Kwashiorkor in North America.

The controversy regarding the relative importance of protein vs energy deficiency in the genesis of kwashiorkor has not been resolved by studies of protein-energy malnutrition (PEM) in developing countries. Cases of edematous PEM (n = 29) in North America on the other hand provide clear indications that protein deficiency is an essential prerequisite for the development of kwashiorkor and marasmic kwashiorkor. Energy intakes may vary from low to high and the main source of energy may be carbohydrate or fat. These findings are in keeping with experimental evidence that a low ratio of protein to energy disrupts the usual hypometabolic response to dietary deficiency and leads to hypoalbuminemia and consequent edema. Protein supplements should be a part of programs aimed at preventing kwashiorkor.