What is protein energy malnutrition?

“Protein–energy malnutrition (PEM) or

protein–calorie malnutrition refers to a form

of malnutrition where there is inadequate

calorie or protein intake. Disability-adjusted

life year for protein–energy malnutrition per

100,000 inhabitants in 2004. no data. less

than 10. 10–100.”

Causes:

• Micronutrient deficiency

• Children from 6 months to 5 years

• Lack of food

• Loss of appetite

• Famine

• Drought

• War

Epidemiology:

1.Global burden

more prevalent In developing countries

“Often starts in womb and ends in tomb”

PEM effects every 4th child worldwide

More than 50% of deaths in 0-4 years

Factors effecting malnutrition:

Localization:

Types of PEM:1. Primary

a) Kwashiorkor

-insufficient protein intake

-lack of child weaned

b)Marasmus

-energy deficiency

2.Secondary

a)common complication in advanced cancer

patients and in patients with AIDS. The malnutrition

in these settings is sometimes called cachexia

KWASHIOKOR:

1. Weight lose

• arms and legs become weak

• Decrease of muscle mass

2.Swallon abdomen

• Ascites: increase of capillary permeability

• Enlarged liver: fatty liver

• Peripheral edema: decrease of oncotic pressure

3. Anemia

4. lethergy

MARASMUS

• Weight lose

• Prominent of ribs

• Drastic loss of appetite

• Growth retardation

• Chronic diarrhea

• muscle atrophy

• Skin folds

• Old man face

Complications:

• Hypoglycemia

• Hypothermia

• Dehydration and shocks

• Electrolyte imbalance

1. Hypokalemia

2. Hyponatremia

• Infections (bacterial, virus etc.)

• Micronutrient deficiencies

Clinical signs and symptoms:

• Poor weight gain.

• Slowing of linear growth.

• Behavioral changes - Irritability,

apathy, decreased social

responsiveness, anxiety, and

attention deficits.

Diagnosis:a) Fluid status should be monitored

b) Hypomagnesaemia, hyperglycemia, hypoalbuminemia, hypophosphatemia

c) Cardiorespiratory monitoring

d) Neuromuscular monitoring

e) Mental status

Treatment and preventions

• Corrections of water and electrolyte balance

• Treat infections and worm infestations

• Dietary supports

• High protein intake level

- 3-4g protein and 200 cal/kg bodyweight/day

• Vitamins and minerals

• Prevention of hypothermia

• Counsel parents

• Plan future including immunization and diet supplement

Initial refeeding:

• Continue breast feeding

• Use liquid diet

• Give vitamin A and and folic acids

• With diarrhea use lactose free or soya bean formula

How to control PEM worldwide

a) Improved water supply, sanitation and hygiene

b) Healthy diet

c) Improved access, by the poor, to the adequate amount of healthy

food

d) Ensuuring industrial and agriculture don’t result in increased

malnutrition