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.
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
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.
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.
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.
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
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.
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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