Conditions · Metabolism (biochemistry)
Kwashiorkor !
A form of severe childhood malnutrition with swelling (oedema), fatty liver and skin and hair changes.
Updated 2026-11-01
Structures involved
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In biochemistry
- Energy requirements and basal metabolic rate (BMR)
- Nitrogen balance
- Fed, fasting and starvation states
In the clinical exam
In physiology
Why it happens
- Severe acute malnutrition: marasmus and kwashiorkor
- Edema and effusions: the four mechanisms
- Fatty change (steatosis)
- What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow
- Causes of cell injury
What it is
Severe acute malnutrition with bilateral pitting oedema, typical of young children after weaning, in settings of poverty and infection.
Who gets it
It is more common in low-income countries and in drought, conflict or disaster; WHO estimates that nearly half of deaths in children under 5 are linked to undernutrition. In Colombia acute childhood malnutrition mainly affects scattered rural and indigenous communities (a qualitative statement, no figure cited here).
Causes
- A diet poor in protein and micronutrients, often starch-based
- Repeated infections (diarrhoea, measles, parasites)
- Oxidative stress and lack of antioxidants
- Abrupt weaning when a sibling arrives
Risk factors
- Poverty and food insecurity
- Age 1 to 4 years
- Chronic diarrhoea and infections
- HIV infection
- Neglect or abandonment
Pathophysiology
Lack of protein and micronutrients, together with infections, reduces liver synthesis of albumin and apolipoprotein B. With little apolipoprotein B the liver cannot export triglycerides in VLDL and fills with fat (hepatomegaly). Low albumin contributes to oedema, along with membrane damage from oxidative stress (low glutathione) and potassium and sodium disturbances. Gut atrophy reduces absorption, cellular immunity fails and the proteins that carry vitamin A and iron are short. Subcutaneous fat is partly kept, so oedema can hide the weight loss.
Symptoms and signs
- Bilateral pitting oedema starting in the feet and legs that can reach the face
- Distended abdomen and large liver
- Patchy peeling dermatosis ('flaky paint')
- Thin, brittle, depigmented hair
- Apathy, irritability and loss of appetite
- Frequent infections and diarrhoea
Diagnosis
- Clinical
- Bilateral pitting oedema defines severe acute malnutrition whatever the weight; weight-for-height, mid-upper arm circumference and examination of skin, hair and liver complete it.
- Tests
- Low glucose, albumin and total protein, electrolytes (potassium, sodium, magnesium, phosphate), blood count, infection screening (including HIV, tuberculosis and malaria in endemic areas) and stool examination.
- Imaging
- Abdominal ultrasound for fatty liver; chest X-ray if pneumonia or tuberculosis is suspected.
Treatment
- Acute
- Stabilisation: treat hypoglycaemia, hypothermia and dehydration with rehydration solutions made for malnourished children
- Medical
- Routine antibiotics and treatment of infections
- Medical
- Careful refeeding with therapeutic formulas (first starter, then catch-up) and micronutrient correction, without iron at first
- Follow-up
- Monitoring for refeeding syndrome (phosphate, potassium, magnesium) and growth follow-up
Complications
- Hypoglycaemia and hypothermia
- Sepsis
- Refeeding syndrome and heart failure
- Delayed growth and development
- Death
Prognosis
With early treatment most recover; mortality is high with severe infection or late treatment.
Prevention
- Breastfeeding and adequate complementary feeding
- Food security and safe water
- Vaccination and infection control
- Child growth monitoring
Test yourself
Think of the answer, then tap the question to see it.
Which sign defines severe acute malnutrition even when weight is normal?
Bilateral pitting oedema.
Why does fatty liver form in kwashiorkor?
Because apolipoprotein B is short and the liver cannot export triglycerides in VLDL.
Why is iron not given at the start of treatment?
Because free iron favours oxidative stress and infection until the carrier proteins have recovered.
What is the risk of refeeding too fast?
Refeeding syndrome, with low phosphate, potassium and magnesium and heart failure.
Related conditions
- Marasmus
- Zinc deficiency (acrodermatitis enteropathica)
- Vitamin A deficiency (night blindness and xerophthalmia)
- Iron deficiency anaemia
- Acute (viral) gastroenteritis
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Kwashiorkor: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Fact sheets - Malnutrition (World Health Organization, 2026); Malnutrition: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026).
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