Kwashiorkor and its dietary management


The term kwashiorkor was introduced in 1933 by Cicely Williams who was a Jamaican physician. She found out that this disease appeared in infants and young children between the ages of 1 to 4 years. Kwashiorkor is mainly caused by the intake of a diet that is low in protein but contain more carbohydrate food. It is associated with a deficiency of calories and a combination of other factors like infection and those that are cultural and psychologically related. It is common in young children who are weaned to a diet consisting chiefly of cereal grains, cassava, plantain and sweet potatoes or similar starchy foods.

Kwashiorkor, also called protein energy malnutrition (PEM) is also a condition caused by severe protein deficiencies. It is most often encountered in developing countries like Asia and Africa where there is famine and poverty.

Kwashiorkor is often associated with deficiencies of one or more other nutrients and of calories. When the calorie intake is inadequate and the level of dietary protein is barely adequate, protein malnutrition may still develop; for some of the protein is metabolized to supply the body’s energy needs.

The term kwashiorkor also means “deposed child” (deposed from the mother’s breast by a new born baby) in one African dialect and in another dialect “Red Boy”. The later term comes from the reddish orange discolouration of the hair that is characteristic of the disease.

Kwashiorkor stunts growth and make children to have bloated belly and thin arms and legs.

What is kwashiorkor?

Kwashiorkor which is also called Protein Energy Malnutrition (P.E.M) is a disease caused by the lack of protein in a child’s diet.

This arises due to both dietary energy and protein. Since energy is mainly supplied by carbohydrate and fat, we can say that protein energy malnutrition is the deficiency of protein, carbohydrate and fats in the diet.

Kwashiorkor is the most important nutritional disorder affecting children throughout the developing countries. Infants and children growing up in typical or subtropical areas such as Africa, South America and Asia where there is much poverty are at a high risk of kwashiorkor.

Protein Energy Malnutrition (P.E.M.) can also be called Protein Calorie Malnutrition (P.C.M.). Inadequate intake of calories or when there is lack of calorie in a child’s diet, it can also lead to kwashiorkor.

According to Sear (2000), the name “kwashiorkor” is a Ghanaian language and it is divided into two “Kwashi” which is a name given to a male child born on Sunday while “orkor” is a light red colour presumably reflecting the changes in the skin and hair found in children who are victims.

Wardlaw (2003) put it as a disease that first children get when a new one comes. In a nutshell, it is the most severe and fatal characteristic from malnutrition. It starts often after weaning period when complementary diet is introduced to a child’s feeding system. It is usually between 9 months and 2 yrs of age.

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Protein energy malnutrition according to Wardlaw is also a condition resulting from regularly consuming insufficient amount of energy and protein giving food. The deficiency eventually results in the body wasting primarily of lean tissues and increased susceptible to infection.

According to Robin (2011) who was a paediatrician says that protein energy malnutrition is an improper development of the body when you do not consume enough protein and calorie in your diet to meet the adequate proportion the body needs.

According to Merck (2007), protein energy malnutrition can be sudden or total elimination of food (saturation). Severity ranges from sub-clinical deficiency to wasting of body tissues.

Lainkien (2002) also contributed by saying that protein energy malnutrition is present mostly in the pre-school children particularly between the ages of six (6) months to five (5) years. However, the origin of the condition goes back to early life, low birth weight and some inadequate growth in the first six (6) months of birth particularly when the mother tries to introduce feeding bottle containing baby food.

Protein energy malnutrition is a combination of two classes of food deficiency which are kwashiorkor and marasmus. This conditions has become a very serious problem in the communities but parents of the children who suffer from this problem do not take it as a life threatening condition, as they feel that this condition is a result of other causes like spiritual case and also they sees it as a normal problem that occur in children. So they feel that the child will grow later in life.

Kwashiorkor or protein energy malnutrition can therefore be referred to as inadequate availability or absorption of energy and protein in the body. Since the major dietary requirement of the body is protein and energy or calorie, it is the major form of malnutrition.

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Causes of kwashiorkor

  1. Family background: According to Sear (2000), traditional customs based on the stable. Extended family cannot meet the demand of life in an informal semi-urban settlement with the needs for both parents to work or the loss of the father due to migration, labour, HIV, war and social unrest. The belief of rural dwellers on condition towards protein giving foods such as meat, fish, milk and eggs affect children.
  2. Limited food supply: Where is lack of food
  3. Malnutrition: when there is lack of nutrient in the body.
  4. Ignorance of parents
  5. Poor infant feeding pattern
  6. Low level of education (when people do not understand how to eat a proper diet.)
  7. Seasonal food shortages
  8. Poor intestinal absorption
  9. Kidney disease and infections
  10. Lack of protein rich foods, both animals and vegetables such as meats, eggs. Fish, beans and nuts.
  11. Burns or other trauma resulting in the abnormal loss of body protein.

Signs and symptoms of kwashiorkor

  1. Children with kwashiorkor have oedema (excess water retention in the body tissues) which makes them look puffy and bloated.
  2. They look weak and in many cases their skin flakes.
  3. Their hair loses its curliness and colour
  4. Diarrhoea occurs: There will be frequent stooling and there may even be blood tool.
  5. Most patients affected with kwashiorkor show some degree of anaemia, due to lack of enough protein to synthesis red blood cells.
  6. Apathy is a characteristic feature and the child appears constantly unhappy.
  7. Increased and more severe infections due to damaged immune system
  8. Large belly that sticks out (protrudes).
  9. Irritability
  10. Loss of muscle mass
  11. Rash (dermatitis)
  12. Shock (late stage)
  13. Kwashiorkor stunts growth and make children to have bloated belly and thin arms and legs.

Effects of kwashiorkor

Getting treatment early generally leads to a good result. Treating kwashiorkor in its late stages will improve the child’s general health status. However, the child may be left with permanent physical and mental problems. If treatment is not given or comes too late can cause enlargement of the liver, loss of fluids (dehydration) from the bloodstream even when the child has oedema, stunted growth and severe infection due to weakened immune system. It can also result in jaundice, drowsiness, coma, shock and lowered body temperature.

Dietary management of kwashiorkor

  1. Increase calories: Because kwashiorkor is a form of malnutrition, the first step in treating people with the condition is to increase their calorie intake. However, because the body has been deprived of proper nutrition for so long, it is important to introduce food slowly. This patient first needs to eat foods rich in carbohydrates, fats and simple sugars. Providing these foods will give the body an immediate source of energy.
  2. Increase proteins: After carbohydrate and sugars have been introduced, people with kwashiorkor should be given protein rich foods. These foods are harder to digest, so they should be introduced slowly. Good source of protein includes milk and dairy products, eggs, beans, nuts, red meat, poultry and fish.
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 Note: However, people with kwashiorkor especially children may not be able to properly digest lactose found in milk and dairy products. If this happens, patient will need to be given supplements containing the enzymes that break down lactose.

  1. Increase vitamins and minerals: Once food has been re-introduced, patient with kwashiorkor will need vitamins and mineral supplements to make up for the deficiencies they developed from being malnourished. This should be done with the guidance and expertise of a doctor or a nutritionist who can identify the deficiencies and prescribe doses to make up for those losses. Preferably, persons can also be given cooked and drained cowpea with salt, cheese of all types namely; cottage cheese, non-creamed cheese and non-fat cheese, see food, tofu, soya sauce, raw pumpkin leaves, etc.


Kwashiorkor is a serious condition but most people who are treated early can make a full recovery. Children who develop the protein deficiencies may not ever grow to their full height and weight potential, additionally, children who develop the condition may have permanent mental and physical disabilities as a result.


Edukugho, E. (2004). Malnutrition on a Silent. Rampage in Schools. Vanguard Newspaper, Nigeria.

Gale Encyclopaedia of Medicine (2008). Protein Energy Malnutrition. Protein Energy Malnutrition.

Heird, W.C. (2007). Food Insecurity, Hunger and Undernutrition. Textbook of Paediatrics. 18th Edition. Philadelphia, Pa: Saunders Elsevier.

Jacquelyn, C. (2012). Medically Reviewed by George Krucik, MD: Clemson Book House.

Klien, S. (2007). Protein Energy Malnutrition. 23rd Edition. London: Goldman Limited

Lankinen, E. (2002) Health and Disease on Developing Countries. Malaysia: Macmillan Educational.

Tamber, L.W. (1997). Yale Guide to Children Nutrition. New Haven: Yale University Press.

Ward, L. M. (2003). Contemporary Nutrition (5th Edition). New York: Mc Grawhill Companies.

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