MEDFORD, Massachusetts – Pictures of poverty-stricken neighborhoods and residents depict a common catalog of gruesome imagery: the exposed rib cage, the shoddy living quarters and the torn, hand-me-down clothing. These are what one expects to see in impoverished communities, but images often depict more than this.
One such display is the bloated stomach. To many it is perplexing, intuitively gross and difficult to explain. How is it possible, after all, that poor kids get such big bellies? Shouldn’t their abdomen shrink with their diets?
The answer is no, not necessarily. When children have this type of inflated stomach it is called kwashiorkor, a form of malnutrition caused by severe protein deficiency. It is brought about by sufficient calorie intake without an adequate amount of protein in one’s diet.
Kwashiorkor occurs most often in areas of rife, abject poverty, rarely occurring in the developed world, but when it does, it is usually the product of child abuse. The predominance of malnutrition in countries like Namibia, Mali and Ethiopia is triggered by the lack of food in undeveloped regions, implying a hypersensitive vulnerability to famine, as well as the lack of education; healthy diets are limited by both a lack of resources and a lack of understanding of what constitutes them.
Cicely Williams, a pediatrician and one of the first female graduates of Oxford University, first used the name “kwashiorkor” to describe scientifically the form of malnutrition causing bloated stomachs. She took the term from the Ga language of coastal Ghana. In Ga it means, roughly, “the sickness the baby gets when the new baby comes.”
This describes the maternal triage that must happen when older but needy children are weened off of breast milk early to grant newborn babies breast feeding priority. Breast milk contains proteins and amino acids essential for early development, and carbohydrates such as starches are inadequate replacements. Diets that exclusively consist of cereal grains, cassava, plantain and sweet potatoes don’t provide the vital range of nutrients.
Besides the striking distended stomach, there are many other characteristics of kwashiorkor. The most serious features are edema (a buildup of fluid in tissues causing body parts to swell, usually the ankles and the feet), irritability, anorexia, ulcerating dermatoses (itchy, reddened and swollen skin followed by the formation of ulcers) and a liver enlarged with fatty infiltrates.
Fatty infiltrates survive in the liver thanks to a process called steatosis. Vacuoles of fat accumulate in liver cells causing an abnormal retention of lipids. Hair loss, teeth loss, skin depigmentation and dermatitis, the inflammation of the skin, are also common elements of kwashiorkor.
To treat a general case of malnourishment, it is sometimes enough to simply reintroduce protein into one’s diet. Adding food slowly is best, since too much food too quickly can cause additional health problems.
The effects of kwashiorkor can be irreversible in chronic cases, however, as long-term physical or mental development is frequently delayed or harmed by stunted protein intake. Those who have had kwashiorkor, for example, will never reach their full potential for height.
Scientists and nutritionists agree that fat, at a bare minimum, should make up at least 10 percent of one’s total diet. Protein, alternatively, should make up at least 12 percent. If kwashiorkor is not treated, if the normal percentages are not reached and maintained or if treatment comes too late, it is a life-threatening condition.
Images of poor, grimy villages complete with their impoverished villagers are pitiful and difficult to view. Understanding what those pictures are made of might just facilitate advocacy.
– Adam Kaminski