Kwashiorkor Pathogenesis

Golden MHN, Ramdath D Free radicals in the pathogenesis of Kwashiorkor. Proc Nutr Soc 46 53-68,1987. 

Roediger, W.E.W. New views on the pathogenesis of kwashiorkor methionine and other amino acids. J. Pediatr. Gastroenterol. Nutr. 1995 21 130-136... 

Among the various forms of malnutrition that continue to afflict the human race, protein deficiency is one of the most common. Typical of protein deficiency is kwashiorkor. Although the condition is frequently seen, its pathogenesis remains poorly understood and requires appropriate knowledge of the fate of dietary proteins. 

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. 

The intricacies of the biochemical changes that take place in kwashiorkor are not known, and the pathogenesis can only be hypothesized. The proposed steps in the pathogenesis of kwashiorkor are summarized in Fig. 4-4. 

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