Liver Distension in Kwashiorkor, characterizing by excessive fat accumulation
In low-resource settings, a severe form of protein-energy malnutrition known as Kwashiorkor poses a significant health concern, particularly for children. This condition, characterised by oedema, irritability, enlarged fatty liver, skin changes, and hair discolouration, is primarily caused by a deficiency in protein intake [1][3].
One of the key features of Kwashiorkor is the presence of a fatty liver, or hepatic steatosis. This condition arises due to the accumulation of fat, especially triglycerides, within hepatocytes [2]. Children with Kwashiorkor and fatty liver typically exhibit low serum triglycerides and cholesterol, markedly reduced β-lipoprotein levels, and variable increases in plasma free fatty acids before treatment [1].
The mechanisms behind this fatty liver are complex. Protein deficiency in children with Kwashiorkor impairs the liver's ability to synthesize essential proteins like apolipoproteins, which are crucial for exporting fat from the liver. This leads to the accumulation of fat because fats cannot be properly transported out of the liver cells [1][3].
Other contributing factors include oxidative stress and altered metabolism due to deficiencies in specific amino acids (e.g., methionine and cysteine) that affect liver function and lipid processing [3]. The combination of reduced protein synthesis, oxidative stress, and metabolic disruption causes the characteristic fatty liver seen in Kwashiorkor.
Improvement in fatty liver in Kwashiorkor depends on nutritional recovery, and there is no specific pharmacological therapy for this condition [1]. Caloric support should be increased slowly to avoid refeeding syndrome, and protein repletion is essential for reversing hepatic steatosis [1][3].
It's important to note that fatty liver in Kwashiorkor differs from non-alcoholic fatty liver disease (NAFLD) or alcoholic liver disease, as it is primarily due to protein deficiency and impaired lipoprotein synthesis.
Delayed treatment can lead to liver failure, infections, and increased mortality. Correction of vitamin and mineral deficiencies is also crucial in nutritional rehabilitation. Kwashiorkor primarily affects children in regions with food insecurity, especially in Sub-Saharan Africa, parts of Asia, and Latin America.
Diagnosis of Kwashiorkor is based on clinical findings, supported by laboratory tests and imaging, such as physical examination, serum biochemistry, imaging, and liver biopsy. Histology reveals macrovesicular steatosis (fat droplets in hepatocytes) in the liver of children with Kwashiorkor and fatty liver.
In conclusion, understanding the mechanisms of fatty liver in Kwashiorkor is crucial for effective management and nutritional rehabilitation. This condition, while preventable with adequate nutrition, remains a significant health concern in regions where food insecurity is prevalent.
References:
[1] Whiting, D. A., & Brown, K. H. (2014). Kwashiorkor. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
[2] Kassebaum, N. J., & Tappy, L. (2012). Fatty liver disease. In Fitzgerald, J. D. (Ed.), Gastrointestinal and Liver Disease (pp. 397–414). Philadelphia, PA: Elsevier.
[3] James, W. P., DeVries, G. B., Berdanier, C. D., Bistrian, B. R., Bode, C. R., Brady, W. J., ... & Woo, P. K. (2017). Obesity and Nutrition (6th ed.). Philadelphia, PA: Elsevier.
- Despite being preventable with adequate nutrition, Kwashiorkor, a severe form of protein-energy malnutrition, remains a significant health concern in regions where food insecurity is prevalent.
- Children affected by Kwashiorkor often exhibit a fatty liver, which is characterized by the accumulation of fat within hepatocytes, due to a deficiency in protein intake and impaired lipoprotein synthesis.
- Correction of vitamin and mineral deficiencies is essential during the nutritional rehabilitation process for children with Kwashiorkor.
- Diagnosis of Kwashiorkor is typically based on clinical findings, supported by laboratory tests and imaging, revealing macrovesicular steatosis in the liver of affected children.
- The combination of reduced protein synthesis, oxidative stress, and metabolic disruption causes the characteristic fatty liver seen in Kwashiorkor.
- Improvement in fatty liver in Kwashiorkor depends on caloric support increase and protein repletion, and there's no specific pharmacological therapy for this condition.
- Other health concerns, such as chronic kidney disease, chronic diseases, respiratory conditions, skin conditions, like psoriasis, and fitness and exercise, are part of the broader health and wellness discussion, but Kwashiorkor stands as a critical issue in low-resource settings due to its impact on children's health.
