Kwashiorkor refers to abnormal protein-energy malnutrition. It is primarily seen in children in developing countries.
What is kwashiorkor?
Kwashiorkor is a protein deficiency disorder. It occurs in children in developing countries and is associated with a protein disorder. In earlier years, kwashiorkor was also common in central Europe. In Germany, the disease was called flour nutritional deficiency. The name Kwashiorkor comes from the pediatrician Cicely D. Williams from Jamaica. She introduced the term in 1935 as part of a technical paper. Kwashiorkor is a term from the Ghanaian language. It means “that the disease gives birth to a child when a new child is born.” During the course of the disease, the development of cachexia is evident, which is associated with severe organic disorders. These disorders can assume life-threatening proportions.
Causes
The reason for the occurrence of kwashiorkor is the lack of food and protein in regions where there is famine. This can be caused by crop failures, natural disasters, political unrest or wars. Not infrequently, however, an unbalanced diet is also the reason for the development of the deficiency disease. In this case, the affected children are fed primarily on corn. Although the calorie intake is sufficient, kwashiorkor symptoms occur. For example, the vital amino acids lysine and tryptophan are not present in corn. However, the human organism needs these to be able to build up its own protein. For this reason, kwashiorkor is widespread in areas of Africa where corn is the most important staple food. In countries where sufficient protein is consumed, however, the disease hardly ever occurs. Due to the lack of the essential amino acids, the albumins in the blood decrease. At the same time, there is a decrease in colloid osmotic pressure. As a result, the tissue fluid in the abdominal region no longer reaches the venous capillaries. However, not all children are affected by this.
Symptoms, complaints, and signs
Kwashiorkor can manifest in different ways in affected children. The symptoms are similar to the signs of celiac disease (indigenous sprue). Thus, the growth as well as the regeneration of the cells are inhibited. In addition, there is a weakness in hormone production. A typical symptom is the hunger belly. This is caused by the storage of water on the entire body. However, the abdomen is particularly affected. In addition, an enlargement of the liver occurs. The skin of the affected person is also affected. Other possible symptoms are diarrhea, loss of weight up to emaciation, muscle atrophy, discoloration of the hair, apathy, and immunodeficiency. In addition, as organ functions decline, there is a risk of liver failure, heart failure or encephalopathy. Likewise, the child’s mental development suffers.
Diagnosis and course of the disease
If kwashiorkor is suspected, a medical examination must be performed. Edema and an enlarged liver are considered typical signs of the disease. In addition, affected children make an emaciated and apathetic impression. Another indication is the appearance of a bulging abdomen due to ascites. In this case, fluid accumulates in the abdominal cavity. Laboratory tests play an important role in the diagnosis. Within the scope of these, the patient’s protein content is determined during a blood or urine test. Other tests may be done to determine liver function or muscle breakdown. The most important examinations are a blood-urine nitrogen test, determination of the arterial blood gases, measurement of the potassium and creatinine values in the blood, and the preparation of a large blood count. A variety of deficiencies can be detected through the laboratory results. The course of kwashiorkor depends on when appropriate medical treatment is given. Thus, if treatment is too late, there is a risk of permanent physical and mental damage. Without treatment, the sick child is at risk of coma or even death. However, if therapy begins in the early stages, recovery is possible in most cases.
Complications
In most cases of kwashiorkor, developmental and growth disorders occur. Children in particular are affected by this disorder, resulting in further sequelae in the patient’s adulthood.This damage is usually irreversible and can no longer be fully treated. Patients suffer from water retention, which can occur all over the body. The liver is also enlarged by kwashiorkor, resulting in pain. The affected persons lose weight and also suffer from malnutrition. Furthermore, malnutrition leads to cardiac insufficiency or liver insufficiency. Both complaints can lead to death in the worst case. Other internal organs can also be damaged. The treatment of Kwashiorkor usually takes place with the help of a diet. This can limit the symptoms to a large extent and in most cases the course of the disease is positive if treatment begins early. Special complications do not occur. With successful treatment of kwashiorkor, there is no reduction in life expectancy for those affected.
When should you see a doctor?
When symptoms such as weight loss and weakness are noticed, kwashiorkor may be underlying. The condition occurs primarily in developing countries, although it can also develop in conjunction with fasting or diet. People who belong to these risk groups must consult their family doctor at the first warning signs of malnutrition. If serious symptoms such as apathy or circulatory problems become apparent, it is best to talk directly to the doctor. Complications such as cardiac arrhythmias or signs of liver failure should be treated by an emergency physician. Parents who notice such warning signs in their children should ideally call the emergency services immediately or take the child to a clinic where the symptoms can be clarified. In the case of kwashiorkor, a stay in hospital is necessary in any case. The initial treatment is carried out by the general practitioner, while various specialists are called in for further therapy. Thus, any muscle atrophy must be treated by physiotherapy, while cardiac insufficiency must be treated by a cardiologist or internist.
Treatment and therapy
For successful treatment of kwashiorkor, it is exceedingly important to begin therapeutic measures as soon as possible. The core of treatment is a high-energy diet. To this end, children are fed small, but regular, portions. In this way, the basic physiological processes of the organism can be maintained. However, care must be taken not to overtax the limited metabolism. An excess of protein, for example, can have negative effects. In addition, the body must first adjust to the new conditions. Milk, which is usually fed with the aid of a tube, is considered to be well suited for the diet. In the further course, the milk diet can be enriched. Later, the milk is replaced by a cereal porridge containing important minerals and vitamins. Fat, carbohydrates and sugar also play an important role. In addition, the administration of nutritional supplements may be useful. This diet is followed until the child reaches about 80 percent of his or her normal weight. After that, he or she is given normal foods again. Kwashiorkor is said to end when the body’s normal weight is 85 percent. However, physical and mental damage can sometimes remain despite treatment.
Outlook and prognosis
Third World children with kwashiorkor have a poor prognosis without expert treatment. In cases of starvation edema or persistent protein-energy malnutrition, affected infants lack sufficient protein food after weaning. Children often receive only one bowl of white rice, corn or millet porridge a day. In kwashiorkor, there is a chronic deficiency of the most important building blocks of life – amino acids. The organism cannot produce essential amino acids itself. It is dependent on their supply through food. If the diet is poor in nutrients and one-sided, starvation edema occurs. This is characterized by a distended abdomen. This indicates a catastrophic condition of the intestinal flora. The immune system is also dependent on the intestinal biome. Whether kwashiorkor develops in a causal relationship with aflatoxins remains to be proven. The prognosis for children with starvation edema and enlarged liver is poor unless protein-rich food and medical help are promptly available.The first food intake after the Kwashiorkor diagnosis must take into account the paralyzed metabolism. This can no longer process larger quantities of proteins. Under nutritional medical treatment, those affected can recover completely. However, those affected may suffer from secondary symptoms of kwashiorkor later in life. This prognosis sounds more optimistic. However, it is important to ensure that kwashiorkor sufferers continue to do well in the future. They must be given sufficient protein-rich food on a sustained basis.
Prevention
Preventing kwashiorkor is certainly possible. For this purpose, a child must get enough protein foods. According to recommendations from the CDC (Centre for Disease Control and Prevention), the recommended amount of protein per day is between 10 and 35 percent of caloric intake.
Follow-up
With kwashiorkor, measures of follow-up care are usually not available or are severely limited. First and foremost, a physician should be consulted quickly and malnutrition interrupted to prevent further worsening of symptoms or other complications. As a rule, Kwashiorkor cannot heal on its own, and in the worst case the disease can lead to the death of the affected person. In this disease, first of all, it is necessary to stop the underfeeding of the child. The child must adapt to the usual diet and get used to it. In this case, a doctor can also prepare a diet plan, which should be followed in any case. Especially the parents of the child must follow this plan and also support the child in taking the food. The trigger for malnutrition or underweight should also continue to be prevented. Possibly a psychological support is necessary with Kwashiorkor therefore, whereby also affectionate and intensive discussions can have a positive effect on the further course of the illness. Possibly also the life expectancy of the affected person is reduced due to the disease.
What you can do yourself
Individuals diagnosed with kwashiorkor should seek medical treatment immediately. Treatment focuses primarily on dietary changes. Affected children must eat a healthy, balanced diet and should also eat more small but regular portions. This will help regulate the physiological processes of the organism. However, the limited metabolism must not be put under too much strain. For example, not too much protein should be included in the daily diet. Milk and milk products are more suitable. The milk diet can be enriched with cereal porridge and fruit during the course of the disease. Accompanying nutritional supplements usually have to be administered. In severe cases, it may be necessary to give the sick child the missing nutrients by infusion. Treatment must be continued until the child has reached about 80 percent of normal body weight. After treatment, it is important to ensure that the child consumes sufficient protein foods in the future. The CDC (Centre for Disease Control and Prevention) recommends a daily protein intake of ten to 35 percent of the daily caloric intake, supplemented with the necessary vitamins and minerals.
