Protein Energy Malnutrition: Protein Energy Malnutrition or PEM is the condition of lack of energy due to the deficiency of all the macronutrients and many micronutrients. It can occur suddenly or gradually. It can be graded as mild, moderate or severe. In developing countries, it affects children who are not provided with calories and proteins. In developed countries, it affects the older generation.

Classification of Protein Energy Malnutrition

PEM can be classified into two types:

• Primary PEM

• Secondary PEM

Primary PEM

This type of Protein Energy Malnutrition is found in children. It is rarely found in the elders, the main cause being depression. It can also be caused due to child or elder abuse. In children, PEM is primarily of two types:

• Kwashiorkor

• Marasmus

Kwashiorkor

• This occurs due to the abandonment of breastfeeding before the actual age due to the birth of a younger sibling.

• Kwashiorkor may also be the outcome of acute illness such as gastroenteritis. It is confined only to a few parts of the world such as rural regions of Africa, Pacific Islands, Caribbean. In these places, the food is low in protein and high in carbohydrates.

• It causes leakage of the cell membrane, releasing the intravascular fluid and proteins. This results in oedema.

• It weakens the immunity of a person, making him susceptible to diseases.

Marasmus

• Weight Loss

• Fat and muscle depletion

• Most common in developing countries.

• More common than Kwashiorkor

• Prevalent in children younger than those affected by Kwashiorkor

• Cell-mediated immunity is impaired, making the children more susceptible to infections.

Secondary PEM

• It is caused due to disorders in the gastrointestinal tract.

• It can be caused due to infections, hyperthyroidism, trauma, burns, and other critical illnesses.

• It decreases appetite and impairs nutrient metabolism.

Symptoms of Protein Energy Malnutrition

The symptoms of Protein Energy Malnutrition or PEM are as follows:

• Apathy and irritability

• The patient becomes weak and inefficient.

• Impaired cognition and consciousness.

• Temporary lactose deficiency

• Diarrhoea

• Gonadal tissues atrophy

• Causes amenorrhea in women

• Causes libido in both men and women

• Weight loss

• Shrinking of muscles

• Protrusion of bones

• The skin gets thin, pale, dry, inelastic and cold

• Hair fall

• Impaired wound healing

• Risk of hip fractures and ulcers increases in elderly patients

• Heart size and cardiac output decreases in severe cases

• A decrease in respiratory rate and vital capacity

• Liver, kidney or heart failure

• Acute PEM might also prove fatal

Diagnosis of Protein Energy Malnutrition

PEM can be diagnosed by identifying the dietary history of the patient.

The measurement of height and weight, fat distribution, anthropometric measurements of lean body mass should be examined.

The Body Mass Index or BMI is calculated to measure the severity of PEM.

Laboratory tests such as measurement of serum albumin, total lymphocyte count, transferrin and response to skin antigens can help to detect the severity of Protein Energy Malnutrition.

The decreased level of hormones, lipids, fats, cholesterol, prealbumin, insulin-like growth factor,  fibronectin, calcium, magnesium, and phosphate can also help to diagnose PEM.

Treatment of Protein Energy Malnutrition

Protein Energy Malnutrition can be treated in the following ways:

• Oral feeding

• Avoiding lactose

• Supportive care

• Reduction in poverty

• Improving nutritional education and public health measures

• Starvation can be treated by providing a balanced diet

• Multivitamin supplements

• Treat infections and fluid and electrolyte abnormalities, in severe cases.

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By Team Learning Mantras