Kwashiorkor: pathophysiological aspects and solutions

Kwashiorkor is a form of severe protein-energy malnutrition known since 1995. It is observed worldwide in regions with high levels of hunger and poverty, especially where the diet consists primarily of carbohydrate-rich foods. This pathology has been reported among hundreds of thousands of children in the world. The clinical presentation of kwashiorkor resembles the symptoms of essential amino acid deficiency, which suggests that not only protein malnutrition, but also disorders of the methionine cycle take part in the pathogenesis of the disease. The study of capillary ultrastructure has shown that edema is the result of increased permeability of microvessels to protein macromolecules, including albumin. Plasma proteins are usually retained in the intravascular space by the endothelial glycocalyx, damage to which leads to edema. Oxidative stress contributes to lower levels of vitamin E and glutathione. An imbalance between the levels of reactive oxygen species and antioxidants leads to mitochondrial damage, which reduces ATP production and impairs liver function. Mitochondrial dysfunction and ATP depletion together with nutrient deficiency may contribute to the development of multiple organ dysfunction syndrome. Three clinical parameters are used to assess the severity of kwashiorkor: mid-arm muscle circumference, body mass index, and the presence of localized symmetric edema. In the absence of timely treatment in the early stages, children may have serious complications, including shock, coma, physical and mental disorders. Normalization of physiological and metabolic functions in patients with kwashiorkor is a complex task. The three-step approach to treating children with severe protein-energy malnutrition recommended by the World Health Organization includes stabilization, rehabilitation, and recurrence prevention. The prognosis in the absence of treatment is unfavorable. Key words: protein-energy malnutrition, kwashiorkor, children