Protein energy malnutrition (PEM) is a major nutritional disorder particularly in developing countries of the world. This condition most often occurs in infants and children hence the disorder is also called infantile pellagra, nutritional edema etc. Cicely Williams while working in Ghana in 1930 described this condition in detail. The condition was named as Kwshiorkor which in Ghanian language means ‘the disease of displaced child’.
It is a macronutrient deficiency caused primarily by dietary energy deficiency due to insufficient food intake. The condition develops when the patient does not get sufficient amount of protein to meet his body’s metabolic demand.Although protein energy malnutrition is mainly present in children, it can occur in people of all ages.
Patient with protein energy malnutrition may pass through various stages and manifest many symptoms. PEM has several underlying causes. Treatment mainly consists of correcting the underlying cause. Providing proper nutrition plays vital role in correcting the disorder.
Causes Of Protein Energy Malnutrition
Protein energy malnutrition (PEM) is caused due to several major factors:
- Poor economy and social factor: PEM is widely prevalent in developing countries of Asia and Africa. Poverty, unhygienic living conditions, unavailability of nutritious food, poor child care, abrupt weaning practices, reduced breast feed, are major factors that may contribute PEM in developing countries. PEM is majorly the disease of poor and downtrodden.
- Environmental issues: Childhood infections and parasitic infestation are usually associated with protein energy malnutrition. Diarrhea caused due to unsanitary environment is leading cause for PEM in infants. Because of alimentary tract problems such as diarrhea and parasites in the intestine, the child has reduced food intake, it hinders absorption of nutrition from intestine, leading to deficiency of protein. Besides this, environmental crisis such as floods, famine, earthquakes, low agricultural output etc can contribute protein energy malnutrition.
- Growing age: With growing age of the child, his nutritional needs also increase. If the requirement is not met in the form of proper nutritious diet, there is increased risk of PEM. Protein energy malnutrition is commonly observed in low economic class having many children. Since the demand of every child in the family is not met due to poverty, it results in malnutrition, especially protein energy malnutrition.
- Maternal factors: If the mother is malnourished during pregnancy or before the conception, there is increased risk that she will give birth to a low weight baby usually a malnourished child. The role of acute diarrhea, measles, and respiratory tract infection is very important cause for PEM in children especially in developing countries.
Clinical Symptoms Of Protein Energy Malnutrition
Kwashiorkor and marasmus are two visible causes among many other causes of PEM. The symptoms of protein energy malnutrition (PEM) will depend on its type:
- Kwashiorkor: It is one of the important forms of protein energy malnutrition. It usually occurs in children between the ages 1 to 3 years. The three major essential features of kwashiorkor are poor growth, edema and mental changes. Growth retardation is early sign of Kwashiorkor. The child has stunted height and low weight compared to peers of his age. Wasting of muscles will result in thin hands and legs with prominent abdomen. Swelling of hands and legs is common. Later it may spread to face. Mentally the child is irritable and prefers to remain alone and in one corner. He avoids talking with people. Other changes include; hair is thinner, silkier and loses its sheen. Hair appears coppery red colored. Moon face, recurrent respiratory tract infection, diarrhea, enlarged liver, dark pigmentation on skin are all other clinical features of Kwashiorkor.
- Marasmus: Severe growth retardation, extreme emaciation due to reduced body fat, and wasting of muscles are prominent symptoms of marasmus. The subcutaneous fat is extremely less and hence the skin hangs and becomes wrinkled. The child looks like an old man. A marasmic child has nothing but skin and bones. Marasmic children are less irritable. In fact the child does not have enough energy even to cry.
- Marasmic Kwashiorkar: In this form of protein energy malnutrition, the features of both Kwashiorkor and Marasmus are present.
Treatment Of Protein Energy Malnutrition
Protein energy malnutrition (PEM) remains an important public health problem in developing countries. Patient suffering from protein energy malnutrition needs treatment in different stages. This include following:
- Hospitalization: Severe form of protein energy malnutrition patients must be treated in hospital. Especially when there is associated other infections such as pneumonia and diarrhea.
- Diet: Patient must be provided with adequate amount of nutrition especially the food consisting protein and energy. Both are needed in large quantity. The food must be easily digestible. Initially the child is provided with milk based diet. Gradually other foods are introduced as the appetite of the child increases. Vegetable oil and sugar is given to increase the energy content.
- Multivitamin and minerals: Supplementary multivitamin and iron is given to the child as most of them are deficient in these nutrients.
- Antibiotics: If required, when the child has infection antibiotics are started immediately because infection increases mortality.
- Mother is trained how to feed the child; give important foods that contains enough protein and other nutrients.