Protein-energy malnutri on or PEM is the condi on 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 genera on.
Classifica on Of Protein Energy Malnutri on
PEM can be classified into two types:
Primary PEM
Secondary PEM
Primary PEM
This type of protein-energy malnutri on 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 breas eeding before the actual age due to the birth
of a younger sibling.
Kwashiorkor may also be the outcome of acute illness such as gastroenteri s. 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 suscep ble to diseases.
Extended reading: Kwashiorkor
Marasmus
Weight Loss
Fat and muscle deple on
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 suscep ble to infec ons.
Secondary PEM
It is caused due to disorders in the gastrointes nal tract.
It can be caused due to infec ons, hyperthyroidism, trauma, burns, and other cri cal
illnesses.
It decreases appe te and impairs nutrient metabolism.
Symptoms of Protein Energy Malnutri on
The symptoms of protein-energy malnutri on or PEM are as follows:
Apathy and irritability
The pa ent becomes weak and inefficient.
Impaired cogni on and consciousness.
Temporary lactose deficiency
Diarrhoea
Gonadal ssues 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, inelas c and cold
Hair fall
Impaired wound healing
Risk of hip fractures and ulcers increases in elderly pa ents
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 Malnutri on
PEM can be diagnosed by iden fying the dietary history of the pa ent.
The measurement of height and weight, fat distribu on, 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 an gens can help to detect the severity of Protein Energy Malnutri on.
The decreased level of hormones, lipids, fats, cholesterol, prealbumin, insulin-like growth
factor, fibronec n, calcium, magnesium, and phosphate can also help to diagnose PEM.
Treatment of Protein Energy Malnutri on
Protein Energy Malnutri on can be treated in the following ways:
Oral feeding
Avoiding lactose
Suppor ve care
Reduc on in poverty
Improving nutri onal educa on and public health measures
Starva on can be treated by providing a balanced diet
Mul vitamin supplements
Treat infec ons and fluid and electrolyte abnormali es, in severe cases
PEM can be treated by providing a balanced diet. The micronutrients should be taken twice, the daily
recommended allowance un l recovery.
