The liver in pre-kwashiorkor and kwashiorkor-marasmus syndromes

Available information suggests gradual development of the fatty liver of kwashiorkor due to derangement of fat metabolism. Variations in fatty changes have also been observed in different types of severe protein-calorie malnutrition but no information on the condition of the liver in mild (pre-kwashiorkor) cases is available. In the present study, liver biopsy material in 38 children with pre-kwashiorkor as well as kwashiorkor-marasmus syndromes were studied. Fatty changes, seen in the liver in the severe types, were inversely proportional to wasting. Only 3 (out of 14) pre-kwashiorkor children having diarrhoea and diet restriction had fatty changes. Apparently, the fatty liver develops fairly acutely due to mobilization of depot fat and inability of the liver to metabolize it when pre-kwashiorkor is precipitated into kwashiorkor. Some histochemical observations were also made.