Kwashiorkor, a Ghanaian word meaning the disease that the first child gets when the new child comes, is typically seen… In addition to protein-deficient diet, other causes of kwashiorkor include poor intestinal absorption, chronic alcoholism , kidney disease, and infection, burns, or other trauma resulting in the abnormal loss of body protein. Protein malnutrition is often associated with deficiencies of one or more other nutrients and of calories. The consumption of dried milk-based formula has proved effective in treating kwashiorkor. As long-term preventive measures, such international groups as the World Health Organization and the Food and Agriculture Organization of the United Nations have actively encouraged the successful development of high-protein plant mixtures based on local food preferences and availability. Protein malnutrition in early life may lead to an adult predisposition to certain diseases such as cirrhosis of the liver and may cause stunted mental development. The term protein-energy malnutrition covers the whole spectrum of deficiencies caused by lack of protein or calories or both.
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Recovering from kwashiorkor What is Kwashiorkor Kwashiorkor is a disease marked by severe protein malnutrition and bilateral extremity swelling 1. Kwashiorkor is most common in some developing regions of the world where babies and children have a diet that lacks protein and other essential nutrients.
It usually begins in the legs, but can involve the whole body, including the face. Kwashiorkor usually affects infants and children, most often around the age of weaning through age 5. Kwashiorkor is seen in very severe cases of starvation and poverty-stricken regions worldwide.
In the s, it was recognized as a public health crisis by the World Health Organization. However, there was a delay in its recognition, because most cases of childhood death were reported as being from diseases of the digestive system or infectious cause.
Since then, various relief efforts were aimed at eradicating kwashiorkor. As scientists continued to investigate the natural history of kwashiorkor in children, they discovered something very striking.
This finding led to the medical conundrum of whether kwashiorkor was the primary or the secondary cause of death. It was concluded to be the secondary cause of death because many cases of the disease would not have developed without the precipitating stress of diarrhea, dehydration and other infectious diseases such as HIV and measles.
Kwashiorkor is rare in children in the United States. There are only isolated cases. When kwashiorkor does occur in the United States, it is most often a sign of child abuse and severe neglect.
Kwashiorkor is most common in areas where there is: Famine Limited food supply Low levels of education when people do not understand how to eat a proper diet Kwashiorkor is more common in very poor countries. It often occurs during a drought or other natural disaster, or during political unrest.
These conditions are responsible for a lack of food, which leads to malnutrition. Prevalence can vary, but kwashiorkor is seen mostly during times of famine. Rural and farming communities are often affected the hardest. Kwashiorkor vs Marasmus While kwashiorkor is a disease of edematous malnutrition, marasmus is similar in appearance.
Signs of marasmus include thinness and loss of fat and muscle without any tissue swelling edema. Marasmus is known as the wasting syndrome malnutrition without edema. Children typically have a depletion of body fat stores, low weight for height, and reduced mid-upper arm circumference. Other features of marasmus can include thin, dry skin; a head that appears large relative to the body; an emaciated, weak appearance; bradycardia; hypotension; hypothermia; and thin, shrunken arms, thighs, and buttocks with redundant skin folds.
Like kwashiorkor, marasmus is caused by a lack of the right types of nutrients. This may occur among kids of all ages, but is more common among one- year-olds. If breast-feeding is unsuccessful or the mother has insufficient breast-milk supply and little or no alternative food is given to the infant, the result could be marasmus.
The following characterize marasmus: Failure to gain weight followed by loss of weight until emaciation results Skin becomes wrinkled and loose Face becomes shrunken and the child looks like an old man The abdomen is distended or thin Muscle wasting buttocks, thighs, shoulders, and upper arms Loose skin folds in the buttocks Growth retardation body weight is 60 percent or less of expected weight Infant is usually quiet and apathetic Associated diseases or conditions include dehydration resulting from infectious diarrhea, tuberculosis, and the presence of intestinal parasites.
Tests may need to be carried out to exclude other causes of thinness. The treatment for marasmus is similar to that for kwashiorkor. What causes kwashiorkor The cause of Kwashiorkor is fairly unknown, but diets based mainly on maize, cassava, or rice are frequently associated kwashiorkor 3. Kwashiorkor was previously believed to be due to protein deficiency and low levels of antioxidants and aflatoxins.
Evidence for these associations exists; however, efforts targeted to replete diets with high-protein and antioxidants have not been successful 4. Aflatoxin, previously thought to be the cause of kwashiorkor, is not always associated with the disease in certain populations.
Some factors that are consistently associated with kwashiorkor include recent weaning, recent infection particularly measles , and disruptions in childhood parental death, temporary home environment, poverty.
Kwashiorkor is most common in developing countries with a limited food supply, poor hygiene, and a lack of education about the importance of giving babies and children an adequate diet. Kwashiorkor is rare in developed countries such as the US, but it can occasionally occur as a result of severe neglect, long-term illness, a lack of knowledge about good nutrition, or a very restricted diet. Kwashiorkor pathophysiology Kwashiorkor is characterized by peripheral edema in a person suffering from starvation.
Edema results from a loss of fluid balance between hydrostatic and oncotic pressures across capillary blood vessel walls. Albumin concentration contributes to the oncotic pressure, allowing the body to keep fluids within the vasculature.
Children with kwashiorkor were found to have profoundly low levels of albumin and, as a result, became intravascularly depleted. Subsequently, antidiuretic hormone ADH increases in response to the hypovolemia, resulting in edema. Plasma renin also responds aggressively, causing sodium retention. These factors contribute to the edema. Kwashiorkor is also marked by low glutathione antioxidant levels. This is thought to reflect high levels of oxidant stress in the malnourished child.
High oxidant levels are commonly seen during starvation and are even seen in cases of chronic inflammation. One measure at reversal would be improved nutritional status and sulfur-containing antioxidants.
Loss of immune function, antioxidant function, subsequent infections, septic shock, and death. Endocrinopathies where insulin levels are decreased; growth hormone is increased, but insulin-like growth factor levels are reduced. Nutritional history, past medical history, vaccination history, and family history are also important to elicit from patients suspected of being malnourished.
However, blood and urine tests may be carried out to rule out other conditions. This can include tests to: Measure blood sugar and protein levels Check how well the liver and kidneys are working by testing the urine and blood for anemia Measure the levels of vitamins and minerals in the body Arterial blood gas.
Oedema in kwashiorkor is caused by hypoalbuminaemia
Email: moc. Abstract It has been argued that the oedema of kwashiorkor is not caused by hypoalbuminaemia because the oedema disappears with dietary treatment before the plasma albumin concentration rises. Reanalysis of this evidence and a review of the literature demonstrates that this was a mistaken conclusion and that the oedema is linked to hypoalbuminaemia. This misconception has influenced the recommendations for treating children with severe acute malnutrition. There are close pathophysiological parallels between kwashiorkor and Finnish congenital nephrotic syndrome CNS pre-nephrectomy; both develop protein-energy malnutrition and hypoalbuminaemia, which predisposes them to intravascular hypovolaemia with consequent sodium and water retention, and makes them highly vulnerable to develop hypovolaemic shock with diarrhoea. In CNS this is successfully treated with intravenous albumin boluses. It is time to trial intravenous bolus albumin for the treatment of children with kwashiorkor and shock.
Kwashiorkor: more hypothesis testing is needed to understand the aetiology of oedema
Role of intestinal microbiota in transformation of bismuth and other metals and metalloids into volatile methyl and hydride derivatives in humans and mice. Kwashiorkor affects most major organs systems. Proceed Natl Acad Sei. Oedema in kwashiorkor is caused by hypoalbuminaemia Antidiuretic hormone values in plasma and urine of malnourished children.