Medical conditionKwashiorkorA young girl with kwashiorkor in a relief camp during the Nigerian Civil WarSpecialtyPediatrics
Kwashiorkor (/ˌkwɒʃiˈɔːrkɔːr, -kər/ KWASH-ee-OR-kor, -kər,[1] is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates.[2] It is thought to be caused by sufficient calorie intake, but with insufficient protein consumption (or lack of good quality protein), which distinguishes it from marasmus. Recent studies he found that a lack of antioxidant micronutrients such as β-carotene, lycopene, other carotenoids, and vitamin C as well as the presence of aflatoxins may play a role in the development of the disease.[3] However, the exact cause of kwashiorkor is still unknown. Inadequate food supply is correlated with kwashiorkor; occurrences in high-income countries are rare.[4] It occurs amongst weaning children to ages of about five years old.[2]
Conditions analogous to kwashiorkor were well documented around the world throughout history.[5] The disease's first formal description was published by Jamaican pediatrician Cicely Williams in 1933. She was the first to research kwashiorkor, and to suggest that it might be a protein deficiency to differentiate it from other dietary deficiencies.[6][7]
The name, introduced by Williams in 1935, was derived from the Ga language of coastal Ghana, translated as "the sickness the baby gets when the new baby comes" or "the disease of the deposed child", and reflecting the development of the condition in an older child who has been weaned from the breast when a younger sibling comes.[8] Breast milk contains amino acids vital to a child's growth. In at-risk populations, kwashiorkor is most likely to develop after children are weaned from breast milk and begin consuming a diet high in carbohydrates, including maize, cassa, or rice.[2][6]
Classification[edit]Kwashiorkor is a type of severe acute malnutrition (SAM). SAM is a category, composed of two conditions: marasmus and kwashiorkor.[9] Both kwashiorkor and marasmus fall under the umbrella of protein–energy malnutrition (PEM).[10] These diseases are oftentimes discussed together, but are distinctly separate conditions of malnutrition. Kwashiorkor is marked by an array of metabolic disturbances of uncertain cause. In contrast, marasmus is more clearly an energy deficiency syndrome, marked by weight loss. On physical exam, kwashiorkor is also distinguished from marasmus by the presence of edema. When children present with both kwashiorkor and marasmus, the condition is referred to as "marasmic-kwashiorkor".[11][3] In general, kwashiorkor is marked by more profound serum depletions of antioxidant molecules and minerals, relative to marasmus.[3]
Wellcome's classification[edit]Wellcome classification[12] is a system for classifying protein-energy malnutrition in children based on weight for their age and based on presence of edema. Other classifications include Gomez classification and Waterlow classification.[13][14]
Weight for age With edema Without edema General considerations 65-85% Kwashiorkor Undernutrition Weight for age +/- oedema Reference standard (50th percentile)