Talk:Kwashiorkor

message: I will not edit medical pages, but think quick quick review on http://nutritionfacts.org/video/the-great-protein-fiasco/ contains a lot of references to research debunking that protein deficiency is the cause of Kwashiorkor.  Please change.  — Preceding unsigned comment added by 2001:980:93A5:1:4D3B:55D3:2103:7F5D (talk) 12:30, 27 June 2016 (UTC)
replies: text: The underlying cause is a lack of protein, more particularly amino acids needed for growth. You (and these authors) are confusing this with the precise physiological mechanism that causes the oedema. If the latter is viewed as the main problem to be treated (and thus the definition of kwashiorkor), then yes, the causes remain "obscure". 2A01:CB0C:CD:D800:B418:5FD3:6F8B:F7F7 (talk) 17:04, 17 November 2022 (UTC)
thread_title: Not a protein-deficiency at all

message: I will second this. Most research now points to complex interaction between microbiome, infection and malnutrition. The association with weaning is likely not linked to the lack of protein, just the lack of calories in general. If/when I have more time will find some sources and edit.
Also the image is NOT a child with kwashiorkor. The child is predominantly marasmic with maybe a touch of edema (combined picture).
Ibrmrn (talk) 14:07, 26 October 2016 (UTC)
thread_title:  second 

message: Very much agree that this the picture is not a good example of kwashiorkor.
There is also a large body of evidence building that, while kwashiorkor may not be due to a deficiency of protein per se, it may be due to a deficiency in particular amino acids.  Sulfur amino acids are one of the most promising culprits currently being investigated.
Roediger WEW, Waterlow JP. New Views on the Pathogenesis of Kwashiorkor: Methionine and Other Amino Acids. Journal of Pediatric Gastroenterology & Nutrition. 1995;21(2):130-6.
Phadke MA, Khedkar VA, Pashankar D, Kate SL, Mokashi GD, Gambhir PS, Bhate SM. Serum Amino Acids and Genesis of Protein Energy Malnutrition. Indian Pediatrics. 1995;32:301-6.
Jahoor F. Effects of decreased availability of sulfur amino acids in severe childhood undernutrition. Nutrition Reviews. 2012;70(3):176-87.
Jahoor F, Badaloo A, Reid M, Forrester T. Protein kinetic differences between children with edematous and nonedematous severe childhood undernutrition in the fed and postabsorptive states. The American Journal of Clinical Nutrition. 2005;82(4):792-800.
Jahoor F, Badaloo A, Reid M, Forrester T. Sulfur amino acid metabolism in children with severe childhood undernutrition: cysteine kinetics. The American Journal of Clinical Nutrition. 2006;84(6):1393-9.
Badaloo A, Hsu JW, Taylor-Bryan C, Green C, Reid M, Forrester T, Jahoor F. Dietary cysteine is used more efficiently by children with severe acute malnutrition with edema compared with those without edema. The American Journal of Clinical Nutrition. 2012;95(1):84-90.
Badaloo A, Reid M, Forrester T, Heird WC, Jahoor F. Cysteine supplementation improves the erythrocyte glutathione synthesis rate in children with severe edematous malnutrition. The American Journal of Clinical Nutrition. 2002;76(3):646-52.  — Preceding unsigned comment added by 130.64.25.58 (talk) 17:11, 4 May 2017 (UTC)
thread_title: third

message: Here are links to some of the references that discuss the cause of kwashiorkor:  "The cause of kwashiorkor remains obscure," (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667500/), "there is no real evidence of dietary protein deficiency," (Kwashiorcor revisited: https://academic.oup.com/trstmh/article-abstract/78/4/436/1893691?redirectedFrom=PDF), and "The mechanisms responsible for oedema formation in kwashiorkor remain obscure," (https://adc.bmj.com/content/76/1/54).
I would appreciate if someone qualified in the field would edit the article to remove its inaccuracies regarding the cause of kwashiorkor.  — Preceding unsigned comment added by Thomaswayneriddle (talk • contribs) 15:27, 12 April 2019 (UTC)
replies: text: The underlying cause is a lack of protein, more particularly amino acids needed for growth. You (and these authors) are confusing this with the precise physiological mechanism that causes the oedema. If the latter is viewed as the main problem to be treated (and thus the definition of kwashiorkor), then yes, the causes remain "obscure". 2A01:CB0C:CD:D800:B418:5FD3:6F8B:F7F7 (talk) 17:04, 17 November 2022 (UTC)
thread_title: fourth

message: Do you have any pictures of people with kwashiorkor? 
Nazism isn't cool 05:41, 2 September 2005 (UTC)
thread_title: Do

message: A professor gave me a math problem concerning the hypoosmotic effects of reduced serum albumin (which has colligative properties, as any other molecule would) due to reduced protein intake/production.  This would lead to an overall decrease in oncotic pressure in the capillaries, in turn increasing the osmotic flux through the capillary wall, resulting in edema. —The preceding unsigned comment was added by Raleightodd (talk • contribs) 01:43, 28 February 2007 (UTC)
thread_title:  another mechanism for Kwashiorkor 

message: I removed the following paragraph:
The swollen abdomen is generally attributed to two causes: First, the appearance of ascites due to increased capillary permeability from the increased production of cysteinyl leukotrienes (LTC4 and LTE4) as a result of generalized intracellular deficiency of glutathione. Tolga is thought to be attributed to the effect of malnutrition on reducing plasma proteins (discussed below), resulting in a reduced oncotic pressure and therefore increased osmotic flux through the capillary wall. A second cause may be due to a grossly enlarged liver due to fatty liver. This fatty change occurs because of the lack of apolipoproteins which transport lipids(cholesterol) from the liver to tissues throughout the body.
The first assertion, that children w/ kwashiorkor have ascites is incorrect;  they abdominal distention is NOT caused by ascites.  Since the rest of the paragraph is unsourced, I removed it;  if you can find a reliable source, please reintroduce this information. This article needs some serious work.
--Wawot1 (talk) 15:43, 5 April 2009 (UTC)
replies: text: Ascites is the correct medical term. It describes what is going on inside the abdomen (physiologically and anatomically) whereas edema is the term for the presentation (the swollen belly that is apparent). It is a shame you removed a good para simply because you don't understand medical terminology. 2A01:CB0C:CD:D800:B418:5FD3:6F8B:F7F7 (talk) 16:58, 17 November 2022 (UTC)
thread_title:  Pathophysiology 

message: Management of acute moderate and severe childhood malnutrition.  http://www.bmj.com/cgi/content/full/337/nov13_1/a2180?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=kwashiorkor&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT#REF2
--Wawot1 (talk) 15:43, 5 April 2009 (UTC)
thread_title:  A useful source 

message: I am going to edit the sections about the reason for Kwashiorkor being "micronutrients" and antioxidants. There is no mention of that in the literature. Only Zink deficiency (Acrodermatitis enteropathica) shows a similar picture but is a diagnosis on it's own. 
I am also deleting the part about aflatoxin because alfatoxin is not the cause for Kwashiorkor as written in the article. Higher alfatoxin levels are the consequence of impaired liver function due to Kwashiorkor. (Sources: peer reviewed journals:
Pediatrics. 1991 Aug;88(2):376-9. Kwashiorkor: the hypothesis that incriminates aflatoxins., Hendrickse RG.
Aflatoxin Exposure and its Relationship to Kwashiorkor in African Children K. C. Househam and H. K. L. Hundt, J Trop Pediatr (1991) 37 (6): 300-302. doi: 10.1093/tropej/37.6.300
Ann Trop Paediatr. 1992;12(3):241-7, Aflatoxins and kwashiorkor in Durban, South Africa. Ramjee G, Berjak P, Adhikari M, Dutton MF.)
I will expand the section about sign and symptoms  — Preceding unsigned comment added by Jadram2011 (talk • contribs) 18:45, 26 July 2012 (UTC)
replies: text: Young children do not take many calories from protein, that is correct. They do need protein to grow, however. The lack of protein leads to low muscle mass and arrested growth, which in turn cause the abnormal disposition of energy reserved in the liver (which would otherwise be expended on growth) and subsequent impairments (which among other things leads to elevated aflatoxins). You are correct in stating that in treatment of kwashiorkor, a reversal of the liver morbidities (including micronutrients, compensating for impaired liver function) is a priority. Moreover, a very high protein content would only be counterproductive as the system is not capable of accommodating this and only makes the child sicker. Nevertheless, the underlying cause remains protein shortage (that is, lack of biochemical available nitrogen) and a steadily increasing amino acid content in the diet is essential to full recovery. 2A01:CB0C:CD:D800:B418:5FD3:6F8B:F7F7 (talk) 16:49, 17 November 2022 (UTC)
thread_title:  Micronutrients 

message: 112.205.39.127 posted this comment on 11 July 2012 (view all feedback).
This article can be improved by adding more explanation on symptoms and other signs of kwashiorkor.
Also add pictures of people with kwashiorkor in front view.
There have also been many other feedback requests for more pictures and about how the disease is treated.
Puffin Let's talk! 21:06, 26 January 2014 (UTC)
thread_title:  Reader feedback: This article can be improved... 

message: There are conflicting sources on the web (none referenced here, however). Some agree with the Wikipedia translation, but others claim that while this may be the most meaningful translation, the literal one is "red-haired boy". If they are in fact different, the Wikipedia article needs both. 72.200.151.13 (talk) 14:18, 11 July 2014 (UTC)
replies: text: The French wiki page says the word literally means "red child" in the language of the Ashanti. The latter speak Twi, whereas the English-language page here claims it comes from Ga. I have no idea how similar these languages are, and I rather suspect one of them has borrowed the term from the other. If all the sources are correct, then the most likely explanation is that it really does mean "red child" in Asante-Twi and that it was borrowed by Ga speakers, who explained the term to the ethnographer in descriptive terms "the sickness the baby gets when the new baby comes" (and the former baby is weaned, which is what brings on the condition). 2A01:CB0C:CD:D800:B418:5FD3:6F8B:F7F7 (talk) 16:50, 17 November 2022 (UTC)
thread_title:  Literal translation 

message: This article is being edited as part of the Foundations II course at UCSF
Proposed edits:
#Expand "diagnosis" section to include specific labs and diagnostic algorithms, definition of muscle wasting
#Add section on Treatment
#add information about prevalence/epidemiology
# literature for up-to-date information on pathophysiology
::::     -insufficient protein intake / amino acids / hypoalbuminemia
::::     -kidney dysfunction
::::     -dysadaptation to a low protein high carbohydrate diet
::::     -aflatoxins
::::   -oxidative stress (free radicals)
::::     -gut microbiota
//current references
Oedema in kwashiorkor is caused by hypoalbuminaemia 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462841/
Kwashiorkor - Statpearls
https://www.ncbi.nlm.nih.gov/books/NBK507876/
Management of complicated severe acute malnutrition in children in resource-limited countries
https://www.uptodate.com/contents/management-of-complicated-severe-acute-malnutrition-in-children-in-resource-limited-countries
Malnutrition in children in resource-limited countries: Clinical assessment
https://www.uptodate.com/contents/malnutrition-in-children-in-resource-limited-countries-clinical-assessment#H4
Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature
https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.12452
The Immune System in Children with Malnutrition—A Systematic Review
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105017
--Alexuang (talk) 21:41, 29 July 2019 (UTC)
replies: text: FYI, check editing tags I used for future reference, in particular the citation added (use "Cite" dropdown). Some of the suggested sources appear to be good reviews while others are quite specific; as noted summary articles are better, where available (but they may not be!) Health policy (talk) 04:38, 31 July 2019 (UTC)
thread_title:  Foundations 2 2019, Group 3b goals 

message: Part 1
Under treatment, there's currently 10 WHO guidelines, but only 8 are listed. Consider updating that
The article contains sections that are easy to understand, a clear chronological structure (from describing the general information, to explaining the signs and symptoms, to the causes/diagnoses, to treatment, prevention, and prognosis). Sources used are reliable and up to date (2019). The lead provided a general view on the topic which allowed me to get a good grasp on what the article is about. Kylett1 (talk) 16:24, 6 August 2019 (UTC)
thread_title:  Foundations 2 Group 3a peer review 

message: As a member of WP:WikiProject Medicine I have volunteered to watch this article while it is a Wikipedia:Wiki Ed/UCSF/Foundations II (Summer 2020) assignment. Feel free to ask me questions here or on my Talk page. David notMD (talk) 00:42, 9 August 2020 (UTC)
thread_title:  WikiProject Medicine 

message: Expand the organization; clean it up
Add new references and replace old ones
Improve the quality or writing. Use more inclusive language
Expand more on the prognosis if there are more articles to refer to
Also include a more reflective image(s)
Expand the treatment. List the options that are available.
a. We have reviewed all references which should now be correctly formatted according to the Manual of Style.  
b. We were unable to identify any references from predatory publishers.
c. Numerous references were identified as duplicates and were consolidated as follows: 
   i. References 10, 39, and 47 were identified as duplicates through the peer review; We consolidated all callouts in the text, which now refer to reference 10.
  ii. References 2, 6, 11, 21, 35, and 38 were identified as duplicates through peer review; We consolidated all callouts in the text, which now refer to reference 2.
 iii. References 3, 13,14, and 40 were identified as duplicates; We consolidated all callouts in the text, which now refer to reference 3.  
J.Choi, Future UCSF Pharm.D. (talk) 21:06, 4 August 2021 (UTC)
thread_title:  Foundations II 2021 

message: 1) Comparing the current article to the version of the article from a couple weeks ago, I would agree that the group substantially improved the article. Looking at the "Guiding Framework" for peer review on Wikipedia, the main aspects of the framework include the lead, content, tone/blanace, sources/references, organization, images/media, and overall impressions.
In respect to the the article's lead, there was improvement through the addition of more sources and further clarifications. The article had a concise introductory sentence, and the group added further details to describe most of the article's major sections. However, there was no talk of Effects on PK, a section in the article contents, in the lead. I believe the article lead was sufficient length.
The content added was up-to-date, relevant and equitable. The sections they added, like mechanisms and prevention, were useful additions. Additionally, the content was neutral and had reliable secondary sources to back up their information added. I would also agree that the organization of the article was both improved and acceptable.
Looking at the group's goals to improve the article's organization, add references, and expand on some sections, I would agree that the group achieved its overall goals for improvement. It seemed that another goal the group had was to  include more images. However, it seems like they were unable to do that. Despite this, I thought their addition of the table in the "Welcome's classification" was a useful addition, as finding images to add without copyright infringement can be challenging. 
2) I believe the draft submission reflects a neutral point of view. When trying to assess whether the point of view is neutral, the material should be presented fairly, proportionately, and without editorial bias.https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view Additionally, the sources used should be reliable and verifiable. Throughout the article, the group members made sure to not state opinions as facts. They also addressed the unclear etiology of the disease and changed wording throughout the article to reflect that uncertainty. Additionally, the group used language throughout the article that promoted neutrality and didn't endorse points of view that could imply a lack of credibility. When looking through the references, there were over 50 citations, with more than 20 of them being new. This dependence on new references for the article improvementis another indication of an article being less biased. Going through the reference list, the references added were accessible and credible, further improving the credibility and neutrality of this article.
 Mmuskat (talk) 21:22, 2 August 2021 (UTC)
thread_title:  Peer Review - Group 20