Kwashiorkor (kwash-ee-OR-kor) is a type of severe malnutrition that affects young children who are one to four years old. It is also found in older children and adults living in extreme poverty in tropical and subtropical parts of the world. The condition develops among individuals who have high-starch diets without sufficient protein, especially among those who are suffering from famine. Kwashiorkor produces such physical characteristics as small stature, weight loss, discolored and puffy skin on arms and legs and sometimes on the face, thin and reddish-blond discolored hair, a large and swollen abdomen (commonly called bloated belly), thin arms and legs, and pigment loss.
Tanya lived outside Tubmanburg in Liberia with her parents and four older brothers and sisters. Her family was poor, and her parents had a hard time feeding all of the children. Nevertheless, Tanya was a healthy infant because she was breastfed; breast milk contains all of the protein and other nutrients a baby needs. When Tanya was just over a year old, her mother had another baby and Tanya could no longer breastfeed. Instead, she had to eat the only food available: white rice, cassava, and yams. These foods contain mostly carbohydrates and have almost no protein. Because of the lack of protein in her diet, Tanya developed kwashiorkor. Her stomach was bloated, her arms and legs got thin, her skin flaked, and she was very weak. Tanya is typical of many children whose families are too poor to feed their children a complete diet. Overcrowded, unhygienic, and poverty-stricken conditions contribute to children being at risk of developing kwashiorkor.
Kwashiorkor is a disease caused by the lack of protein in a child's diet. It is a type of protein-energy malnutrition (PEM) that is widespread throughout regions where the diet is composed almost exclusively of starchy foods such as rice, yams, maize, cassava, or plantains. People afflicted with kwashiorkor are often deficient in such nutrients as folic acid, iodine, iron, and vitamin C and in such antioxidants as albumin, polyunsaturated fatty acids, and vitamin E. Children living in extreme poverty, such as those suffering through famine or living in refugee camps, are at increased risk for kwashiorkor.
British physician and pediatrician Cicely Delphine Williams (1893–1992) first described kwashiorkor to the scientific community in 1935 after treating villagers in the area later called Ghana. Williams found that first-born children often developed the condition after they were weaned when a second child was born. The term kwashiorkor was derived from a word used in Ghana that means “rejected one.” Kwashiorkor usually develops after a baby is weaned from protein-rich breast milk (for any reason) and switched to protein-poor foods. In extreme poverty and during famines and wars that displace populations from farmland to refugee camps, protein-rich foods are not available. Kwashiorkor was not globally recognized as a serious disease until the late 1940s.
Children with kwashiorkor have degraded skin conditions such as edema (excess water retention in body tissues that causes swelling and bloating); inflammation of the skin (dermatitis); flaking and peeling skin that contains whitish patches; skin pigment changes; thinning and brittle hair, along with lack of curliness and color; and hair that is easily pulled out. Afflicted children have diarrhea * and loss of appetite. They are usually weak, irritable, and lethargic.
Symptoms of kwashiorkor result from a lack of amino acids, which are the building blocks of protein. The amino acids are not present in sufficient quantities for the body to produce the various proteins needed for the body to develop normally.
For example, albumin is an important protein; it plays a vital role in maintaining oncotic pressure * within blood vessels. Oncotic pressure is maintained by the presence of proteins, such as albumin, which helps to keep fluids within the capillaries. However, in kwashiorkor sufferers, the level of albumin is low and more fluid flows out of the capillaries than into them. This fluid tends to accumulate in the tissues. Consequently, it is not available to be used for hydration of the body.
When medical staff and resources are available, kwashiorkor patients are given intravenous fluids to increase fluid balances lost from sweating and urine output and to replace losses from vomiting and diarrhea. Medical professionals also monitor blood constituents such as albumin that maintain what are called Starling forces * .
An international team of medical workers traveling in Liberia saw Tanya sitting on the ground too tired to play and realized the extent of her malnutrition. They took her to the hospital in Tubmanburg, where she was kept warm and given fluids to replace those she had lost. Initially, she was given small amounts of milk and vitamin and mineral supplements. Zinc supplements helped stop her skin from flaking. After the edema went away, the doctors gave her a high-calorie diet rich in protein.
Of the children who are hospitalized and treated for kwashiorkor, 85 percent survive. Most children properly treated for kwashiorkor early enough recover completely. However, children who develop kwashiorkor before two years of age in areas where medical help is not available usually experience stunted height and growth potentials as well as diminished mental capabilities.
Individuals in shock should have their blood volume immediately replenished and their blood pressure constantly monitored. When stabilized, these patients should slowly receive carbohydrates, simple sugars, and fats. Later, proteins, vitamins, and minerals should be added, as well as milk products. If the patients are lactose intolerant, an enzyme lactase supplement can serve as a substitute.
Because kwashiorkor is a dietary deficiency condition, it can be prevented by individuals consuming a well-balanced diet that consists of appropriate amounts of fat (at least 10 percent of total calories), carbohydrates, and protein (around 12 percent of total calories). However, extreme poverty, natural disasters, and wars all too often make it impossible for poor people to enjoy well-balanced diets.
International efforts to provide medical support and food have been unable to meet the severe demands of huge populations. These efforts also include teaching people how to grow other kinds of foods, combine available foods to maximize protein intake, and use contraception * methods to limit family size. These approaches address the ongoing problem of malnutrition. Within industrial countries, such as the United States, kwashiorkor is rare. When it does occur in developed countries, the cause is often child abuse.
See also Dietary Deficiencies • Jaundice • Malnutrition
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* diarrhea (di-ah-RE-uh) is frequent, watery stools (bowel movements).
* edema (KO-ma) is an unconscious state, like a very deep sleep. A person in a coma cannot be woken up and cannot move, see, speak, or hear.
* shock is a serious condition in which blood pressure is very low and not enough blood flows to the body's organs and tissues. Untreated, shock may result in death.
* jaundice (JON-dis) is a yellowing of the skin and sometimes the whites of the eyes caused by a buildup in the body of bilirubin, a chemical that the liver produces and releases. An increase in bilirubin may indicate disease of the liver or certain blood disorders.
* edema (e-DEE-ma) is swelling in the body's tissues caused by excess fluids.
* oncotic pressure is the pressure difference of blood plasma and tissue fluid.
* Starling forces are hydrostatic and oncotic pressures that control fluid movements in capillary membranes.
* contraception (kon-tra-SEPshun) is the deliberate prevention of conception or impregnation.