Why Does Protein Malnutrition Cause Kwashiorkor?

Kwashiorkor, also called protein-energy malnutrition, occurs when the diet is lacking in protein. It occurs most often in world regions with consistently low food supplies, famine, political upheavals, droughts, natural disasters, poor education and where food sources used to wean babies lack protein. Occurrence in the United States is limited to children subjected to neglect and abuse, the elderly in nursing homes and those with untreated pre-existing diseases and conditions.

Protein Malnutrition

Protein-energy malnutrition, a persistent health problem in developing countries, occurs most often in children who have been weaned from breast milk at the birth of a sibling. Foods used to replace breast milk, such as rice, sweet potatoes, green bananas and yams, lack protein and, though carbohydrates, don't provide enough energy for the body. The results lead to depleted carbohydrate stores in the liver, muscle proteins broken down to produce new proteins and fat stores broken down to form calories. In industrialized countries, the condition occurs with nutrient losses, increased nutritional needs from an underlying illness or decreased intake.

Symptoms

Protein-energy malnutrition is a progressive disease with symptoms that reflect a greater deficiency of protein than calories in the diet. Symptoms include alterations in skin color, loss of muscle mass, lack of weight gain, failure to grow, altered hair color and texture, protruding abdomen, fatigue and diarrhea. With progression of protein malnutrition, an enlarged liver and edema might be present on physical exam. In severe forms of kwashiorkor, fatty stores fade away, muscle tissue greatly diminishes and swelling develops in dependent areas of the body.

Effects

The result of kwashiorkor affects all body systems causing multiple organ dysfunction. The prolonged lack of protein in the diet causes the body to break down its own tissues to meet calorie and energy needs resulting in weight loss, depleted fatty tissues and increased skeletal muscle wasting. Kwashiorkor depresses normal digestion and absorption in the gastrointestinal tract. The effects on the respiratory system include diminished muscle function and weakness. The liver decreases production of serum proteins and the heart's ability to contract efficiently is depressed.

Treatment

Treatment relies upon the severity of illness with priority placed on correcting abnormalities in fluids and replacing electrolytes such as sodium, chloride and potassium. Gradual introduction of proteins, carbohydrates, vitamins and minerals follows, with fats and lactose last. Emphasis is placed on slowly replacing nutrients and fluids to minimize the risk of life-threatening complications such as congestive heart failure, diarrhea and development of malabsorption syndromes. Treatment of late-stage kwashiorkor might improve general health but can't repair existing developmental health and mental impairment problems.