7.6 – Diseases Involving Protein

Health Consequences of Protein Deficiency

Although severe protein deficiency is rare in the developed world, it is a leading cause of death in children in many poor, underdeveloped countries. There are two main syndromes associated with protein deficiencies: Kwashiorkor and Marasmus. Kwashiorkor affects millions of children worldwide. When it was first described in 1935, more than 90 percent of children with Kwashiorkor died. Although the associated mortality is slightly lower now, most children still die after the initiation of treatment. The name Kwashiorkor comes from a language in Ghana and means, “rejected one.” The syndrome was named because it occurred most commonly in children who had recently been weaned from the breast, usually because another child had just been born. Subsequently, the child was fed watery porridge made from low-protein grains, which accounts for the low protein intake. Kwashiorkor is characterized by swelling (edema) of the feet and abdomen, poor skin health, growth retardation, low muscle mass, and liver malfunction. Recall that one of protein’s functional roles in the body involves fluid balance. Diets extremely low in protein do not provide enough amino acids for the synthesis of albumin. One of the functions of albumin is to hold water in the blood vessels, so having lower concentrations of blood albumin results in water moving out of the blood vessels and into tissues, causing swelling. The primary symptoms of Kwashiorkor include not only swelling, but also diarrhea, fatigue, peeling skin, and irritability. Severe protein deficiency in addition to other micronutrient deficiencies, such as folate (vitamin B9), iodine, iron, and vitamin C all contribute to the many health manifestations of this syndrome.

Children and adults with marasmus lack sufficient protein and kilocalories. Marasmus affects mostly children below the age of one in poor countries. Body weights of children with Marasmus may be up to 80 percent less than that of a normal child of the same age. Marasmus is a Greek word, meaning “starvation.” The syndrome affects more than fifty million children under age five worldwide. It is characterized by an extremely emaciated appearance, poor skin health, and growth retardation. The symptoms are acute fatigue, hunger, and diarrhea.

Kwashiorkor and marasmus often coexist as a combined syndrome termed marasmic kwashiorkor. Children with this syndrome have variable amounts of edema and symptoms of marasmus. Although organ system function is compromised by undernutrition, the ultimate cause of death is usually infection. Undernutrition is intricately linked with suppression of the immune system at multiple levels, so undernourished children commonly die from severe diarrhea and/or pneumonia resulting from bacterial or viral infection (Figure 7.7). The United Nations Children’s Fund (U.N.I.C.E.F.), the most prominent agency with the mission of changing the world to improve children’s lives, reports that undernutrition causes nearly one-half of all deaths in children less than five years of age ¹. In 2018, the prevalence of stunted growth in children younger than 5 was 21.9% (149 million children).

^{1 https://data.unicef.org/topic/nutrition/malnutrition/ Accessed June 21, 2019}

Health Consequences of Too Much Protein in the Diet

An explicit definition of a high-protein diet has not yet been developed by the Food and Nutrition Board of the Institute of Medicine (I.O.M.), but typically diets high in protein are considered as those that derive more than 35 percent of calories from protein. Many people follow high-protein diets because marketers tout protein’s ability to stimulate weight loss. It is true that following high-protein diets increases weight loss in some people. However the number of individuals that remain on this type of diet is low and many people, who try the diet and stop, regain the weight they had lost.  As the high-protein diet trend arose so did the intensely debated issue of whether there are any health consequences of eating too much protein. Observational studies conducted in the general population suggest diets high in animal protein, specifically those in which the primary protein source is red meat, are linked to a higher risk for kidney stones, kidney disease, liver malfunction, colorectal cancer, and osteoporosis. However, diets that include lots of red meat are also high in saturated fat and cholesterol and sometimes linked to unhealthy lifestyles, so it is difficult to conclude that the high protein content is the culprit.

High protein diets appear to only increase the progression of kidney disease and liver malfunction in people who already have kidney or liver malfunction, and not to cause these problems. However, the prevalence of kidney disorders is relatively high and underdiagnosed. In regard to colon cancer, an assessment of more than ten studies performed around the world published in the June 2011 issue of PLoS purports that a high intake of red meat and processed meat is associated with a significant increase in colon cancer risk.² Although there are a few ideas, the exact mechanism of how proteins, specifically those in red and processed meats, causes colon cancer is not known and requires further study. Despite widespread knowledge of this association, processed meat intake by U.S. adults has not changed in the U.S. in the past 18 years (1999-2016).³

As with any nutrient, protein must be eaten in proper amounts. Moderation and variety are key strategies for achieving a healthy diet and need to be considered when optimizing protein intake. While the scientific community continues its debate about the particulars regarding the health consequences of too much protein in the diet, you may be wondering just how much protein you should consume to be healthy. Read on to find out more about calculating your dietary protein recommendations, dietary protein sources, and personal choices about protein.

^{2 Chan, D. S., et al. “Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies.” PLoS One 6, no. 6 (2011): e20456. DOI: 10.1371/journal.pone.0020456. Accessed June 21, 2019.}

^{3 Zeng, L. et al. Trends in Processed Meat, Unprocessed Red Meat, Poultry, and Fish Consumption in the United States, 1999-2016. J Acad Nutr Diet. 2019; 119 (7): 1085–1098.e12 . Accessed June 19, 2019.}