Kwashiorkor Edema

In addition to the wasting of muscle tissue, loss of intestinal mucosa, and impaired immune responses seen in marasmus, children with kwashiorkor show a number of characteristic feamres. The defining characteristic is edema, associated with a decreased concentration of plasma proteins. In addition, there is enlargement of... 

The absence of edema or reduction in albumin distinguishes marasmus from kwashiorkor. 

Marasmus Marasmus occurs when calorie deprivation is rela tively greater than the reduction in protein. Marasmus usually occurs in children younger than one year of age when the mother s breast milk is supplemented with thin watery gruels of native cereals, which are usually deficient in protein and calories. Typical symptoms include arrested growth, extreme muscle wast ing (emaciation), weakness, and anemia. Victims of marasmus do not show the edema or changes in plasma proteins observed in kwashiorkor. 

Kwashiorkor usually occurs in the second or third year in the life of a child. Edema is the principal symptom. The condition arises from a combination of circumstances, but the primary cause appears to be a weaning diet that is both inadequate and indigestible and, notably, is lacking of protein. The principal calories are supplied by carbohydrate. The condition is accelerated by repeated infections of a bacterial, parasitic, or vital nature. Without treatment, the disease is fatal in most cases. 

Free radicals through lipid peroxidation can cause membrane damage, induce electrolyte imbalance and edema. Indeed, children with kwashiorkor display low levels of polyunsaturated fatty acids (e.g., linoleic acid) in the erythrocyte membrane compared to the marasmic children, presumably due to increased lipid peroxidation (Leichsenring et al., 1995). Interestingly, cysteinyl leukotrienes, which can cause edema by altering capillary permeability, are also enhanced in those with kwashiorkor but not marasmic children (Mayatepek et al., 1993). 

If a child is fed a diet that is poor in proteins but rich in carbohydrate and antioxidants, would the edema associated with kwashiorkor be prevented ... 

Symptoms of kwashiorkor are apathy, muscular wasting, and edema. Both the hair and the skin lose their pigmentation. The skin becomes scaly and there is diarrhea and anemia, and permanent blindness can result from this condition. Marasmus is another condition of a wasting away of the body tissues from the lack of calories as well as protein in the diet. In marasmus the child is fretful rather than apathetic and is skinny rather than swollen with edema. Aside from contrasting symptoms between the two diseases, there may be converging symptoms which would be described as marasmic kwashiorkor. 

Severe protein-energy malnutrition often occurs after weaning, the transition frcim nursing to the consumption of foods from other sources (i.e.. Solid foods). The marasmus common in Latin America is caused by early weaning, followed by use of overdiluted commercial milk formulas. Kwashiorkor occurs in Africa, where babies arc fed starchy roots, such as cassava, that arc low in protein. It also occurs in the Caribbean, where babies are fed sugar cane. The major symptom of kwashiorkor is edema, mainly of the feet and legs. Edema is the condition produced when water normally held in the bloodstream by osmotic pressure leaks into (jther extracellular spaces. It can result from reduced osmotic pressure in the bloodstream caused by catabolism and depletion of serum albumin. 

Marasmus results from deficiency of protein and energy intake, as in starvation, and results in generalized wasting (atrophy of muscles and subcutaneous tissues, emaciation, loss of adipose tissue) Edema occurs in kwashiorkor but not in marasmus however, the distinction between these disorders is not always clear. The treatment of marasmus requires supplementation of protein and energy intake. 

Kwashiorkor develops when there is adequate calorie but a relatively inadequate protein intake. These patients generally are well nourished but are extremely catabolic, usually secondary to trauma, infection, or burns. There is depletion of visceral (and to some degree somatic) protein pools with relative adipose tissue preservation, and hypoalbuminemia and edema are commonly seen. In the setting of severe metabolic stress and protein deprivation, kwashiorkor may develop rapidly and may result in impaired immune function. 

ALB was one of the first identified biochemical markers of malnutrition and has long been used in population studies. ALB is a relatively insensitive index of early protein malnutrition because there is a large amount normally found in the body (4 to 5 g/kg of body weight), it is highly distributed in the extravascular compartment (60%), and it has a long half-life (18 to 20 days). However, chronic protein deficiency in the setting of adequate nonprotein calorie intake leads to marked hypoalbuminemia because of a net ALB loss from the intravascular and extravascular compartments (kwashiorkor). Serum ALB concentrations also are affected by moderate-to-severe calorie deficiency hepatic, renal, and GI disease and infection, tramna, stress, and burns. In many cases, interpretation of serum ALB concentrations relative to nutrition status is difficult however, a positive correlation between decreased serum ALB concentrations and poor clinical outcome has been demonstrated in a variety of settings. Additionally, serum ALB concentrations of 2.5 g/dL or less can be expected to exacerbate ascites and peripheral, pulmonary, and GI mucosal edema due to decreased colloid oncotic pressure. 

The term kwashiorkor refers to a disease originally seen in African children suffering from a protein deficiency. It is characterized by marked hypoalbuminemia, anemia, edema, pot belly, loss of hair, and other signs of tissue injury. The term marasmus is used for prolonged protein-calorie malnutrition, particularly in young children. 

Kwashiorkor, a common problem of children in Third World countries, is caused by a deficiency of protein in a diet that is adequate in calories. Children with kwashiorkor suffer from muscle wasting and a decreased concentration of plasma proteins, particularly albumin. The result is an increase in interstitial fluid that causes edema and a distended abdomen that make the children appear "plump" (see Chapter 44). The muscle wasting is caused by the lack of essential amino acids in the diet existing proteins must be broken down to produce these amino acids for new protein synthesis. 

In cases of severe protein malnutrition (kwashiorkor), the concentration of the plasma proteins decreases, as a result of which the osmotic pressure of the blood decreases. As a result, fluid is not drawn back to the blood and instead accumulates in the interstitial space (edema). The distended bellies of famine victims are the result of fluid accumulation in the extravascular tissues because of the severely decreased concentration of plasma proteins, particularly albumin. Albumin synthesis decreases fairly early under conditions of protein malnutrition. 

A negative nitrogen balance represents a state of protein deficiency, in which the body is breaking down tissues faster than they are being replaced. The ingestion of insufhcient amounts of protein, or food with poor protein quality, cau result in serious medical conditions in which an individual s overall health is compromised. The immune system is severely affected the amount of blood plasma decreases, leading to medical conditions such as anemia or edema aud the body becomes vulnerable to infectious diseases and other serious conditions. Protein malnutrition in infants is called kwashiorkor, and it poses a major health problem in developing countries, such as Africa, Central and South America, and certain parts of Asia. An infant with kwashiorkor suffers from poor muscle and tissue development, loss of appetite, mottled skin, patchy hair, diarrhea, edema, and, eventually, death (similar symptoms are preseut in adults with protein deficiency). Treatment or prevention of this condition lies in adequate consumption of protein-rich foods [106]. 

Kwashiorkor is a word coined by the natives of the Gold Coast, and it means red boy. Kwashiorkor develops in the weaned child as a result of dietary protein deficiency, and it is characterized by digestive disturbance, edema, dermatosis, and hepatomegaly. Kwashiorkor must have been known for a long time, but it was not described in detail until 1933. Soon after the original description of kwashiorkor, reports came from various parts of Africa, Asia, and South America which proved that kwashiorkor is found in many countries where the diet is inadequate. The syn-... 

The total body water content increases in patients with severe protein malnutrition. The increase involves both the extracellular fluid, in which the water content may rise up to 400 ml/kg compared to 250 ml/kg in normal individuals, and in the intracellular fluid, in which the water content may reach values above 80%, compared to the normal 67% values in normally fed individuals. Fluid accumulation in the extracellular tissues leads to edema. The severity of the edema may be masked somewhat by the loss of body solids and fats. However, in the later stages of the disease, edema becomes obvious. The edema fluid is not distributed uniformly throughout the body of the victim—swelling usually starts in the inferior limbs, probably as a result of gravity and deficient circulation. The back of the hand and the face are frequently swollen. A patient with kwashiorkor— particularly an older patient— may have edema in the lower part of the body and be dehydrated in the upper part. In younger children, this does not occur because the upright position is not maintained constantly and does not play such an important role in the accumulation of fluid in the inferior limbs. The pathogenesis of the edema in protein deficiency is discussed in the section on body fluids. 

Kwashiorkor results from a severe protein deficiency, and is characterized by changes in pigmentation of the skin and hair, edema, skin lesions, anemia, and apathy. Kwashiorkor differs from marasmus in terms of the greater role of protein... 

Kwashiorkor Syndrome produced by a severe protein deficiency and an inadequate consumption of carbohydrates that mainly occurs in weaned and preschool children. Kwashiorkor is characterized by changes in skin and hair pigmentation, a bulging belly, edema, and apathy. 

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