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Paper short abstract

Kwashiorkor’s etiology remains unknown after 90 years. The paper asks if diet is overstressed as a causative factor & analyzes the role of adverse childhood experiences. The mortality rates from kwashiorkor & life-long consequences for survivors say it’s time to reimagine causes.

Paper long abstract

After more than 90 years, the exact etiology of kwashiorkor is still unknown. Despite the first description of the condition in a specific social and environmental context in the Gold Coast (Ghana), subsequent research has largely focused on dietary and biochemical factors in rather narrow contexts. This paper raises the question of whether poor diet been overstressed as a causative factor in kwashiorkor. It looks at the reasons why some malnourished children, even in the same family, develop marasmus while others develop kwashiorkor, which has a much poorer prognosis. The mortality rate from kwashiorkor can exceed 40 per cent. Kwashiorkor likely arises from a constellation of genetic, biological, social and environmental factors; thus, deepening understanding calls for a broad syndemic approach. Here, based on a very wide-ranging review, plus empirical data from Zimbabwe, questions are posed about the relationship between adverse childhood experiences (ACEs) and the onset of kwashiorkor. Specifically, what is the role of the gut-brain axis in mediating the link between ACEs and gastrointestinal conditions? Are ACEs, such as stress or trauma, good predictors of the onset of kwashiorkor? Given the continuing high mortality rates associated with kwashiorkor and the life-long consequences for survivors, it is past time for attention to be redirected toward its causes.