Kwashiorkor

Like other forms of malnutrition, kwashiorkor initially causes:

• fatigue
• irritability
• drowsiness

If the person continues to be deprived of protein, they will typically:

• fail to put on weight and fail to grow in height
• lose muscle mass
• develop swelling under the skin (
  oedema
  )
• develop a 'pot belly'
• have an enlarged
  fatty liver
• be vulnerable to infections because of a failing immune system
• develop red, inflamed patches of skin that darken and peel or split open ('crazy pavement dermatosis')
• develop dry, sparse, brittle hair that may turn reddish yellow or white
• develop ridged nails

Many malnourished children will become intolerant to milk sugar (develop

When does it happen?

Kwashiorkor is commonly seen in developing regions of the world, where there is famine or a limited food supply. It is particularly seen in countries where the diet consists mainly of corn, rice and beans.

It is more common in children than adults.

Kwashiorkor is unusual in developed countries such as the UK and the US – cases that are seen in these countries may be a sign of child abuse and severe neglect.

How is kwashiorkor diagnosed?

Kwashiorkor can be diagnosed on physical appearance (the pot belly and oedema) and knowledge about the person's diet. The diagnosis can be confirmed by blood and urine tests showing the following:

• low blood sugar levels
• low blood protein levels
• high levels of growth hormone and the stress hormone cortisol
• low levels of salt in the blood
• low level of the waste product urea in the urine
• iron deficiency anaemia
• low blood pH

Other tests may include growth measurements, calculating body mass index, taking a skin biopsy and analysing a hair sample.

How is kwashiorkor treated?

A person with kwashiorkor must first have their blood and body fluid levels corrected, and any infections treated. This may take 48 hours.

Only then can small amounts of food be introduced slowly – carbohydrates first, to provide energy, followed by high-protein foods.

This reintroduction of food may take over a week. At this point, a child should be consuming about 175 calories and 4g protein per kg of bodyweight, and an adult 60 calories and 2g protein per kg of bodyweight.

Outlook for kwashiorkor

How well the person does after treatment depends on their stage of malnutrition when treatment began.

If treatment was started early, the person usually recovers well, although children will never reach their full growth potential.

If treatment was started in the later stages of malnutrition, the person may be left with physical and intellectual disabilities.

If kwashiorkor is not treated or treatment is delayed, it can result in death.