Kwashiorkor's name means the illness a child gets when a sibling arrives
A starving child with kwashiorkor can look plump, because the disease swells the feet, belly and face with fluid. One family feeding their child cassava took the swelling for good health. The name, from Ghana's Ga language, describes the older child pushed off the breast when a new baby comes.
Kwashiorkor is a severe form of malnutrition in which a child may get enough calories but too little good-quality protein. It usually strikes after weaning, up to about the age of five, when breast milk and its amino acids give way to starchy staples such as maize, cassava or rice. It is rare in rich countries. The Jamaican paediatrician Cicely Williams published the first formal description in 1933, proposed that protein deficiency lay behind it, and introduced the Ga name in 1935.
Doctors separate it from marasmus, the other main type of severe acute malnutrition. Marasmus is essentially a shortage of energy that shows up as wasting. Kwashiorkor's hallmark is swelling in both feet, alongside a fatty, often inflamed liver and trouble in the kidneys, pancreas, heart and nerves. Children may lose hair colour and teeth, develop dermatitis, and become irritable and refuse food. Children who show features of both conditions are said to have marasmic-kwashiorkor.
The classic explanation drew on Starling's account of fluid movement. Albumin, the main blood protein, pulls fluid back from tissues into vessels; with too little of it, fluid leaks out and pools. That story explains the swelling well but not the rest: depleted glutathione, oxidative stress, altered DNA methylation, immune failure and more. Researchers now broadly accept that low protein alone cannot account for the syndrome, and the exact cause is still unknown. Gut microbes, missing antioxidants such as vitamin C and carotenoids, and aflatoxins produced by a mould on crops like maize are all under investigation, with conflicting evidence on the aflatoxin link.
Care centres on restoring high-quality protein. In low-resource settings that means ready-to-use therapeutic food or the F-75 and F-100 milk formulas based on skim milk powder. The skin changes can resemble acrodermatitis enteropathica, a zinc-deficiency disorder, so clinicians distinguish the two by their underlying causes.
Source: Kwashiorkor
