Editing Kwashiorkor (section)

== Diagnosis ==
Kwashiorkor, or edematous malnutrition, like many other malnutrition diseases, is indirectly assessed using [[anthropometry]].<ref name="Bhutta Berkley Bandsma 2017">{{cite journal |last1=Bhutta |first1=Zulfiqar A. |last2=Berkley |first2=James A. |last3=Bandsma |first3=Robert H. J. |last4=Kerac |first4=Marko |last5=Trehan |first5=Indi |last6=Briend |first6=André |title=Severe childhood malnutrition |journal=Nature Reviews Disease Primers |date=21 December 2017 |volume=3 |issue=1 |pages=17067 |doi=10.1038/nrdp.2017.67 |pmid=28933421 |pmc=7004825 }}</ref> Kwashiorkor is a subtype of severe acute malnutrition (SAM) characterized by bilateral peripheral pitting edema. According to the World Health Organization, the SAM diagnosis parameters are a "mid-upper arm circumference (MUAC) of < 115 mm, weight-for-height/length Z-score (WHZ) of < -3Z and nutritional edema or any combination of these parameters."<ref>{{cite book |last1=Roberfroid |first1=Dominique |last2=Hammami |first2=Naïma |last3=Mehta |first3=Pankti |last4=Lachat |first4=Carl |last5=Verstraeten |first5=Roosmarijn |last6=Weise Prinzo |first6=Zita |last7=Huybregts |first7=Lieven |last8=Kolsteren |first8=Patrick |title=Management of oedematous malnutrition in infants and children aged >6 months: a systematic review of the evidence |date=2013 |hdl=1854/LU-5700347 |hdl-access=free |citeseerx=10.1.1.655.6549 }}</ref><ref name="Benjamin & Lappin Kwashiorkor"/><ref>{{cite journal |last1=Grellety |first1=Emmanuel |last2=Golden |first2=Michael H. |title=Severely malnourished children with a low weight-for-height have similar mortality to those with a low mid-upper-arm-circumference: II. Systematic literature review and meta-analysis |journal=Nutrition Journal |date=December 2018 |volume=17 |issue=1 |pages=80 |doi=10.1186/s12937-018-0383-5 |pmid=30217196 |pmc=6138903 |doi-access=free }}</ref> Additional clinical findings on physical exam include marked muscle atrophy, abdominal distension, dermatitis, and hepatomegaly.<ref name="Benjamin & Lappin Kwashiorkor"/><ref>{{cite journal |last1=Heilskov |first1=S. |last2=Rytter |first2=M.J.H. |last3=Vestergaard |first3=C. |last4=Briend |first4=A. |last5=Babirekere |first5=E. |last6=Deleuran |first6=M.S. |title=Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature |journal=Journal of the European Academy of Dermatology and Venereology |date=August 2014 |volume=28 |issue=8 |pages=995–1001 |doi=10.1111/jdv.12452 |pmid=24661336 |s2cid=24731334 }}</ref>

WHO criteria for clinical assessment of malnutrition are based on the degree of wasting (MUAC), stunting (weight-for-height Z-score), and the presence of edema (mild to severe).<ref name="WHO 10665/95584">{{cite book |title=Guideline: updates on the management of severe acute malnutrition in infants and children |date=2013 |publisher=World Health Organization |isbn=978-92-4-150632-8 |hdl=10665/95584 |hdl-access=free }}{{pn|date=February 2022}}</ref>

In addition to anthropometric measures, laboratory tests can be critical for diagnosing kwashiorkor.<ref>{{Cite journal |last1=Bunker |first1=Sarah |last2=Pandey |first2=Jyotsna |date=2021-01-01 |title=Educational Case: Understanding Kwashiorkor and Marasmus: Disease Mechanisms and Pathologic Consequences |journal=Academic Pathology |language=English |volume=8 |doi=10.1177/23742895211037027 |issn=2374-2895 |pmc=8392804 |pmid=34458565}}</ref> Low serum albumin levels ([[hypoalbuminemia]]) are a hallmark of protein deficiency, and elevated [[Liver function tests|liver enzymes]] may indicate liver dysfunction.<ref>{{Cite journal |last1=Bunker |first1=Sarah |last2=Pandey |first2=Jyotsna |date=2021-01-01 |title=Educational Case: Understanding Kwashiorkor and Marasmus: Disease Mechanisms and Pathologic Consequences |journal=Academic Pathology |language=English |volume=8 |doi=10.1177/23742895211037027 |issn=2374-2895 |pmc=8392804 |pmid=34458565}}</ref> [[Electrolyte]] imbalances and blood tests may also be used to assess the degree of organ involvement and complications.<ref>{{Cite journal |last1=Bunker |first1=Sarah |last2=Pandey |first2=Jyotsna |date=2021-01-01 |title=Educational Case: Understanding Kwashiorkor and Marasmus: Disease Mechanisms and Pathologic Consequences |journal=Academic Pathology |language=English |volume=8 |doi=10.1177/23742895211037027 |issn=2374-2895 |pmc=8392804 |pmid=34458565}}</ref>

Specifically in children, severe malnutrition, such as kwashiorkor, can lead to notable changes in brain function and behavior.<ref>{{Cite journal |last1=Bhutta |first1=Zulfiqar A. |last2=Berkley |first2=James A. |last3=Bandsma |first3=Robert H. J. |last4=Kerac |first4=Marko |last5=Trehan |first5=Indi |last6=Briend |first6=André |date=2017-09-21 |title=Severe childhood malnutrition |journal=Nature Reviews Disease Primers |language=en |volume=3 |issue=1 |page=17067 |doi=10.1038/nrdp.2017.67 |issn=2056-676X |pmc=7004825 |pmid=28933421}}</ref> Children with kwashiorkor tend to be irritable and may develop [[cerebral atrophy]], whereas those with severe wasting frequently show [[apathy]], reduced movement, and speech delays.<ref name="Bhutta Berkley Bandsma 2017" /> These neurological and behavioral changes are key factors in the clinical assessment of malnutrition.<ref name="Bhutta Berkley Bandsma 2017" />