"When compared to marasmus in developing countries, kwashiorkor has a lower prevalence, "0.2%-1.6% for kwashiorkor and 1.2%-6.8% for marasmus." Factors such as "diet, geographical locations, climate and aflatoxin exposure" are associated with the difference in prevalence for kwashiorkor and marasmus. History
It is likely that kwashiorkor was commonly seen around the world long before 1933, when Cicely Williams published research which took the Ga name for the disease. There were already many names for the illness which referenced the cessation of breastfeeding, or the consumption of diets which were too high in starch. However, Williams was the first to suggest that this might be a deficiency of protein. Despite publishing in 1933, it was only in 1949 that the World Health Organization officially recognized kwashiorkor as a public health concern. This period also correlated with the promotion of infant formula, often by European colonial powers. The substitution of breastmilk for formula contributed significantly to the increasing visibility of kwashiorkor throughout the twentieth century. Cicely Williams later described the promotion of formula as "the most criminal form of sedition, and that those deaths should be regarded as murder." These arguments underpinned the 1970s Nestlé boycott. Effects on pharmacokinetics
Those experiencing poverty-related infectious diseases (PRDs) such as malaria and tuberculosis are also likely to be malnourished. Malnutrition can affect the pharmacokinetics of various drugs used to treat PRDs by changing a drugs bioavailability, distribution, and elimination. To optimize treatment of those diseases, there needs to be more research into how severe malnutrition, specifically kwashiorkor, can affect treatment response.
Low glutathione levels
Kwashiorkor is also marked by low glutathione levels. Glutathione is used in many of the body processes on a molecule level.It is believed to be related to high oxidant levels commonly seen in people who suffer from starvation and rarely in chronic inflammation. Glutathione serves vital functions including management of oxidative stress which is an imbalance that plays a key role in the pathogenesis of many diseases. Cysteine is an essential amino acid that acts as the limiting amino acid for glutathione synthesis in humans. Factors that stimulate cysteine uptake by cells will increase glutathione levels and prevent glutathione deficiency in humans under various conditions including protein malnutrition.Evidence indicates that dietary amino acids balance has an important effect on protein nutrition and therefore on glutathione homeostasis. Others
A proposed experimental theory suggests that alterations in the microbiome/virone contributes to edematous malnutrition, but further studies are required to understand the mechanism. Diagnosis
Kwashiorkor, or edematous malnutrition, like many other malnutrition diseases, is indirectly assessed using anthropometry. Kwashiorkor is a subtype of severe acute malnutrition (SAM) characterized by bilateral peripheral pitting edema. According to the World Health Organization, the SAM diagnosis parameters are a "mid-upper arm circumference (MUAC) of < 115 mm, weight-for-height/length Z-score (WHZ) of < -3Z and nutritional edema or any combination of these parameters." Additional clinical findings on physical exam include marked muscle atrophy, abdominal distension, dermatitis, and hepatomegaly.WHO criteria for clinical assessment of malnutrition are based on the degree of wasting (MUAC), stunting (weight-for-height Z-score), and the presence of edema (mild to severe).