Definition of Protein
Energy Malnutrition (PEM)
Energy Malnutrition (PEM)
Protein
energy malnutrition (PEM) is the term given to a group of clinical conditions
which occur due to inadequate protein and calorie intake, especially in
children.
energy malnutrition (PEM) is the term given to a group of clinical conditions
which occur due to inadequate protein and calorie intake, especially in
children.
It is a grave problem in
developing countries as pregnant mothers do not get enough nutrition and
healthy food, which puts the baby at a disadvantage even before he/she is born.
developing countries as pregnant mothers do not get enough nutrition and
healthy food, which puts the baby at a disadvantage even before he/she is born.
Classification of Protein Energy Malnutrition
Protein energy malnutrition
has been classified in many ways, two of the important types are mentioned
below.
has been classified in many ways, two of the important types are mentioned
below.
- Kwashiorkor
- Marasmus
- Marasmic Kwashiorkor
Causes of Protein Energy Malnutrition
- When PEM is purely due to dietary deficiency, it
is termed as the primary type. This begins at the foetal stage and
continues into infancy and childhood. - Secondary malnutrition arises due to a serious
illness like tuberculosis, cancer or inability of the body to absorb
nutrients. - Dietary factors contributing to PEM are
inadequate breast feeding by the mother due to inability of mother’s body
to make milk due to inadequate nutrition, stopping breastfeeding early in
case of working mothers and inadequate supplementation of other foods,
ignorance of weaning and weaning foods, inverted or cracked nipples in
mother causing difficulty in breastfeeding. Another important reason is
nipple confusion when the baby is switched from breast to the artificial
nipple and bottle. Formula milk may not be well tolerated leading to diarrhoea. - Problems in the mother such as mental or
psychiatric illnesses, post-natal depression (severe cases), poor maternal
health like anaemia and having too many children in quick succession or
having twins may lead to the mother producing not enough milk to meet the
demand of the infants. - Traditional methods which are harmful to the baby
may be practised in villages and rural areas such as not offering colostrums
(the fluid that comes out of the nipple in the first few hours after
delivery) which is very healthy and boosts the baby’s immune system and
withholding breast milk when the baby has diarrhoea. - All kinds of infections in the baby such as oral
ulcers, gastroenteritis, food poisoning, diarrhoea and serious conditions
such as congenital heart or kidney disease may cause inability to suckle
which causes malnutrition. - Low socioeconomic status of the people coupled
with the desire to have more children (especially boys) is the social
malady that many uneducated people suffer from.
Kwashiorkor
Kwashiorkor comes from an
African word meaning `displaced child’ referring to the illness of the older
infant who is denied breast milk when the new baby is born. Kwashiorkor is
common in children between one and five years. It is due to a protein deficiency
which occurs after protein rich foods are discontinued during weaning and the
child is given food low in proteins and calories.
African word meaning `displaced child’ referring to the illness of the older
infant who is denied breast milk when the new baby is born. Kwashiorkor is
common in children between one and five years. It is due to a protein deficiency
which occurs after protein rich foods are discontinued during weaning and the
child is given food low in proteins and calories.
Symptoms of kwashiorkor
- Children appear smaller than their age
- Skin is pale, dry and flaky, hair turns reddish
- Muscles are limp and underdeveloped
- Children frequently have digestive problems
- Fluid retention in the body causes a distended
abdomen, swollen hands and ankles. This is called oedema - Very thin limbs, liver may be enlarged
- Children lack enthusiasm and look unhappy
Marasmus
This condition is generally
seen in infants less than one year old. It occurs due to a deficiency of
proteins, carbohydrates and fats. Marasmus is the childhood equivalent of
starvation in adults and is more serious than Kwashiorkor.
seen in infants less than one year old. It occurs due to a deficiency of
proteins, carbohydrates and fats. Marasmus is the childhood equivalent of
starvation in adults and is more serious than Kwashiorkor.
Symptoms of Marasmus
- A large face over a shrunken body
- Eyes are sunken, cheeks are hollow giving a
prematurely aged look - Oedema is absent, abdomen is curved inwards
- Skin is dry, loose and wrinkled due to loss of
fat below the skin - Hair may be normal or dry, thin and light
coloured. - Muscles are wasted and have poor tone
- Bones are prominent due to absence of fat around
them
Marasmic Kwashiorkor
This includes symptoms of
both Marasmus and Kwashiorkor and represents the gravest form of PEM.
both Marasmus and Kwashiorkor and represents the gravest form of PEM.
Prevention and Control of Protein Energy Malnutrition
Protein Energy Malnutrition
can be prevented if the following are put into practice;
can be prevented if the following are put into practice;
i.
Exclusive breast feeding from infancy till six
month and continue breast feeding until two years of age.
Exclusive breast feeding from infancy till six
month and continue breast feeding until two years of age.
ii.
Intake of nutritious diet.
Intake of nutritious diet.
iii.
Children should be fed with body building food
e.g. protein to grow well.
Children should be fed with body building food
e.g. protein to grow well.
iv.
Spacing of children to have sufficient
nutritious food for the family.
Spacing of children to have sufficient
nutritious food for the family.
