Kwashiorkor
Classification and external resources
Kwashiorkor sufferers show signs of thinning hair, edema, inadequate growth, and weight loss. The stomatitis on the pictured infant indicates an accompanying Vitamin B deficiency.
ICD-10	E40., E42.
ICD-9	260
DiseasesDB	7211
MeSH	D007732

A seated, listless child, who was among many kwashiorkor cases found in Nigerian relief camps during the Nigerian–Biafran War.

Typical ulcerating dermatosis on a Malawian child suffering from kwashiorkor.

Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. Kwashiorkor is a low serum albumin of dietary origin, marked by edema.^[1] Kwashiorkor was thought to be caused by insufficient protein consumption but with sufficient calorie intake, distinguishing it from marasmus. More recently, micronutrient and antioxidant deficiencies have come to be recognized as contributing to kwashiorkor as well. Cases in the developed world are rare.^[2]

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.

[edit] Signs and symptoms

The defining sign of kwashiorkor in a malnourished child is pedal edema (swelling of the feet). Other signs include a distended abdomen, an enlarged liver with fatty infiltrates, thinning hair, loss of teeth, skin depigmentation and dermatitis. Children with kwashiorkor often develop irritability and anorexia. ^[1]

Victims of kwashiorkor fail to produce antibodies following vaccination against diseases, including diphtheria and typhoid.^[6] Generally, the disease can be treated by adding food energy and protein to the diet; however, it can have a long-term impact on a child's physical and mental development, and in severe cases may lead to death.

[edit] Possible causes

There are various explanations for the development of kwashiorkor and the topic remains controversial.^[7] It is now accepted that protein deficiency, in combination with energy and micronutrient deficiency, is necessary but not sufficient to cause kwashiorkor^{[citation needed]}. The condition is likely due to deficiency of one of several types of 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 one nutrients or anti-oxidants is exposed to stress (e.g. an infection or toxin) he/she is more liable to develop kwashiorkor.

Ignorance of nutrition can be a cause. Dr. Latham, director of the Program in International Nutrition at Cornell University cited a case where parents who fed their child cassava failed to recognize malnutrition because of the edema caused by the syndrome and insisted the child was well-nourished despite the lack of dietary protein.^{[citation needed]}

One important factor in the development of kwashiorkor is aflatoxin poisoning. Aflatoxins are produced by molds and ingested with moldy foods. They are toxified by the cytochrome P450 system in the liver, the resulting epoxides damage liver DNA. Since many serum proteins, in particular albumin, are produced in the liver, the symptoms of kwashiorkor are easily explained. It is noteworthy that kwashiorkor occurs mostly in warm, humid climates that encourage mold growth. In dry climates, marasmus is the more frequent disease associated with malnutrition. This has important consequences for treatment of the patients. Protein should be supplied only for anabolic purposes. The catabolic needs should be satisfied with carbohydrate and fat. Protein catabolism involves the urea cycle, which is located in the liver and can easily overwhelm the capacity of an already damaged organ. The resulting liver failure can be fatal.

Other malnutrition syndromes include marasmus and cachexia, although the latter is often caused by underlying illnesses.

[edit] Epidemiology

Disability-adjusted life year for protein-energy malnutrition per 100,000 inhabitants in 2002.^[8]

     no data      less than 10      10-100      100-200      200-300      300-400      400-500      500-600      600-700      700-800      800-1000      1000-1350      more than 1350

[edit] See also

• Starvation
• Cachexia
• Emaciation
• Marasmus
• Anemia

[edit] References

Wikimedia Commons has media related to: Kwashiorkor

[[sv:Kwashiorkor] is when you don't have enough protein]