Kwashiorkor
Classification & external resources

Kwashiorkor sufferers show signs of thinning hair, edema, inadequate growth, and weight loss. The stomatitis on the pictured infant indicates an accompanying Vitamin B deficiency.
ICD-10	E40., E42.
ICD-9	260
DiseasesDB	7211
MeSH	D007732

Many of the children in this photograph from a Nigerian orphanage in the late 1960's show symptoms of malnutrition, with four in particular illustrating the gray-blond hair symptomatic of kwashiorkor.

Kwashiorkor is a type of malnutrition with controversial causes, but it is commonly believed to be caused by insufficient protein intake. It usually affects children aged 1–4 years, although it also occurs in older children and adults. Jamaican pediatrician Cicely D. Williams introduced the name into international scientific circles in her 1935 Lancet article^[1]. When a child is nursing, it receives certain amino acids vital to growth from its mother's milk. 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. Image File history File linksMetadata Download high-resolution version (1205x1806, 661 KB) This photograph is public domain implicitly by being the work of a US Government agency, but the public domain status is also explicitly stated on the CDC website. ... This page is about the condition called edema. ... Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, and roof or floor of the mouth. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Image File history File linksMetadata Download high-resolution version (1642x1226, 565 KB) This photograph is public domain implicitly by being the work of a US Government agency, but the public domain status is also explicitly stated on the CDC website. ... Image File history File linksMetadata Download high-resolution version (1642x1226, 565 KB) This photograph is public domain implicitly by being the work of a US Government agency, but the public domain status is also explicitly stated on the CDC website. ... An orphanage (historically an orphans asylum before the latter word took on its modern insane asylum connotation) is an institution dedicated to caring for orphans (children who have lost their parents) and abused, abandoned, and neglected children. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... Phenylalanine is one of the standard amino acids. ... Starch (CAS# 9005-25-8) is a complex carbohydrate which is insoluble in water; it is used by plants as a way to store excess glucose. ... Lactose is a disaccharide found in milk. ...

Derivation of kwashiorkor

The name is derived from one of the languages of coastal Ghana and means "one who is physically displaced" reflecting the development of the condition in the older child who has been weaned from the breast. Breastfeeding an infant Symbol for breastfeeding (Matt Daigle, Mothering magazine contest winner 2006) Breastfeeding is the feeding of an infant or young child with milk from a womans breasts. ...

Symptoms of kwashiorkor

Symptoms of kwashiorkor include a swollen abdomen known as a pot belly, as well as reddish discoloration of the hair and depigmented skin. The swollen abdomen is generally attributed to two causes: First, the observation of ascites due to increased capillary permeability from the increased production of cysteinyl leukotrienes (LTC4 and LTE4) as a result of generalized intracellular deficiency of glutathione. It is also thought to be attributed to the effect of malnutrition on reducing plasma proteins (discussed below), resulting in a reduced oncotic pressure and therefore increased osmotic flux through the capillary wall. A second cause may be due to a grossly enlarged liver due to fatty liver. This fatty change occurs because of the lack of apolipoproteins which transport lipids from the liver to tissues throughout the body. Victims of kwashiorkor fail to produce antibodies following vaccination against diseases including diphtheria and typhoid.[1] Generally, the disease can be treated by adding food energy and protein to the diet; however, mortality can be as high as 60% and it can have a long-term impact on a child's physical growth and, in severe cases, affect mental development. The abdomen is a part of the body. ... Leukotrienes are autocrine and paracrine eicosanoid lipid mediators derived from arachidonic acid by 5-lipoxygenase. ... Glutathione (GSH) is a tripeptide. ... In blood plasma, the dissolved compounds have an osmotic pressure. ... The liver is an organ present in vertebrates and some other animals. ... Fatty liver (also known as steatorrhoeic hepatosis or steatosis hepatis) is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis. ... Apolipoproteins are a class of apoproteins, which are proteins that depend on the presence of other small molecules, or cofactors, to function. ... Wikipedia does not yet have an article with this exact name. ... Vaccination is the process of administering pathogens that cant reproduce (due to being weakened or dead) to a healthy person or animal, with the intent of conferring immunity against a targeted form of a related disease agent. ... This is about the disease typhoid fever. ... Food energy is the amount of energy in food that is available through digestion. ...

Possible causes of kwashiorkor

There are various explanations for the development of kwashiorkor, and the topic remains controversial^[2]. It is now accepted that protein deficiency, in combination with energy and micronutrient deficiency, is certainly important but may not be the key factor. The condition is likely to be due to deficiency of one of several type one nutrients (e.g. iron, folic acid, iodine, selenium, vitamin C), particularly those involved with anti-oxidant protection. Important anti-oxidants in the body that are reduced in children with kwashiorkor include glutathione, albumin, vitamin E and polyunsaturated fatty acids. Therefore, if a child with reduced type one nutrients or anti-oxidants is exposed to stress (e.g. an infection or toxin) he/she is more liable to develop kwashiorkor. General Name, Symbol, Number iron, Fe, 26 Chemical series transition metals Group, Period, Block 8, 4, d Appearance lustrous metallic with a grayish tinge Standard atomic weight 55. ... Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... General Name, Symbol, Number iodine, I, 53 Chemical series halogens Group, Period, Block 17, 5, p Appearance violet-dark gray, lustrous Standard atomic weight 126. ... Se redirects here. ... For other uses, see Vitamin C (disambiguation). ... An antioxidant is a chemical that prevents the oxidation of other chemicals. ... Glutathione (GSH) is a tripeptide. ... It has been suggested that this article or section be merged into serum albumin. ... Tocopherol, or Vitamin E, is a fat-soluble vitamin in eight forms that is an important antioxidant. ... // In nutrition, polyunsaturated fat is an abbreviation of polyunsaturated fatty acid. ...

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. Cornell University is a university located in Ithaca, New York, USA. Its two medical campuses are in New York City and Education City, Qatar. ... Binomial name Crantz The cassava, casava, yuca or manioc (Manihot esculenta) is a woody shrub of the Euphorbiaceae (spurge family) native to South America that is extensively cultivated as an annual crop in tropical and subtropical regions for its edible starchy tuberous root, a major source of carbohydrates. ...

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. This has important consequences for treatment of the patients: Protein should be supplied only for anabolic purposes, the catabolic needs should be satisfied with carbohydrate and fat. Protein catabolism involves the urea cycle, which is located in the liver and can easily overwhelm the capacity of an already damaged organ. The resulting liver failure can be fatal. Chemical structure of aflatoxin B1 Aflatoxins are naturally occurring mycotoxins that are produced by many species of Aspergillus, a fungus, most notably Aspergillus flavus and Aspergillus parasiticus. ... Cytochrome P450 Oxidase (CYP2E1) Cytochrome P450 oxidase (commonly abbreviated CYP) is a generic term for a large number of related, but distinct, oxidative enzymes (EC 1. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... Albumin can refer to ovalbumin, the principal protein in egg white albumins, a group of proteins including serum albumin and together constituting roughly 60% of the protein in blood plasma. ... Marasmus is a form of severe protein-energy malnutrition characterised by calorie deficiency and energy deficiency. ... Anabolic is an adjective referring to processes of metabolism that result in growth of cells or organisms. ... Anabolism is the aspect of metabolism that contributes to growth. ... Lactose is a disaccharide found in milk. ... Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. ... Urea is an organic compound with the chemical formula (NH2)2CO. Urea is also known as carbamide, especially in the recommended International Nonproprietary Names (rINN) in use in Europe. ... Liver failure is the final stage of liver disease. ...

Other malnutrition syndromes include marasmus and cachexia, although the latter is often caused by an underlying illness. Marasmus is a form of severe protein-energy malnutrition characterised by calorie deficiency and energy deficiency. ...

References

1. ^ Williams CD. (1935) Kwashiorkor: a nutritional disease of children associated with a maize diet. Lancet 229:1151-2.
2. ^ Krawinkel M. (2003) Kwashiorkor is still not fully understood. Bull World Health Organ, vol.81, no.12, p.910-911.

• Malnutrition in Third World Countries