What is Kwashiorkor?

Kwashiorkor: Kwashiorkor is the medical name for malnutrition.
When the child is weaned, if the diet that replaces the milk is high in starches and carbohydrates,  and deficient in protein (as is common in parts of the world where the bulk of the diet consists of starchy vegetables, or where famine has struck), the child may develop kwashiorkor.

The name is derived from one of the languages of coastal Ghana , translated literally "first-second", and means "rejected one" reflecting the development of the condition in the older child who has been weaned from the breast.

Kwashiorkor causes the distended bellies in children :

Protein malnutrition. Proteins function in the blood to help keep blood from leaking out of the blood vessels into body tissues and cavities. When blood proteins are very low serum seeps in to the soft tissues and the abdominal cavities causing diffuse body swelling or edema, and abdominal bloating or ascites.

What are the causes of Kwashiorkor ?

Both kwashiorkor (edematous PCM) and marasmus (nonedematous PCM) are common in underdeveloped countries and in areas in which dietary amino acid content is insufficient to satisfy growth requirements. Kwashiorkor typically occurs at about age 1, after infants are weaned from breast milk to a protein-deficient diet of starchy gruels or sugar water, but it can develop at any time during the formative years. Marasmus affects infants ages 6 to 18 months as a result of breast-feeding failure, or a debilitating condition such as chronic diarrhea.

Kwashiorkor occurs most commonly in areas of famine, limited food supply, and low levels of education, which can lead to inadequate knowledge of proper diet.
Early symptoms of any type of malnutrition are very general and include fatigue , irritability , and lethargy. As protein deprivation continues, growth failure, loss of muscle mass, generalized swelling  edema, and decreased immunity occur.
A large, protuberant belly is common. Skin conditions (such as dermatitis, changes in pigmentation, thinning of hair, and vitiligo ) are seen frequently. Shockand coma precede death.

Ignorance of nutrition can be a cause. Dr. Latham, director of the Program in International Nutrition at Cornell University  cited a case where parents who fed their child cassava  failed to recognize malnutrition because of the edema caused by the syndrome and insisted the child was well-nourished despite the lack of dietary protein.

Important factor in the development of kwashiorkor:

One important factor in the development of kwashiorkor is aflatoxin poisoning. Aflatoxins are produced by molds and ingested with moldy foods. They are toxified by the cytochrome P450 system in the liver, the resulting epoxides damage liver DNA . Since many serum proteins, in particular albumin, are produced in the liver, the symptoms of kwashiorkor are easily explained. It is noteworthy that kwashiorkor occurs mostly in warm humid climates that encourage mold growth, in dry climate marasmus is the more frequent disease associated with malnutrition.

Conditions that cause defective utilization of nutrients include malabsorption syndrome, short-bowel syndrome, and Crohn’s disease.