CDS (II) 2022 General Knowledge · Question 20 of 120

Correct — D, Proteins. Kwashiorkor is severe protein malnutrition — a clinical description puts it as 'a disease marked by severe protein malnutrition and bilateral extremity swelling'. It appears in young children whose diet supplies enough bulk and calories but too little protein, typically after weaning onto a starchy staple such as maize, cassava or rice. The characteristic sign is oedema, swelling that starts in the feet and legs and works upward, and it is what distinguishes kwashiorkor from marasmus, the wasting form of severe malnutrition in which calories as well as protein are short and there is no swelling. Other features are a swollen abdomen from an enlarged fatty liver, a rounded face, thin peeling skin with patches of scaling and pigment change, muscle wasting, stunted growth and apathy.

• (a)Minerals — Mineral deficiencies produce their own specific conditions — iron gives anaemia, iodine gives goitre, calcium and phosphorus weaken bone. None of them produces the oedema and liver enlargement that define kwashiorkor.
• (b)Vitamins — Vitamin deficiencies are also disease-specific: vitamin C gives scurvy, vitamin D rickets, vitamin A night blindness and xerophthalmia, thiamine beriberi. A child with kwashiorkor may have several of these as well, but they are not its cause.
• (c)Fats — The tempting choice, because the child looks puffy and the liver is fatty. That fat is a consequence, not a deficit — the liver accumulates it because there is too little protein to package and export it.

Protein energy malnutrition covers a spectrum with two named extremes. Kwashiorkor sits at the protein-deficient end: energy intake is roughly adequate, protein is not, and the child swells. Marasmus sits at the other: everything is short, the child wastes to skin and bone, and there is no oedema. Cases with features of both are called marasmic kwashiorkor. The word kwashiorkor comes from a Ghanaian language and describes the sickness of the older child displaced from the breast by a new baby, which is exactly the situation that produces it.

The four options are the four classes of nutrient, so the question reduces to remembering which class kwashiorkor belongs to. The swelling is the hook — it comes from a shortage of plasma proteins, chiefly albumin, which normally hold fluid inside the blood vessels; with too little of them fluid leaks into the tissues. Keep kwashiorkor and marasmus paired in memory as swelling against wasting and the pair answers several questions at once. A caution for a modern answer: the older textbook account of kwashiorkor as purely a protein-deficiency disease has been questioned, because feeding protein alone does not reliably cure it and children on similar diets do not all develop it. Protein deficiency remains the answer any examination expects and the one this key gives.

• Kwashiorkor is caused by severe protein deficiency and is marked by bilateral pitting oedema.
• Marasmus is the wasting form of severe malnutrition, with a deficit of calories as well as protein and without oedema.
• Other signs of kwashiorkor include an enlarged fatty liver, a rounded face, peeling and discoloured skin, muscle wasting and apathy.
• It typically follows weaning onto a starchy staple such as maize, cassava or rice.
• Both conditions fall under the heading of protein energy malnutrition.

• Choosing fats because of the swollen appearance and the fatty liver, both of which are effects.
• Confusing kwashiorkor with marasmus; oedema is present in the first and absent in the second.
• Assuming a child with kwashiorkor is simply underfed — calorie intake may be close to adequate.

As a deficiency-to-disease question, as a kwashiorkor against marasmus comparison, or inside a broader item on nutrition programmes.

• practice — not a real PYQ

  Which one of the following distinguishes kwashiorkor from marasmus?

  • (a)Stunted growth
  • (b)Bilateral oedema
  • (c)Muscle wasting
  • (d)Occurrence in children

  Answer(b) Bilateral oedema — swelling is present in kwashiorkor and absent in marasmus; the other three features are shared.

• practice — not a real PYQ

  A diet that supplies enough calories but too little protein to a young child is most likely to cause

  • (a)Marasmus
  • (b)Kwashiorkor
  • (c)Scurvy
  • (d)Beriberi

  Answer(b) Kwashiorkor — marasmus follows a shortage of calories as well as protein, while scurvy and beriberi are vitamin deficiencies.