Kwashiorkor: A Prospective Ten-Year Follow-up Study

Abstract

The physical status of 123 cases of kwashiorkor, followed up longitudinally for 10 years, was analysed. Their status was compared with that of 97 control siblings who had never suffered from kwashiorkor, but who had grown up under the same environmental conditions as the expatients. It was found that 10 years after the episode of kwashiorkor about half of the children had reached international growth standards in weight and height, thus demonstrating the capacity for complete physical recovery. No significant anthropometric or biochemical differences were found between ex-patients and control siblings at the 10-year follow-up examination. This is adequate proof that the episode of kwashiorkor per se cannot be held responsible for the growth retardation that occurred in some of the children. The children who were most severely retarded in weight and height on admission tended to remain the most severely retarded in growth after 10 years. The children who were the oldest on admission were more retarded in weight after 10 years than the children who were admitted at a younger age. Although these facts may imply that the severity and possibly the duration of the malnutrition episode adversely affected subsequent physical growth, a high current incidence of hypoalbuminaemia was found in both ex-patients and control siblings, indicating continuing malnutrition, the effects of which cannot be separated from possible deleterious effects of thil original malnutrition episode. Linear growth also correlated significantly with midparental height and a complex of adverse social circumstances.
Failure to attain international growth standards in some of the children was therefore apparently due to a combination of factors and at present it is impossible to distinguish any single one of these as being more important than the others. Since about half of the children did reach adequate growth standards despite their poor living conditions, it is clearly worth while to treat every case of malnutrition. At the same time public health supervision and preventative social measures should be greatly increased to protect the child population throughout the growing period.

S. Afr. Med. J., 45, 1427 (1971)