Two pathways to kwashiorkor?

Comparisons, based on anthropometric and biochemical measurements, have been made between Gambian and Ugandan children with kwashiorkor, and Gambian children with marasmus. Cases of kwashiorkor and marasmus in The Gambia were very similar both anthropometrically and in their plasma hormone and amino-acid patterns, but quite different in these respects from kwashiorkor in Uganda. Additional data from a prospective longitudinal study recently completed in The Gambia indicated that, when it occurred, hypoalbuminaemia appeared acutely, in contrast to the gradual development observed in Uganda. These findings suggest that kwashiorkor in The Gambia and in Uganda have distinct aetiologies and possible reasons for the difference in pathophysiologies are discussed. In particular the association of hypoalbuminaemia with diarrhoeal disease in The Gambia indicates that plasma protein loss from the gastro-intestinal tract could be a factor precipitating kwashiorkor in children who would otherwise be regarded as cases of marasmus.