Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer reviewed journal
Publication Acceptance Date: 10/20/2006
Publication Date: 4/1/2007
Citation: Lin, C.A., Boslaugh, S., Ciliberto, H.M., Maleta, K., Ashorn, P., Briend, A., Manary, M.J. 2007. A prospective assessment of food and nutrient intake in a population of Malawian children at risk for kwashiorkor. Journal of Pediatric Gastroenterology and Nutrition. 44(4):487-493. Interpretive Summary: Kwashiorkor is a form of severe malnutrition of unknown etiology. It has been speculated that kwashiorkor is the result of protein deficiency or excessive oxidative stress. A prospective survey of rural Malawian children at high risk for the development of kwashiorkor was conducted. About 2,400 children participated. Their dietary intake was quantified with a food frequency questionnaire, and all children were followed for 10 weeks to determine if they developed kwashiorkor. Surprising the development of kwashiorkor was not associated with the intake or lack of intake of any food or nutrient, nor with common symptoms of infection (fever, cough and diarrhea). This questions the notion that kwashiorkor is the result of something in the diet.
Technical Abstract: Our objective was to determine what foods, nutrients, and dietary patterns are associated with development of kwashiorkor in populations of vulnerable 1- to 3-year-old Malawian children. This was a prospective observational study conducted in 8 rural villages. Upon enrollment, demographic, anthropometric, and dietary intake data were collected. Children were studied every 2 weeks for 10 weeks to determine whether they developed kwashiorkor. Dietary intake was assessed on enrollment using a food frequency questionnaire, which included all possible foods in the child's diet. Food frequency data were used to estimate energy, protein, vitamins C and A, niacin, thiamin, zinc, and iron intake using food composition and serving size data. Dietary diversity was assessed with a 7-point score. Regression modeling was used to determine whether the consumption of any food or nutrient was associated with the development of kwashiorkor. A total of 43 (2.6%) of the 1651 healthy children ages 1 to 3 years enrolled developed kwashiorkor. Children who developed kwashiorkor were younger and had more nutritional wasting than those who did not. Thirty children (70%) who developed kwashiorkor were breast-fed. In the combined regression model no foods or nutrients were found to be associated with the development of kwashiorkor. There were no differences in the dietary diversity between children who developed kwashiorkor and those who did not. No association between the development of kwashiorkor and the consumption of any food or nutrient was found.