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Kainar Syndrome: History of the 

First Epidemiological Case-control 

Study of the Effect of Radiation 

and Malnutrition  

 

Aidar Atchabarov  

 
Atchabarov Institute for Basic and 
Applied Biomedical Research, 
Asfeniyarov National Medical University, 
Almaty, Kazakhstan 

 

Vol. 4, No. 1 (2015)   |   ISSN 2166-7403 (online)    

DOI 10.5195/cajgh.2015.221   |   http://cajgh.pitt.edu 

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ATCHABAROV 

 

 

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.221  |  http://cajgh.pitt.edu 

 

 

Kainar Syndrome:  
History of the First Epidemiological Case-
control Study of the Effect of Radiation and 
Malnutrition  

 

Aidar Atchabarov  

 
Atchabarov Institute for Basic and Applied 
Biomedical Research, Asfeniyarov National 
Medical University, Almaty, Kazakhstan 

Editorial 

Kainar Syndrome was originally described in 

the late 1950s as a health condition associated with 

increased bleeding, hair loss, fainting, and fatigue.1 The 

name “Kainar” came from the village in Kazakhstan 

where most of the affected patients resided. Initial 

explorations of the etiology of Kainar Syndrome 

identified radiation exposure and insufficient levels of 

vitamin C as risk factors for the syndrome.  

An extensive study of the syndrome was 

conducted by the National Academy of Sciences of 

Kazakh SSR from 1957 to 1960,1,2 which established 

the presence of harmful effects of nuclear tests in 

Semipalatinsk Nuclear Test Site (SNTS) on human and 

animal health.3 However, not all results were published, 

as authorities did not believe that such a condition 

existed. Once the results of this research became known 

to the leaders of Kazakhstan and the former Soviet 

Union, the Military-Industrial Complex grew more 

concerned about the health effects of nuclear testing, 

and declared a moratorium on nuclear testing. Since 

1961, dangerous ground-level tests ceased; in 1962, 

testing was switched to high-altitude tests; and in 1963, 

only underground tests were allowed. On August 5, 

1963, the Limited Test Ban Treaty was signed, banning 

nuclear weapon testing in the atmosphere, outer space, 

and underwater.4,5 

The Institute of Regional Pathology in Alma-

Ata, the former capital of Kazakhstan (currently, 

Almaty), was founded due to the need to better 

understand the effects of penetrating radiation. This 

need arose due to the emergence of a new understanding 

that the early appearance of radiation sickness 

symptoms mimicked various other pathologies (e.g. 

infection, intoxication, burns, etc.). Previous 

understanding of radiation sickness assumed that 

radiation sickness primarily manifested itself in genetic 

mutations at the cellular, tissue, and organ levels. The 

goal of this research program was to develop in-depth 

comprehensive studies of health outcomes impacted by 

radiation effects.  

 

A pilot study6 

A group of researchers led by Dr. Bahia 

Atchabarov, a renowned Kazakh scientist, recruited 

3,564 cases (individuals who lived in radiation exposed 

areas of the former Semipalatinsk region) and 2,028 

controls (individuals in areas without contamination) 

and examined their health status. Cases were recruited 

from three radiation exposed areas of the former 

Semipalatinsk region (Abai, Beskaragai, and 

Shubartausky), and controls were recruited from four 

areas without contamination Zhezkazgan (Ulutausky 

district), Karaganda (Kounrad and Kuvsky areas), and 

Pavlodar (Bayanaul area) regions. Participants were 

matched based on key baseline health characteristics. In 

order to ensure the reliability of findings on health 

effects of radiation exposure, animal populations (farm 

animals) were also studied in addition to the human 

participants.  

To confirm the clinical data identified in 

humans and to clarify the severity of radiation influence 

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on health, the health status of farm animals (1,257 cows 

and 1,000 sheep) from the Abai (case area) district and 

four control areas (800 cows and 605 sheep)  were 

assessed.  

Radiation in animals 

It was concluded that animals examined in the 

Abai district suffered from hypochromic anemia, 

accelerated erythrocyte sedimentation rate, erythrocyte 

dysfunction, leucopenia, eosinophilia, stab and 

segmented neutrophilia, leukocytopenia, abnormality of 

redox processes of cellular respiration, decreased 

concentration of vitamin C in the blood, and abnormal 

liver function. Extensive pathological changes in organs 

and tissues of animals in Abai district were similar for 

all animals examined. The overall pattern of health 

deterioration was characterized by degenerative changes 

and sclerotic processes in parenchymal organs, tissue 

atrophy and hyperplasia of the respiratory and digestive 

tracts, pre-cancerous lesions in the lungs, degenerative 

changes in cortical neurons and the brain stem, a 

decrease in the islet apparatus of the pancreas, inhibition 

of germinal elements in the ovaries, and distinct 

changes in the thyroid gland. Pronounced changes were 

also identified in the mucosa of the upper respiratory 

tract. There were areas of acute thinning and destruction 

of the epithelial lining, formation of dense cellular 

infiltrates beneath the epithelium, acute proliferation of 

smooth muscle, and abnormal intestinal wall elements, 

with an increasing number of nuclei in which amniotic 

division occurs. There were also pronounced 

inflammatory-degenerative changes in the thyroid 

gland. 

Pathological changes in farm animals were 

more pronounced than changes in human participants. It 

was hypothesized that this may be due to the fact that 

animals were held in the fields during environmental 

radiation exposure without protective cover. Animals 

also consumed forage contaminated with radioactive 

particles, and were in constant contact with the surface 

soil contaminated with radioactive fallout. 

Radiation in participants 

Human research participants examined in the 

Semipalatinsk region (especially among the population 

of the Abai district) had a higher number of clinical 

symptoms when compared to participants from control 

areas. These symptoms included: hemorrhages in the 

mucous membranes of the upper respiratory tract, 

mouth, and genitals, degenerative changes in the 

mucous membranes (e.g. erosion, leukoplakia, hyper 

pigmentation, and telangiectasia), abnormal changes in 

peripheral blood (e.g. leukopenia, lymphopenia, 

thrombocytopenia, lymphocytosis, anemia, and white 

blood cell stimulation), cataracts diagnosed at young 

age, increased fragility of blood vessels and 

capillaroscopic changes, changes in menstrual and 

ovarian cycles, abnormal liver function, atrophic rhinitis 

and pharyngitis, gingivitis, pathologies of the 

gastrointestinal tract (e.g. gastritis), skin changes - 

particularly on skin surfaces not protected by clothing 

(e.g. hyperkeratosis and hyper pigmentation), nail 

dystrophy, asthenic and wasting syndromes, and 

hypotension. 

The frequency of detection of pathological 

changes in individuals who lived in areas with 

radioactive contamination was significantly higher than 

those from the control areas. Pathological changes 

identified in human participants and animal subjects 

were not specifically attributed to any well-known 

common diseases characterized by inflammatory, 

degenerative, or sclerotic changes in the organs.  

In the evaluation of clinical samples, all 

participants were classified into four groups based on 

the number and severity of symptoms: A, B, C, and D. 

Group A included individuals with the highest number 

of symptoms, many of which could be attributed to the 

nature and severity of the symptoms of chronic radiation 

sickness. Group B had the second greatest number of 

symptoms, with greater than three clinical symptoms 

with the disease. Group C consisted of individuals who 

had two or three clinical symptoms of the disease, 

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ATCHABAROV 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.221  |  http://cajgh.pitt.edu 

 

 

which (although they could occur in patients with 

chronic radiation sickness) more often were symptoms 

of well-known chronic somatic and infectious diseases. 

Group D consisted of healthy individuals without any 

clinical symptoms of the disease or in the presence of 

one or two clinical symptoms within the normal range 

for residents of those areas.  

Introduction of Kainar Syndrome 

Later, the symptoms of the groups that 

exhibited clinical manifestations (A-C) were named 

"Kainar Syndrome," after the village where these 

clinical manifestations were most prevalent. Kainar 

Syndrome was very common among the symptomatic 

population in the surveyed regions, with a prevalence 

ranging from 48.2% to 62.6% in control areas, and 

ranging from 72.8% to 96.2% in areas with radiation 

contamination. In areas with radiation contamination 

and an increase in the disease frequency, the incidence 

of severe forms of disease also increased. Kainar 

Syndrome was divided into two groups based on the 

number of clinical symptoms and their severity: 

strongly pronounced rate - "Kainar A" (or "Major 

Kainar") and weakly pronounced rate - "Kainar C" (or 

"Minor Kainar"). Major Kainar includes the clinical 

manifestations of groups A and B, whereas Minor 

Kainar includes the clinical manifestations of the group 

C. 

Major Kainar encompasses the largest number 

of clearly defined clinical manifestations: vascular 

changes, hematopoietic system changes, functional 

changes in the nervous system (i.e. indicating the 

presence of wasting syndrome), and changes more 

specific to penetrating radiation exposure (e.g. changes 

in the eye lens at a young age and changes in exposed 

skin). Minor Kainar encompasses individuals with 2-3 

clinical manifestations of mild severity, which have 

similar characteristics for chronic radiation sickness. 

Individuals with Minor Kainar also develop infectious 

diseases or toxicities typically associated with age or 

with hypovitaminosis, in addition to mild radiation 

exposure. 

The prevalence of Major Kainar in the 

contaminated areas was 3 to 5 times greater than that of 

the control areas. This demonstrates the potential role of 

radiation in the development of this disease. The next 

question is “What is the cause, mechanism, and etiology 

of Kainar Syndrome, particularly Minor Kainar, which 

is found even in populations in control areas?”  

Previous studies have found that lack of 

essential vitamins, such vitamins C, B, and A, are 

associated with an increased risk of developing Kainar 

Syndrome.1 Based on the results of a previously 

published preliminary study,6 hypovitaminosis of 

vitamin C was associated with the development of 

Kainar Syndrome among the examined population in 

control areas. There was also a synergistic effect of 

radiation and hypovitaminosis of vitamin C in people 

residing in contaminated regions. According to the data, 

hypovitaminosis of vitamin C was identified as a very 

widespread condition among the examined population 

of Central Kazakhstan.  Chronic radiation sickness was 

found to be aggravated by hypovitaminosis  of vitamin 

C.6 However, results were preliminary, and further 

studies are needed to examine the etiology of Kainar 

Syndrome in Central Asia. 

In conclusion, analysis of case-control data 

collected between 1957 and 1959 led to the assumption 

that pathological changes in humans and animals are 

directly related to radiation exposure. Kainar Syndrome 

was also found not to be specific for people living in 

areas with radioactive contamination, but is also found 

in people from control areas. While Kainar Syndrome, 

overall, has received significant attention in the 

literature, Minor Kainar Syndrome remains an 

underpublished phenomenon. Therefore, future research 

is needed to further investigate Kainar Syndrome in the 

geographic areas impacted by radiation exposure.  

 

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Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)  |  DOI 10.5195/cajgh.2015.221  |  http://cajgh.pitt.edu 

  

 

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Paper presented at: The Report of Expedition 19571957; Alma 

Ata, Kazakhstan. 

 

 

 

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