kwashiorkor

Kwashiorkor is a form of severe acute malnutrition caused by inadequate protein intake, often occurring after weaning when a child’s diet becomes high in carbohydrates but low in protein. It typically appears in environments with food scarcity and poor diet diversity.

Clinical features include edema (especially around the feet, legs, and abdomen), an enlarged fatty liver that gives a distended abdomen, hair changes such as thinning or flag sign, skin changes, irritability, apathy, and loss of appetite. Children may have growth failure, recurrent infections, and anemia. The condition results from low plasma protein levels and impaired metabolite synthesis, leading to reduced oncotic pressure, fatty degeneration of the liver, and weakness of immune defenses.

Diagnosis is clinical, supported by anthropometric measurements such as weight-for-height or mid-upper-arm circumference, and the presence of edema. Laboratory tests may show hypoalbuminemia, anemia, electrolyte disturbances, and signs of infection, but treatment should not be delayed for laboratory confirmation.

Treatment emphasizes rapid stabilization and nutritional rehabilitation. This includes management of infections and dehydration, correction of electrolytes, and gradual initiation of protein- and energy-rich feeds. Ready-to-use therapeutic foods (RUTF) are commonly used, with hospitalization or careful monitoring for severe cases. Refeeding should be gradual to avoid refeeding syndrome. Micronutrient supplementation (including vitamin A and zinc) and treatment of comorbidities are essential.

Prognosis improves with early, appropriate treatment; without it, mortality remains high. Prevention focuses on improved maternal and child nutrition, exclusive breastfeeding for the first six months, timely introduction of protein-rich complementary foods, food security, and public health strategies to reduce poverty and disease. Kwashiorkor is a form of severe acute malnutrition distinct from marasmus, which presents with severe wasting and little or no edema.

---