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How does kwashiorkor develop in children whose diets provide too little protein?

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USDA MyPlate dietary guidelines — human nutrition MyPlate, a revised set of dietary guidelines introduced by the U.S. Department of Agriculture (USDA) in 2011, divides the four basic food groups (fruits, grains, protein, and vegetables) into sections on a plate, the size of each section representing the relative dietary proportions of each food group. The small blue circle shown at the upper right illustrates the inclusion and recommended proportion of dairy products in the diet.

Kwashiorkor is a form of protein-energy malnutrition that develops primarily when a child is weaned from high-protein breast milk onto a diet consisting of starchy, low-protein foods, such as cereal grains, cassava, or plantain.12

Unlike marasmus, where both calories and protein are severely lacking, children with kwashiorkor typically consume a moderate number of calories from carbohydrates but receive insufficient protein to meet the body's physiological needs. When dietary protein is inadequate, the body may metabolize its own protein stores to meet energy requirements, leading to systemic physiological breakdown.231

This deficiency manifests in several ways:
* Edema: Fluid retention often causes a characteristic swollen belly, which can mask actual weight loss.12
* Liver Dysfunction: The condition is frequently associated with fatty infiltration of the liver.12
* Physical Symptoms: Affected children may exhibit anemia, dry or peeling skin, and reddish-orange hair discoloration.12
* Immune Suppression: Weakness and increased susceptibility to infectious diseases are common, often leading to fatal complications like diarrhea.12