Protein Energy Malnutrition – Definition and Classification of PEM

Protein-energy malnutrition (PEM) is a condition resulting from inadequate intake of protein and calories, leading to severe health issues such as stunted growth, weakened immunity, and muscle wasting. Understanding protein-energy malnutrition causes and protein-energy malnutrition types helps in developing effective prevention and treatment strategies to combat malnutrition.

In this article, we will cover Protein-energy malnutrition (PEM) classification, causes, symptoms, prevention, and management in detail.

Protein-Energy Malnutrition (PEM) is a condition resulting from inadequate intake of protein and calories, leading to severe health issues, particularly in children. It manifests in two primary forms: marasmus, characterized by extreme weight loss and muscle wasting, and kwashiorkor, marked by edema, an enlarged liver, and skin lesions.

PEM impairs growth, weakens the immune system, and increases susceptibility to infections. The condition is prevalent in regions with food scarcity and can be worsened by illnesses that reduce appetite or nutrient absorption.

The causes of PEM or Protein-Energy Malnutrition are given below:

• Inadequate Dietary Intake: Not consuming enough protein and calories to meet the body’s needs.
• Food Scarcity: Limited availability of nutritious food due to poverty, drought, or conflict.
• Illness and Infections: Diseases like diarrhea, HIV/AIDS, and tuberculosis that reduce appetite and nutrient absorption.
• Poor Feeding Practices: Inadequate breastfeeding and improper weaning practices in infants and young children.
• Malabsorption Disorders: Conditions like celiac disease and chronic pancreatitis that impair the body’s ability to absorb nutrients.
• Social and Economic Factors: Poverty, lack of education, and inadequate access to healthcare services.

PEM is mainly of two types based on how the nutrient deficiency is created in the body. They are mainly of two types- Primary PEM and Secondary PEM.

Primary PEM occurs as a result of inadequate nutrient intake. Kwashiorkor, a common form in children from developing countries with poverty and food insecurity, is caused by protein deficiency and micronutrient imbalances. It is further of two types:

Kwashiorkor Disease

Kwashiorkor is one of the two main types of protein-energy malnutrition. It occurs when individuals have an extreme deficiency in protein and certain key micronutrients. This severe lack of protein leads to fluid retention in the tissues (edema), distinguishing kwashiorkor from other forms of malnutrition. The following are the signs and side effects of Kwashiorkor:

• Edema (enlarging with liquid, particularly in the lower legs and feet).
• Swollen stomach with ascites (a development of liquid in the stomach cavity).
• Dry, weak hair, balding
• Dermatitis — dry, stripping skin, layered patches or red patches.
• Expanded liver, a side effect of greasy liver infection.
• Loss of hunger (anorexia).
• Peevishness and weariness.
• Hindered development in kids.

Marasmus

Marasmus is a severe form of malnutrition, specifically protein-energy undernutrition, resulting from a significant lack of calories. It involves a deficiency of all macronutrients: carbohydrates, fats, and proteins. Marasmus primarily affects children, especially infants, who need more calories for growth. It is more common in developing countries with widespread poverty and food scarcity, often worsened by parasites and infectious diseases.

The digestive system can deteriorate from disuse, impairing nutrient absorption and sometimes leading to food aversion. The following are the signs and side effects of Marasmus:

• Anorexia
• Conspicuous skeleton.
• Apparent squandering of fat and muscle.
• Head shows up huge for the body.
• Dry, free skin (skin decay).
• Depressed fontanelles in newborn children.
• Weight reduction of over 40%.

Secondary PEM, or Protein-Energy Malnutrition is caused due to insufficient dietary intake. Unlike primary PEM caused by insufficient dietary intake, secondary PEM results from underlying factors that affect nutrient absorption, utilization, or digestion. Some of the factors causing secondary protein energy malnutrition are:

1. Gastrointestinal Issues: Conditions like Crohn’s disease, celiac disease, and inflammatory bowel disease can impair nutrient absorption, leading to malabsorption of essential nutrients and contributing to secondary PEM.
2. Infections: Chronic or severe infections such as HIV, tuberculosis, and certain parasitic infections increase the body’s energy and protein requirements, potentially leading to secondary PEM.
3. Hyperthyroidism: Overactive thyroid glands, as seen in hyperthyroidism, can raise the body’s metabolic rate, increasing the need for calories and protein. Failure to meet these increased nutritional needs can result in secondary PEM.
4. Injury: Severe injuries, surgeries, or burns can elevate the body’s energy and protein requirements for tissue repair and healing.
5. Critical Illness: Conditions like sepsis, major organ failure, or extensive surgeries can induce a catabolic state, where the body breaks down muscle and tissues for energy, leading to an increased need for protein and calories and potentially resulting in secondary PEM.

The common symptoms of Protein-Energy Malnutrition are:

• Edema: Swelling, particularly in the feet and ankles, due to fluid retention.
• Muscle Wasting: Loss of muscle mass, leading to weakness and fatigue.
• Weight Loss: Unintentional weight loss, often accompanied by a thin or emaciated appearance.
• Fatigue: Increased tiredness and lethargy.
• Growth Impairment: Stunted growth and development, particularly in children.
• Hair and Skin Changes: Dry, brittle hair and skin problems such as dermatitis.
• Enlarged Liver: Hepatomegaly, a symptom of fatty liver disease.
• Loss of Appetite: Reduced or absent desire to eat.
• Irritability: Increased irritability and changes in mood.

PEM can be prevented by:

• Promote Access to Nutritious Foods: Ensure availability and affordability of protein-rich foods like lean meats, fish, eggs, dairy, legumes, nuts, and seeds.
• Nutrition Education: Provide information on balanced diets and the importance of protein and calorie intake for overall health.
• Breastfeeding Promotion: Encourage exclusive breastfeeding for the first six months of life and continued breastfeeding with complementary foods up to two years or beyond.
• Public Health Interventions: Implement measures to alleviate poverty, improve sanitation, and prevent infectious diseases.
• Food Assistance Programs: Offer support through food assistance programs for vulnerable populations, such as food banks, school meal programs, and community feeding programs.
• Early Detection and Treatment: Screen for malnutrition in at-risk populations and provide timely treatment and support services.
• Empowerment and Advocacy: Empower individuals and communities to advocate for improved nutrition policies and access to nutritious foods.

The PEM management can be done by the following ways:

• Nutritional Therapy: Providing a balanced diet rich in protein, carbohydrates, fats, vitamins, and minerals to meet the body’s energy and protein requirements.
• Supplementary Feeding: Offering fortified foods, nutritional supplements, or therapeutic formulas to address specific deficiencies and promote weight gain.
• Medical Monitoring: Regular assessment of nutritional status, growth, and development to adjust treatment plans as needed.
• Treatment of Underlying Conditions: Managing gastrointestinal disorders, infections, thyroid disorders, or other medical issues contributing to malnutrition.
• Supportive Care: Providing emotional support, counseling, and education to patients and caregivers on proper nutrition and dietary habits.
• Multidisciplinary Approach: Involving healthcare professionals such as dietitians, physicians, nurses, and social workers to provide comprehensive care and address all aspects of malnutrition management.

The difference between Kwashiorkor and Marasmus are discussed below:

Also Read:

• Difference Between Kwashiorkor and Marasmus
• Deficiency Symptoms Of Essential Elements
• Diseases – Definition, Classification, Types and Causes

What are the Causes of PEM?

Inadequate dietary intake, food scarcity, illness, poor feeding practices, poverty, and lack of nutritional knowledge.

What are the Types of PEM?

Kwashiorkor and marasmus are the primary types of PEM, characterized by protein-energy deficiencies.

What are the Symptoms of PEM?

Edema, swollen abdomen, dry skin, hair loss, irritability, fatigue, and stunted growth are common symptoms.

What is PEM?

Protein-Energy Malnutrition (PEM) is a condition resulting from inadequate intake of protein and calories, leading to severe health issues, particularly in children.