It is mainly caused by inadequate protein intake resulting in a low concentration of amino acids. The extreme lack of protein causes an osmotic imbalance in the gastro intestinal system causing swelling of the gut diagnosed as an edema or retention of water.
Extreme fluid retention observed in individuals suffering from kwashiorkor is a direct result of irregularities in the lymphatic system and an indication of capillary exchange. The lymphatic system serves three major purposes: fluid recovery, immunity and lipid absorption. Victims of kwashiorkor commonly exhibit reduced ability to recover fluids, immune system failure and low lipid absorption, all of which result from a state of severe undernourishment.
Fluid recovery in the lymphatic system is accomplished by re-absorption of water and proteins which are then returned to the blood. Compromised fluid recovery results in the characteristic belly swelling observed in highly malnourished children.
Kwashiorkor can be treated by eating more protein and more calories overall, especially if treatment is started early.
Patient should first be given more carbohydrates, sugars and fats. These help in providing energy, they should also be given foods with proteins. Foods must be introduced and be increased slowly because patients have been without proper nutrition for a long period hence the body may need to adjust to the increased intake. Long-term vitamins and mineral supplements can also be included in the diet.
The main symptoms include edema i.e. swelling of feet and ankles, wasting, liver enlargement, thinning hair, loss of teeth, skin and hair depigmentation and dermatitis. Children with kwashiorkor often develop irritability and anorexia. Generally, the disease can be treated by adding protein to the diet. However, it can have a long-term impact on a child’s physical and mental development and in severe cases may lead to death.
Sufficient intake of carbohydrates, but with insufficient protein consumption, distinguishes it from marasmus.
Kwashiorkor cases occur in areas of famine or poor food supply.
It is a form of severe malnutrition caused by an inadequate intake of protein and energy. A child with marasmus looks emaciated. Body weight is reduced to less than 60% of the normal (expected) body weight for the age.
Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein.
The main symptoms are severe wasting, leaving little or no edema, minimal subcutaneous fat, severe muscle wasting and non-normal serum albumin levels. Marasmus can result from a sustained diet of inadequate energy and protein, where the metabolism adapts to prolonged survival. It is traditionally seen in famine, significant food restriction, or more severe cases of anorexia.
It is necessary to treat not only the causes but also the complications of the disorder, including infections, dehydration, and circulation disorders, which are frequently lethal and lead to high mortality of children if ignored.
Ultimately, marasmus can progress to the point of no return when the body’s ability for protein synthesis is lost. At this point, attempts to correct the disorder by giving food or protein are futile. Vitamin D will help to alleviate this problem.
Both kwashiorkor and marasmus are life-threatening medical emergencies which need to be treated by sophisticated feeding programmes. Such programmes must be run by medical professionals with experience in re-feeding children with severe protein-energy malnutrition.