Kwashiorkor

Kwashiorkor, disease resulting from a deficiency of dietary protein relative to caloric intake. Kwashiorkor is one of the most common forms of protein-energy malnutrition (PEM). The disorder occurs most commonly in young children in developing countries when mothers’ breast milk no longer provides enough protein, and other protein-rich foods are not given in sufficient quantity. Although its symptoms can occur at any age, kwashiorkor usually appears in already poorly nourished children after an infection further worsens their health. The disease is rapidly fatal unless the individual receives more dietary protein.

Kwashiorkor is characterized by swollen and discolored skin on the arms and legs (and sometimes on the face or the whole body), thin and pale hair that is easily and painlessly pulled out, diarrhea, profound apathy, and loss of appetite. Internally, tissues and organs waste away, except for the liver, which increases in size owing to the accumulation of fat. These changes occur because amino acids, the building blocks of protein, are not available in adequate amounts for forming the many different proteins needed for normal structure and function.

Another form of protein-energy malnutrition in children is marasmus, which results from slow starvation caused by a deficiency not only of protein but also of calories and of other nutrients. Marasmus is characterized first by a relatively rapid loss of fat and then by a slow loss of lean body tissue. Except for wasting of the body, no other signs, symptoms, or other changes occur, because the slow breakdown of lean tissues provides sufficient amino acids for essential new protein manufacture. For complex metabolic reasons, this process does not occur in kwashiorkor. As body fat becomes exhausted in marasmus, the lean body mass is increasingly broken down to provide energy, and death soon follows.

The World Health Organization reports that 1.5 to 3.5 percent of children in developing countries have severe protein-calorie malnutrition with some manifestations of kwashiorkor or marasmus. Kwashiorkor and marasmus are often confused because symptoms and the progress of the disease depend greatly on the relative degrees of protein and calorie deficiencies. Kwashiorkor may therefore be superimposed on marasmus, and most cases can more properly be called marasmic kwashiorkor. If caught in time, both kwashiorkor and marasmus respond to dietary treatment, with complete recovery except for retarded growth and development.

British physician Cicely Williams, who observed the progress of the disease among people in the present-day western African country of Ghana, first described kwashiorkor in 1933. The name means literally “first-second” in the language of the Ga tribe of Ghana and refers to a disease that develops in the first-born when the second-born displaces it at the mother's breast. Not until 1949 was the disease recognized to be a problem in many parts of the world. See also Human Nutrition.