Kwashiorkor is characterised by all of the following features except –
Kwashiorkor and marasmus are manifestations of protein-energy malnutrition (PEM).
Marasmus represents the compensated phase of PEM.
Kwashiorkor represents the uncompensated phase of PEM.

Kwashiorkor

It is characterized by following three essential features -

1) Edema

Edema starts in lower extremities and later involves upper limbs and the face.
Face appears moon shaped and puffy.
	a Edema is caused by -
Hypoalbuminemia → Major factor
Increased capillary permeability due to infection.
Free radical injury to the cell membrane.

2) Markedly retarded growth

Muscles of the upper limb are wasted, but the lower extremities appear swollen due to oedema. a Muscle wasting is masked by oedema.

3) Psychomotor (mental) changes

The child is lethargic, listless and apathetic (in contrast to marasmus, where the child is alert and irritable).
Appetite is impaired (in contrast to marasmus, where children show voracious appetite).

Other features of kwashiorkor
1) Hepatomegaly

Due to fatty infiltration

2) Hair changes in Kwashiorkor


Hair is thin, dry and brittle, easily pluckable
Straight and hypopigmented
Flag sign (Alternate bands of Hypo and hyperpigmented hair corresponding to the period of under and proper nutrition).

3) Skin changes in Kwashiorkor

Large areas of skin show erythema followed by hyperpigmentation
Flaky paint dermatitis → Hyperpigmentation patches desquamate to expose raw hypopigmented areas. It gives the appearance of paint flaking off the surface of the wood.

4) Infections

These children suffer from recurrent episodes of diarrhoea, respiratory and skin infections.
Edema.
Patchy depigmentation of hair
Fatty liver
Fatty infiltration of  pancreas