• A dietary history of a monotonous single cereal-based diet with inclusion of animal-source foods less than once per week will raise suspicion of kwashiorkor. 
  • Diets based on corn, cassava, and rice are those most commonly associated with kwashiorkor.
  • In Kwashiorkor, the letter ‘K’ is post-fixed to denote edema
  • Cessation of breast-feeding in the few months before presentation is a common finding. 
  • There may be a history of preceding diarrhea or measles infection. 
  • Kwashiorkor edema starts in the feet and develops over a few days.
  • Alternative Names:Protein malnutrition; Protein-calorie malnutrition; Malignant malnutrition


  • Early signs of kwashiorkor present as general symptoms of malnutrition and include fatigue, irritability and lethargy. 
  • In malnourished subjects, secretory IgA is generally reduced. Therefore infections tend to be severe and recovery delayed. 

Flag sign is seen :

  • In Kwashiorkor hair is thin, dry, brittle, easily pluckable, sparse & devoid of their normal sheen.
  •  It becomes straight and hypopigmented. 
  • The colour of the hair that grows during the period of nutritional deprivation appears reddish brown. 
  • During the phase of better nutrition, the growing part of the hair gets appropriately pigmented. 
  • This gives appearance of alternate bands of hypopigmented & normally pigmented hair. This is called Flag sign.

As protein deprivation continues the following abnormalities become apparent.

  • Failure to thrive (failure to put on height and weight)
  • Loss of muscle mass
  • Pitting oedema- This is the main sign(due to low albumin level)
  •  Poor appetite
  • Large protuberant belly (pot belly)
  • Fatty liver
  • Failing immune system so prone to infections and increased severity of normally mild infections

Skin and hair changes:

  • Apathy, 
  • Flaky paint dermatosis
  • Retarded growth
  • Psychomotor changes

Tests may include:

  • Arterial Blood Gas
  • BUN(Blood Urea Nitrogen)
  • Complete Blood Count(CBC)
  • Creatinine Clearance
  • Serum Creatinine
  • Serum Potassium
  • Total Protein Levels
  • Urinalysis


  • Antibiotics to treat infections
  • Gradual increases in dietary calories from carbohydrates, sugars and fats
  • Gradual increases in dietary protein
  • Intravenous fluids to correct fluid and electrolyte imbalances
  • Lactase to assist in digestion of dairy products
  • Vitamin and mineral supplements to treat deficiencies


  • Anemia (low red blood cell count)
  • Coma
  • Frequent infections
  • Intellectual disability
  • Physical disability
  • Poor wound healing
  • Shock
  • Short stature
  • Skin pigmentation changes
  • Fatty liver


  • Kwashiorkor can be prevented by including foods in your diet that are rich in proteins, such as 
  • Meat, 
  • Fish, 
  • Dairy products, 
  • Eggs, 
  • Soya, and beans. 
  • Treatment involves slow increases in calories from carbohydrates, sugars, and fats, followed by protein. 
  • Vitamin and mineral supplements and enzymes to help digest dairy products are often needed
Exam Question
  • Flag sign is seen in kwashiorkor 
  • Kwashiorkor is characterised by Markedly retarded growth, psychomotor changes,Dermatitis,Edema,Flag sign
  • Apathy, Flaky paint dermatosis, Poor appetite & low albumin level is seen in Kwashiorkor 
  • In malnourished subjects, secretory IgA is generally reduced. 
  • In Kwashiorkor, the letter ‘K’ is post-fixed to denote Edema
Don’t Forget to Solve all the previous Year Question asked on Kwashiorkor

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