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Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance.

Abstract

BACKGROUND

Kwashiorkor is the edematous form of protein-energy malnutrition. It is associated with extreme poverty in developing countries and with chronic malabsorptive conditions such as cystic fibrosis in developed countries. Rare cases of kwashiorkor in affluent countries unrelated to chronic illness have been reported. We present 12 cases of kwashiorkor unrelated to chronic illness seen over 9 years by pediatric dermatologists throughout the United States, and discuss common causative themes in this easily preventable condition.

OBSERVATIONS

Twelve children were diagnosed as having kwashiorkor in 7 tertiary referral centers throughout the United States. The diagnoses were based on the characteristic rash and the overall clinical presentation. The rash consisted of an erosive, crusting, desquamating dermatitis sometimes with classic "pasted-on" scale-the so-called flaky paint sign. Most cases were due to nutritional ignorance, perceived milk intolerance, or food faddism. Half of the cases were the result of a deliberate deviation to a protein-deficient diet because of a perceived intolerance of formula or milk. Financial and social stresses were a factor in only 2 cases, and in both cases social chaos was more of a factor than an absolute lack of financial resources. Misleading dietary histories and the presence of edema masking growth failure obscured the clinical picture in some cases.

CONCLUSIONS

Physicians should consider the diagnosis of kwashiorkor in children with perceived milk allergies resulting in frequent dietary manipulations, in children following fad or unorthodox diets, or in children living in homes with significant social chaos. The presence of edema and "flaky paint" dermatitis should prompt a careful dietary investigation.

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  • Authors+Show Affiliations

    ,

    Department of Dermatology, University of California, San Francisco 94143-0316, USA.

    , , , , , , , ,

    Source

    Archives of dermatology 137:5 2001 May pg 630-6

    MeSH

    Diet Fads
    Dietary Proteins
    Female
    Humans
    Infant
    Infant, Newborn
    Knowledge
    Kwashiorkor
    Male
    Milk Hypersensitivity
    Nutritional Physiological Phenomena

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    11346341

    Citation

    Liu, T, et al. "Kwashiorkor in the United States: Fad Diets, Perceived and True Milk Allergy, and Nutritional Ignorance." Archives of Dermatology, vol. 137, no. 5, 2001, pp. 630-6.
    Liu T, Howard RM, Mancini AJ, et al. Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol. 2001;137(5):630-6.
    Liu, T., Howard, R. M., Mancini, A. J., Weston, W. L., Paller, A. S., Drolet, B. A., ... Frieden, I. J. (2001). Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Archives of Dermatology, 137(5), pp. 630-6.
    Liu T, et al. Kwashiorkor in the United States: Fad Diets, Perceived and True Milk Allergy, and Nutritional Ignorance. Arch Dermatol. 2001;137(5):630-6. PubMed PMID: 11346341.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. AU - Liu,T, AU - Howard,R M, AU - Mancini,A J, AU - Weston,W L, AU - Paller,A S, AU - Drolet,B A, AU - Esterly,N B, AU - Levy,M L, AU - Schachner,L, AU - Frieden,I J, PY - 2001/5/18/pubmed PY - 2001/6/8/medline PY - 2001/5/18/entrez SP - 630 EP - 6 JF - Archives of dermatology JO - Arch Dermatol VL - 137 IS - 5 N2 - BACKGROUND: Kwashiorkor is the edematous form of protein-energy malnutrition. It is associated with extreme poverty in developing countries and with chronic malabsorptive conditions such as cystic fibrosis in developed countries. Rare cases of kwashiorkor in affluent countries unrelated to chronic illness have been reported. We present 12 cases of kwashiorkor unrelated to chronic illness seen over 9 years by pediatric dermatologists throughout the United States, and discuss common causative themes in this easily preventable condition. OBSERVATIONS: Twelve children were diagnosed as having kwashiorkor in 7 tertiary referral centers throughout the United States. The diagnoses were based on the characteristic rash and the overall clinical presentation. The rash consisted of an erosive, crusting, desquamating dermatitis sometimes with classic "pasted-on" scale-the so-called flaky paint sign. Most cases were due to nutritional ignorance, perceived milk intolerance, or food faddism. Half of the cases were the result of a deliberate deviation to a protein-deficient diet because of a perceived intolerance of formula or milk. Financial and social stresses were a factor in only 2 cases, and in both cases social chaos was more of a factor than an absolute lack of financial resources. Misleading dietary histories and the presence of edema masking growth failure obscured the clinical picture in some cases. CONCLUSIONS: Physicians should consider the diagnosis of kwashiorkor in children with perceived milk allergies resulting in frequent dietary manipulations, in children following fad or unorthodox diets, or in children living in homes with significant social chaos. The presence of edema and "flaky paint" dermatitis should prompt a careful dietary investigation. SN - 0003-987X UR - https://www.unboundmedicine.com/medline/citation/11346341/full_citation L2 - https://jamanetwork.com/journals/jamadermatology/fullarticle/vol/137/pg/630 DB - PRIME DP - Unbound Medicine ER -