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| __NOTOC__ | | [https://www.wikidoc.org/index.php?title=Kwashiorkor&veaction=edit Edit]__NOTOC__ |
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| {{CMG}}; {{AE}}
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| {{DiseaseDisorder infobox |
| | '''For the Patient information page for this topic, click [[Kwashiorkor (patient information)|here]]''' |
| Image = Kwashiorkor 6180.jpg |
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| Caption = 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. |
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| Width = 120px |
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| Name = Kwashiorkor |
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| ICD10 = {{ICD10|E|40||e|40}}, {{ICD10|E|42||e|40}} |
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| ICD9 = {{ICD9|260}} |
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| MeshName = Kwashiorkor |
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| MeshNumber = D007732 |
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| DiseasesDB = 7211 |
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| ==Overview==
| | {{CMG}} ; {{AE}}{{DAMI}} |
| '''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<ref>Williams CD. (1935) Kwashiorkor: a nutritional disease of children associated with a maize diet. ''Lancet'' 229:1151-2.</ref><ref>{{cite web |url=http://www.jamaica-gleaner.com/pages/history/story0037.htm |title=Jamaica Gleaner : Pieces of the Past: A Pioneer, A Survivor: Dr. Cicely Williams |accessdate=2007-09-18 |format= |work=}}</ref>. When a child is nursing, it receives certain [[amino acid]]s vital to growth from its mother's milk. When the child is weaned, if the diet that replaces the milk is high in [[starch]]es and [[carbohydrate]]s, 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.
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| ==Derivation of kwashiorkor == | | {{SK}} edematous malnutrition; Protein malnutrition; Protein-calorie malnutrition; Malignant malnutrition |
| 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 [[Breastfeeding#Weaning|weaned]] from the breast.
| | ==[[Kwashiorkor overview|Overview]]== |
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| ==Symptoms of kwashiorkor == | | ==[[Kwashiorkor patient information|Patient information]]== |
| 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 [[Leukotriene|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]].[http://www.religion-online.org/showarticle.asp?title=1405] 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.
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| ==Possible causes of kwashiorkor == | | ==[[Kwashiorkor classification|Classification]]== |
| [[Image:Kwashiorkor_6903.jpg|thumb|left|190px|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'''.]]
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| There are various explanations for the development of kwashiorkor, and the topic remains controversial<ref>Krawinkel M. (2003) Kwashiorkor is still not fully understood. ''Bull World Health Organ'', vol.81, no.12, p.910-911.</ref>. 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]], [[human serum albumin|albumin]], [[vitamin E]] and [[polyunsaturated fat]]ty 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.
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| 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.
| | ==[[Kwashiorkor historical perspective|Historical Perspective]]== |
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| 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.
| | ==[[Kwashiorkor pathophysiology|Pathophysiology]]== |
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| Other malnutrition syndromes include [[marasmus]] and [[cachexia]], although the latter is often caused by underlying illnesses.
| | ==[[Kwashiorkor causes|Causes]]== |
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| * [http://www.religion-online.org/showarticle.asp?title=1405 Malnutrition in Third World Countries]
| | ==[[Kwashiorkor differential diagnosis|Differentiating Kwashiorkor from other Diseases]]== |
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| | ==[[Kwashiorkor epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Kwashiorkor risk factors|Risk Factors]]== |
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| | ==[[Kwashiorkor natural history|Natural History, Complications and Prognosis]]== |
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| | ==[[Kwashiorkor diagnosis|Diagnosis]]== |
| | [[Kwashiorkor history and symptoms|History and Symptoms]] | [[Kwashiorkor physical examination|Physical Examination]] | [[Kwashiorkor laboratory tests|Laboratory Findings]] | [[Kwashiorkor chest x ray|Chest X Ray]] | [[Kwashiorkor CT|CT]] | [[Kwashiorkor other diagnostic studies|Other Diagnostic Studies]] |
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| | ==Treatment== |
| | [[Kwashiorkor medical therapy|Medical Therapy]] | [[Kwashiorkor primary prevention|Primary Prevention]] | [[Kwashiorkor secondary prevention|Secondary Prevention]] | [[Kwashiorkor cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Kwashiorkor future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Case Studies== |
| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |