Kwashiorkor (marasmático): what is it? Check the symptoms

Growth is a biological process, of cellular increase and multiplication, which can be perceived through bodily changes.

However, some people are unable to reach the ideal size due to genetic potential, living conditions and other intrinsic (genetic and metabolic) or extrinsic (food, health, hygiene and general care) factors.

That’s where Kwashiorkor is. Of complicated name, this condition can present other difficulties besides the pronunciation.

Pathology can be understood as malnutrition caused by protein deficiency in the body.

To learn more about this condition, check out the article below!

What is Kwashiorkor?

Currently, according to the Ministry of Health, there are about 800 million chronic malnourished people worldwide. Of these, about 70 million are severely malnourished children, most around 18 to 36 months of age.

Kwashiorkor is a condition characterized by severe malnutrition with the presence of edema (accumulation of fluids) predominantly protein. That is, caused by insufficient protein, however, usually with normal calorie intake.

This can occur mainly due to early weaning or a diet characterized by low or no consumption of vegetables and carotenoids (substances that color vegetables).

In addition, some biochemical abnormalities, such as fat in the liver, can influence the development of the disease.

Treatment is essentially based on changes in eating habits. In addition, it is possible to seek alternative therapies for oral rehydration, which we will explain better in the treatment topic.

This condition can be found in the ICD-10 using the following code:

  • E42 –  Kwashiorkor marasmático.

What is the difference between marasmus and kwashiorkor?

Child malnutrition must be diagnosed through laboratory tests and clinical evaluation. In general terms, kwashiorkor is a protein deficiency, while marasmus is an energy deficiency.

However, there are some specific characteristics that differentiate the doldrums from kwashiorkor, one of which is the difference in growth of children with the condition.

That is, children with marasmus tend to grow less than 50% of what is expected for their age, when children with kwashiorkor show growth of up to 80% of what is expected.

This is because the body is not receiving the ideal amount of carbohydrates and fats, causing it to resort to proteins.

As a consequence, it is possible to notice a decrease in body weight, in addition to a decrease in muscles, being classified as general malnutrition.

What is marasmatic kwashiorkor?

It can be considered a combination of both conditions, being classified as protein-calorie malnutrition. One way to diagnose the condition is through the presence of edema (bumps on the body, such as ankles and wrists).

In general, it is possible for the patient to have symptoms characteristic of both conditions.


Kwashiorkor is a complex condition, with many controversies related to its development.

It is believed that it is a nutritional dysfunction due to insufficient protein intake and predominance of carbohydrates, which are food groups are essential for the growth and regulation of vital processes.

Another possible explanation regarding the causes of kwashiorkor is related to the deficiency of nutrients, such as iron, folic acid and vitamin C, which are responsible for the body’s antioxidant protection.

Read more: Food in childhood: what to know

Children with kwashiorkor have reduced amounts of these substances, making the body more susceptible to free radical damage.

Most children with kwashiorkor had early weaning, in addition to a diet characterized by low or no consumption of foods with minerals and vitamins .

Risk factors

As a condition considered as malnutrition, kwashiorkor can be triggered or aggravated by some specific conditions that we will mention below:

Low maternal education

This factor is related to the low amount of information and knowledge related to both prevention and maintenance of sexual health (at the time of pregnancy) and child health (breastfeeding time, for example).

In general, low education is also associated with poor diet, indicating an unbalanced consumption of nutrients and high intake of processed foods.

Low weight at birth

The child’s weight at birth can be used as a comparison to classify pregnancy as healthy or deficient.

In this way, children born weighing less than 2500g can be classified as “low birth weight” and are at greater risk of suffering from malnutrition.

Early weaning

Breastfeeding is considered the best food to offer for children up to 6 months of age. When this breastfeeding is stopped before the time considered ideal, the child may suffer developmental impairments.


Despite being rich in calories, alcohol is a substance that lacks other nutrients that enrich the body. Thus, people who face alcoholism are more likely to develop kwashiorkor.

Low income and family structure

People who live in countries with less socioeconomic structure are more likely to develop kwashiorkor. This is because the difficulties in accessing foods rich in vitamins and minerals end up being greater.

Read more: Lack of hygiene and sanitation affect 1 in 4 health centers


Kwashiorkor can be understood as a protein deficiency, which causes swelling, skin diseases or changes in hair color. In addition, you may notice the following symptoms:

Distended abdomen

This characteristic can be understood as an enlargement of the liver, due to the lack of apolipoproteins, responsible for distributing the fat from the liver to other parts of the body.

In addition, there is another explanation called the water belly, which occurs due to the increased permeability of blood vessels. This means that other substances in the blood are able to pass through the walls of the vessels and thus accumulate in the tissues.

Dry and inflamed skin

These symptoms can be understood as peeling skin, reddish in color, and can be classified as generalized skin dermatitis .

The explanation is related to the alteration of nutrients due to malnutrition, in which lipids, proteins, hydro and fat-soluble vitamins are compromised, in addition to calcium and iron.


This condition can be understood as the accumulation of fluids in the body, which in the case of kwashiorkor mainly affects the ankles and feet.

Liver fat

It is possible to notice a deficiency in the organ’s balance mechanisms, causing an accumulation of fats present in the liver.

Lack of amino acids

There is a reduction in the concentration of plasma proteins produced by the liver, among which we can mention albumin, which ends up changing the amount of amino acids present in the body.

We can consider this as one of the main causes of edema present in the body.

Other symptoms

  • Apathy;
  • Weakness;
  • Inability to gain weight.

How is the diagnosis made?

The evaluation can be done by a general practitioner , nutrologist or nutritionist , however, it must be detailed, looking for other signs besides malnutrition.

For this, the responsible physician can request food history, which consists of registering the dietary routines in a descriptive manner, in addition to records of the patient’s weight and measurements.

In addition, there is a set of classifications and indices, called anthropometry, which assists in the assessment of child development . For this, make the comparison between:

  • Weight and age;
  • Height and age;
  • Weight and height.

Kwashiorkor is associated with other biochemical abnormalities in the body, which can also aid in the diagnosis of the condition.


The main way to examine and diagnose people with kwashiorkor is through anthropometry, which is understood as a combination of classifications and indices that point to the child’s health or malnutrition, along with physical observation.

For this, the responsible physician must weigh, measure and evaluate the child’s physical aspects in relation to the numbers considered ideal for the corresponding age group.

Is there a cure?

Yes. Once discovered early, Kwashiorkor can be cured. For this, the main treatment is linked to the introduction of a protein-rich diet.

What is the treatment?

Essentially, the treatment of kwashiorkor occurs through changes in eating habits, introducing proteins and carotenoids. Make necessary calorie intake in order to allow the body to rehabilitate.

In addition, in some cases, the physician in charge may find it necessary to introduce vitamin and mineral supplements.

Depending on the case, it may also be necessary to carry out a treatment to combat possible bacterial infections resulting from kwashiorkor.

In general, the treatment takes around 2 to 6 weeks to be carried out completely. When done early, it has a good chance of recovery.

Treatment may go through periods, which are:

Stability phase

The stability phase can be characterized as a period in which there are no changes in symptoms or worsening of health status.

It comprises the first week, that is, from the 1st to the 7th day and aims to control metabolic and feeding abnormalities.

Rehabilitation phase

It is the process of introducing new foods, aiming to increase weight and height. It includes from the 2nd to the 6th week of treatment, where the intensification of food and weight recovery occurs.

In addition, this phase is important, as it is where the process of emotional and physical stimulation to return to daily activities begins.

Follow-up phase

In this period it is possible to notice a growth similar to that of children who do not have the condition. However, it is necessary to continue monitoring for possible preventions, guiding families on the consequences of malnutrition.


According to the World Health Organization (WHO), children with little or no infection can use Sulfamethoxazole + Trimethoprim , every 12 hours, for 7 days.

Children with more apparent signs of infection, on the other hand, can administer the following medication Gentamicin Sulfate , once a day, for 7 days.


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

The ideal for those who are experiencing kwashiorkor is to always stay hydrated, drinking plenty of water during the day. In addition, it is essential to seek foods rich in vitamins, minerals and proteins in order to improve weight and consequently the body as a whole.


The prognosis for kwashiorkor is complex. This is because, many people show a significant improvement, however, about 40% die due to electrolyte imbalance, infections, hypothermia or as a result of cardiac arrest.

Read more: Child abuse can cause depression in adulthood


Children with mild to moderate malnutrition may have some other conditions due to kwashiorkor. Among the possible diseases that can develop are:

Acute infectious diseases

Due to the lack of nutrients, the body has a weakened immune system, facilitating the entry of bacteria, viruses and other possible infections.


Iron is one of the possible scarce substances when kwashiorkor develops. When it is not at adequate levels, a lack of iron can cause anemia .

Intestinal parasites

These conditions are known to be present in rural or more precarious areas. Also known as “worms”, these conditions have several subtypes, the transmission of which depends a lot on the sanitary conditions and local hygiene.

Read more: Brain and intestine: their health in childhood reflects on adulthood

How to prevent kwashiorkor?

Kwashiorkor is considered a socioeconomic condition, since it affects predominantly poor countries, mainly due to poor health and hygiene conditions.

Therefore, some attitudes can make a difference in the appearance and development of this condition, for example:


Maintaining a balanced and adequate feeding routine for each age group is essential for the full development of the organism.

In addition, it is extremely important to maintain breastfeeding until the child is 2 years old. This is because breast milk is considered the healthiest food for developing children, as it is rich in proteins, fats, vitamins, minerals and water.

Environmental and food hygiene

Some of the main gastrointestinal conditions are caused by the lack of care in preparing food, as well as the place where meals take place. Therefore, some ways to prevent possible conditions are:

  • Be careful when choosing suppliers;
  • Separate damaged leaves, stems and vegetables;
  • Take all items under running water;
  • Keep food refrigerated;
  • Do not refreeze defrosted meats;
  • Keep the kitchen and pantry always clean.

Integration with the community

Kwashiorkor can be diagnosed more frequently in underdeveloped countries, however, it can be better controlled when everyone is aware and collaborating to combat it. With this in mind, the ideal would be to promote healthy habits in the community, in addition to monitoring pregnant women, introducing nutritional education.

Common questions

What is the ideal amount of protein daily?

It is recommended that you allocate about 10% of your daily calories to protein. The ideal calculation is that 0.75g per body weight is consumed, that is, on average 55g daily for men and 45g daily for women.

When is hospitalization necessary?

When the child or adult shows clinical signs of edema and / or malnutrition, it is necessary to redouble the care. In addition, it is necessary to take into account the weight deviation in relation to what is taxed as ideal for each age group.

Is Kwashiorkor malnutrition?

-Yeah . Kwashiorkor is a protein malnutrition condition, that is, when the body receives less protein than recommended for daily intake.

Growth is a necessary biological process for the development of children. However, some people still live in conditions of poor hygiene and health care.

That is why it is so important to always look for information related to possible conditions developed in these circumstances, such as kwashiorkor.

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