> Kwashiorkor (AKA protein-energy malnutrition)

Kwashiorkor and protein-energy malnutrition are two very different things.

Kwashiorkor is protein deficiency in the presence of abundant calories.  You
ordinarily find kwashiokor only in places where the staple food has no
protein, such as plantains, or manioc, and there are no/few other sources of
protein.  Breastfed babies seldom/never get kwashiorkor as breast milk has
plenty of protein in it.  In fact, kwashiorkor is the Ga word (language of
one of the ethnic groups of Ghana) for "child at the knee" -- meaning the
just-weaned child, as opposed to the "in lap" child, the younger sibling who
has replaced the older child at the breast.  As long as the child was
breastfeeding, even if the solids were protein-free, it did not develop
kwashiorkor.  You ordinarily see kwashiorkor in children 2-3 years of age,
therefore.  It can quickly kill a child.  Symptoms include marked edema
(fluid retention and swelling) of the hands, feet, abdomen, and face, skin
flakiness and peeling, reddish tinge to the hair (in dark-haired
populations), hair that falls out, and marked behavioral changes such as
loss of all physical activity and severe apathy.  Children who were walking
stop walking.  Children who were talking stop talking.  Children who were
happy become very sad and quiet.  The swelling comes and goes.  In Mali, the
Bambara term for this disease is "funu-bana", which means "swelling
sickness."  I have seen it in children as old as 12 who are getting plenty
of calories (from manioc, bananas, avocados, etc.) but no protein.

Protein-energy malnutrition is a deficiency of BOTH protein and
energy/calories at the same time.  It is also known as "marasmus."  Children
with marasmus look skinny and wizened, with all their ribs showing, and
little stick legs and arms.  These children don't have enough calories, nor
enough protein.  Children can live for *years* with marasmus, in contrast to
kwashiorkor, which kills quickly.

Kathy D.
mailto:[log in to unmask]