by severe weight loss and muscular atrophy due to a lack of nutrients and calories.
- Kwashiorkor: Swelling or edema caused by water retention owing to protein deficiency.
- Marasmic-Kwashiorkor: A condition characterized by muscular atrophy and bilateral edema.
According to the United Nations Children's Fund, Marasmus is the most prevalent manifestation of acute malnutrition in food scarcity circumstances. Both children and adults are affected by this illness.
Points to Remember
- Kwashiorkor is sometimes known as "edematous malnutrition" because of its association with edema.
- Kwashiorkor is triggered by a protein shortage in the diet.
- This condition is uncommon in affluent nations such as the United Kingdom and the United States. However, it can occur on rare occasions due to extreme negligence, lengthy sickness, lack of nutritional understanding, or a limited diet.
- Kwashiorkor is usually caused by diarrhea, malaria, or pneumonia. The clinical manifestation includes lethargy, anorexia, soft edema of the feet, legs, hands, arms, and face produced by hypoalbuminemia, and hepatomegaly with fatty liver.
- Kwashiorkor can be addressed in its initial stages with either specially designed milk-based meals or ready-to-use therapeutic meals (RUTF). RUTF is produced from powdered milk, almond butter, vegetable oil, sugars, minerals, and vitamins added.
Sample Questions
Ques - What precisely is protein-energy malnutrition? (2 marks)
Ans - Protein-energy malnutrition (PEM), also known as protein-energy undernutrition, is characterized by limited protein, energy, and micronutrient consumption or digestion to fulfill metabolic demand. It might also appear if there's been a considerable caloric loss.
Ques - What exactly is Marasmus? (2 marks)
Ans - Marasmus is a kind of malnutrition that can afflict small kids in areas with insecure food production. Skinniness and decrease of muscle and fat without even any tissue enlargement (edema) are indications of Marasmus, which is related to Kwashiorkor-like deficiency illnesses.
Ques - How do clinical characteristics change between skin types? Also, write some other clinical features of Kwashiorkor. (4 marks)
Ans - Patients with darker skin types had more frequent and severe cutaneous indications of Kwashiorkor. Some other clinical features of Kwashiorkor are as follows:
- Abnormal growth of eyelashes accompanied by pigmentation alterations
- Potbelly as a result of abdominal muscle atrophy
- Peripheral and facial edema
- Changes in the skin, hair, and nails
- Moon's 'bulldog' expression
Ques - What factors contribute to Marasmus? (2 marks)
Ans - The loss of certain nutrients characterizes Marasmus. Other reasons for thinness may need to be ruled out using tests. The therapy for Marasmus is comparable to the treatment for Kwashiorkor.
Ques - What is the result of the Kwashiorkor case? (3 marks)
Ans - Kwashiorkor has an overall death rate of 5-40% in children, depending on medical treatment available and the timeliness with which the ailment is recognized. Early therapy promotes recovery, although development potential is never completely realized. Although delayed therapy may potentially improve PEM, physical and cognitive effects may persist, and death is more likely. PEM has a substantial influence on mortality in older people with underlying medical disorders, tripling the probability of death.
Ques - Who suffers from Kwashiorkor? (3 marks)
Ans - Primary protein-energy malnutrition is caused by insufficient dietary intake and is especially frequent in developing-country preschool children. Initially identified in the 1930s by pediatrician Cicely Williams, Kwashiorkor is frequently caused by infection or the discontinuation of breastfeeding with weaning onto maize porridge. It mainly impacts youngsters in areas with high rice, maize, yams, and sweet potato consumption, such as rural Africa, the Pacific Islands, and the Caribbean.
Ques - How can Kwashiorkor be stopped? (2 marks)
Ans - Maintaining a protein-rich diet can help to avoid Kwashiorkor. Meat, fish, dairy products, eggs, soy, and beans should all be included. Slow increases in calories from carbs, sugars, and fats are used in the therapy, followed by protein. The therapy also includes correcting any fluid and electrolyte imbalances and treating any infections.
Ques - What exactly causes Kwashiorkor and Marasmus? (2 marks)
Ans - Kwashiorkor (malnutrition with edema) happens when nutrient intake is sufficient but inadequate protein consumption, whereas a protein and total calorie shortage cause Marasmus (severe wasting illness).
Ques - What symptoms indicate protein deficiency? (3 marks)
Ans - Protein insufficiency is thought to be the primary cause of Kwashiorkor. Mild to medium villous blunting, enhanced mononuclear lymphocytes in the lamina propria, normal or slightly decreased mucosal width, cuboidal division of epithelial cells, and other indications of protein insufficiency in children are common. Microvilli brush boundary abnormalities, decreased endoplasmic reticulum, dilated cytoplasmic vesicles, and phagocytic vacuoles are shown by malnutrition-related electron microscopy.
Ques - What are the clinical signs and symptoms of protein-energy malnutrition? (3 marks)
Ans - Weight loss or poor weight gain, slowed linear development, weariness, indifference at rest, and irritability when disturbed are early indications of protein-energy malnutrition in children. Edema can disguise weight loss in people. Subcutaneous fat loss becomes noticeable over time; muscle mass declines, skin and hair become dry and brittle, bones protrude, and wound healing is hampered.
Ques - What are the side effects of protein-energy malnutrition caused by Kwashiorkor? (2 marks)
Ans - The side effects of protein-energy malnutrition caused by Kwashiorkor are as follows:
- Encephalopathy
- Hypothermia
- Infection
- Failure of many organs
Ques - What treatment is available for Kwashiorkor's nutritional deficiencies? (3 marks)
Ans - Kwashiorkor treatment is complex and must be performed with caution to avoid refeeding syndrome, which can be fatal. The World Health Organization has released a three-stage method, including resuscitation/stabilization, nutritional rehabilitation, and recurrence prevention. Topical zinc paste is applied to the skin, and oral zinc supplements may be useful.
Ques – What do you mean by edematous malnutrition? (3 marks)
Ans - Kwashiorkor is also known as edematous malnutrition because it causes swelling in numerous body regions. In Kwashiorkor, water retention or edema develops in the abdomen, legs, and feet. The illness is much more prevalent in African countries because of the scarcity of nutrition and starvation circumstances. Youngsters and adults are especially prone to illness due to negligence. Kwashiorkor is a potentially fatal disease if not addressed promptly.
Ques - How do you deal with Kwashiorkor? (3 marks)
Ans - Kwashiorkor, and Marasmus are two common indicators and symptoms of low protein content. As a result, anyone suffering from these symptoms should eat protein-rich meals. It includes pulses and nuts such as cashews, almonds, and coconut, among other things. Soya is the most abundant plant-based protein source. Non-vegetarians may incorporate chicken and egg whites into their diet.
Ques - Why don't individuals with Marasmus develop edema like those with Kwashiorkor? (3 marks)
Ans - Because visceral proteins are retained in Marasmus, characterized by a usually reduced caloric intake, Marasmus patients do not develop edema like Kwashiorkor patients. Only muscle proteins are used in the production of glucose. Proteinemia is maintained or slightly reduced, and oncotic pressure does not fall. Protein consumption is inadequate in Kwashiorkor. The organism has enough energy and does not need to use proteins to produce glucose but lacks amino acids. As a result, muscles and fat are not catabolized. It is simply not feasible to create extra protein, routinely destroyed but not replaced.
Ques - What exactly is the distinction between Kwashiorkor and obesity? (3 marks)
Ans - An excess of calorie consumption often induces obesity. In obesity, the body turns extra calories into lipids, mainly fats, for preservation. This results in adipocytes, or fat-storing cells, and several lengthy metabolic abnormalities. One's way of living mostly causes obesity. It can also be caused by genetics, various medical disorders, and adverse drug effects. Kwashiorkor is a protein deficiency disorder. It usually affects children who have stopped breastfeeding in disadvantaged settings. Their diets are frequently high in nutrients but low in protein. The infant is unable to produce sufficient of their very own proteins.
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