Kwashiorkor is a type of malnutrition characterized by severe protein deficiency. It causes fluid retention and a swollen, distended abdomen. Kwashiorkor most commonly affects children, particularly in developing countries with high levels of poverty and food insecurity. People with kwashiorkor may have food to eat, but not enough protein.
Kwashiorkor is one of the two main types of severe protein-energy undernutrition. People with kwashiorkor are especially deficient in protein, as well as some key micronutrients. Severe protein deficiency causes fluid retention in the tissues (edema), which distinguishes kwashiorkor from other forms of malnutrition. People with kwashiorkor may look emaciated in their limbs but swollen in their hands and feet, face and belly. The distended abdomen typical of kwashiorkor can be misleading in people who are actually critically malnourished.
Kwashiorkor is rare in developed countries. It’s mostly found in developing countries with high rates of poverty and food scarcity. Poor sanitary conditions and a high prevalence of infectious diseases also help set the stage for malnutrition. Kwashiorkor can affect all ages, but it’s most common in children, especially between the ages of 3 to 5. This is an age when many children have recently transitioned from breastfeeding to a less adequate diet — one higher in carbohydrates but lower in protein and other nutrients.
Kwashiorkor and marasmus are the two main types of severe protein-energy undernutrition recognized by healthcare providers worldwide. The main difference between them is that kwashiorkor is predominantly a protein deficiency, while marasmus is a deficiency of all macronutrients — protein, carbohydrates and fats. People with marasmus are deprived of calories in general, either because they’re eating too little or expending too many, or both. People with kwashiorkor may not be deprived of calories in general but are deprived of protein-rich foods.
Protein deficiency is the main feature of kwashiorkor, and many researchers believe it's the cause — but not all are convinced. Some have noted cases where dietary protein failed to prevent or improve kwashiorkor. This suggests that protein deficiency may only be part of the picture.
The primary factors associated with kwashiorkor are:
Other factors that may contribute include:
Healthcare providers can often diagnose kwashiorkor by physically examining the child and observing its telltale physical signs. They will ask about the child’s diet and history of illnesses or infections. They may measure the child’s weight-to-height ratio and height-to-age and score them according to various charts. The weight-to-height score tells them how severe the child’s condition is. Their height-to-age score tells them how much the child's growth has been affected by malnutrition.
The World Health Organization has outlined 10 steps to follow when treating severe undernutrition:
Left untreated, kwashiorkor can be fatal. Death may be caused by infection, dehydration or liver failure. When treatment begins, people are also at high risk of complications from refeeding syndrome. However, those who are successfully rehabilitated can make a strong recovery. They may have some lingering effects from kwashiorkor, but they may not.
The complications of kwashiorkor are more severe and last longer the longer they’ve been left untreated. Some children may never fully recover from their growth and development shortages. They may remain predisposed to liver disease and pancreatic insufficiency. Earlier intervention leads to better outcomes.
A note from Cleveland Clinic
Kwashiorkor may not look like malnutrition because it causes swelling and bloating. It also comes with hidden side effects that may be unexpected, such as loss of appetite and fatty liver disease. Kwashiorkor needs to be understood to be treated effectively. Simply feeding with protein may be insufficient and even dangerous. But kwashiorkor should be treated as soon as possible, especially in children. Earlier intervention can help minimize the long-term effects of malnutrition.
Last reviewed by a Cleveland Clinic medical professional on 05/18/2022.
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