Kwashiorkor is a disease marked by severe protein malnutrition and bilateral extremity swelling. It usually affects infants and children, most often around the age of weaning through age. The disease is seen in very severe cases of starvation and poverty-stricken regions worldwide.
Kwashiorkor is one of two major classifications of severe acute malnutrition. While marasmus is characterised by low weight-for-height, kwashiorkor is diagnosed by bipedal pitting oedema. Other associated signs include pale and brittle hair, skin lesions, lethargy and a fatty liver as well as numerous metabolic anomalies.
In the 1950s, it was recognized as a public health crisis by the World Health Organization. However, there was a delay in its recognition, because most cases of childhood death were reported as being from diseases of the digestive system or infectious etiology. Since then, various relief efforts were aimed at eradicating it.
Etiology[edit | edit source]
The etiology of kwashiorkor is largely unknown, but diets based mainly on maize, cassava, or rice are frequently associated with the disease. It was previously believed to be due to protein deficiency and low levels of antioxidants and aflatoxins. Evidence for these associations exists; however, efforts targeted to replete diets with high-protein and antioxidants have not been successful. Aflatoxin, previously thought to be the etiology of kwashiorkor, is not always associated with the disease in certain populations. Some factors that are consistently associated with the disease include recent weaning, recent infection (particularly measles), and disruptions in childhood (parental death, temporary home environment, poverty).
Epidemiology[edit | edit source]
Worldwide, the most affected regions include Southeast Asia, Central America, Congo, Puerto Rico, Jamaica, South Africa, and Uganda. Prevalence can vary, but it is seen mostly during times of famine. Rural and farming communities are often affected the hardest. Kwashiorkor is rare in the United States.
Symptoms[edit | edit source]
Following symptoms indicate the presence of Kwashiorkor:
Diagnosis[edit | edit source]
Associated Co-morbidities[edit | edit source]
Some complications of kwashiorkor include:
Treatment[edit | edit source]
Many pathophysiological steps are involved in the development of protein malnutrition from starvation. Food with more proteins and more calories can treat Kwashiorkor.
The child's diet must be introduced slowly to limit potential problems associated with the change in cellular and organ function due to inadequate diet. Problems are associated with excessive amounts of fat in the diet leading to bowel and intestinal dysfunction . The main component for medical management, and ensuring that the diet is both cost and resource efficient, is utilizing locally grown products that are cheap, tasteful, easily preserved, and can be incorporated into a variety of food options to provide adequate, additional, and essential nutrients.
Prognosis[edit | edit source]
In kwashiorkor, mortality decreases as the age of onset of the disease increases.
Good Food as Good Medicine[edit | edit source]
Changes in traditional eating patterns have brought about new health threats on the African continent eg an increase in non-communicable diseases. Food is a key component in fighting kwashiorkor. Image: Fried pigeon peas.
Physical Therapy Management[edit | edit source]
The primary medical intervention is to treat kwashiorkors with an adequate diet. It is more likely for Physical Therapy to play a crucial role in the nursing home setting. Once the patient's diet has been balanced and they are receiving the adequate amount of calories and nutrients, then physical therapy intervention can be applied. If the patient's diet is not adequately met, then the physical therapy intervention will add an increase in energy demands that is not being met, and the intervention will be detrimential instead of beneficial. Physical Therapy intervention should include a general strength and aerobic conditioning program to minimize signs and symptoms associated with kwashiorkor (muscle atrophy and fatigue).
Differential Diagnosis[edit | edit source]
Protein-energy malnutrition describes a spectrum of diseases that are a result of inadequate nutrients that often affect children living in poor communities of developing countries. Marasmus is the differential diagnosis of kwashiorkor. Marasmus involves inadequate intake of protein and calories, without the presences of edema. The crucial diagnostic features include the percentage of weight loss based on aged norms, and if there is a presence of edema. Using Harvard weight standards, children 60-80% of expected weight for their age are diagnosed with kwashiorkor is edema is present. Children below 60% of expected weight for their age are classified with a diagnosis of marasmic kwashiorkor is edema is present or marasmus if edema is absent.
References[edit | edit source]