In at-risk populations, kwashiorkor may develop after children are weaned from breast milk and begin consuming a diet high in carbohydrates, including maize, cassava or rice. Classification
Children with severe malnutrition have an increased risk of serious illness and death. Kwashiorkor is one of the main forms of childhood malnutrition living in low-income and middle-income countries. Kwashiorkor is oftentimes referred to as severe acute malnutrition (SAM). Severe forms of malnutritions are recognized, including stunting, marasmus, and kwashiorkor. Both kwashiorkor and marasmus fall under the umbrella of deficiencies called protein–energy malnutrition (PEM). These diseases are oftentimes discussed together, but can be distinguished. Kwashiorkor is classified by its insufficient protein consumption whereas marasmus is related to general energy deficiency and severe muscle wasting. Kwashiorkor is also distinguished from marasmus by the presence of edema. There is also marasmic kwashiorkor that is the deficiency in calories and in protein. Although they are both different types of severe acute malnutrition, there was greater consumption of antioxidants, vitamins, and minerals seen in those with kwashiorkor compared to those with marasmus. Wellcomes classification
Wellcome classification is a system for classifying protein-energy malnutrition in children based on weight for their age and based on presence of edema. Other classifications include Gomez classification and Waterlow classification. Signs and symptoms
The defining sign of kwashiorkor in a malnourished child is pitting edema (particularly swelling of the hands and feet).
A case was described where parents who fed their child cassava failed to recognize malnutrition because of the edema caused by the syndrome and believed the child was well-nourished despite the lack of dietary protein.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. This means in individuals suffering from kwashiorkor, protein must be introduced back into the diet gradually. Clinical solutions include weaning the affected with milk products and increasing the intake of proteinaceous material progressively to daily recommended amounts. Aflatoxins
Recent studies have attempted to pinpoint a relationship between kwashiorkor and high levels of aflatoxins. Aflatoxins are naturally occurring toxins produced by the mold Aspergillus flavus, a fungus found in areas with hot and humid climates. These toxins tend to grow and can be found in agricultural crops such as millet, maize, and rice. An analysis found that the presence of aflatoxins was found more frequently and in higher concentrations in individuals with kwashiorkor when compared to individuals with marasmus (another form of severe acute malnutrition). In particular, biological samples showed greater levels of aflatoxins in the brain, heart, kidney, liver, lungs, serum, stool, and urine. Aflatoxins were not found in liver samples of individuals with marasmus.