protein energy malnutrition

1. PROTEIN ENERGY
MALNUTRITION
By
Dev Ram Sunuwar, M.Sc. Nutrition and
Dietetics

2.  A pathological state resulting from relative or absolute
deficiency of one or more essential nutrients
Comprises four forms:
a) Undernutrition
b) Overnutrition
c) Imbalance
d) Malabsorption
The world health organization (WHO) defines Malnutrition as –
“The cellular imbalance between the supply of nutrients and
energy and the body’s demand for them to ensure growth,
maintenance, and specific functions."
MALNUTRITION

5. •Marasmus
•Kwashiorkor
•Xeropthalmia
•Nutritional anemias
•Iodine deficiency
disorders
On a global
scale, there
are five main
nutritional
deficiency
diseases that
are being
accorded the
highest
priority
action-

7. “ A range of pathological
conditions arising from
simultaneous deficiency of
“proteins & energy” and
commonly associated with
infections”.
• PEM is the single most important
cause of childhood morbidity and
mortality.
• Severe form of PEM is found in
about 5% children below the age
of 5 yrs .
•About 50-60% have mild to
moderate PEM.
Protein Energy Malnutrition

8. The term protein energy malnutrition
has been adopted by WHO in 1976.
Highly prevalent in developing countries
among <5 children; severe forms 1-10% &
underweight 20-40%.
All children with PEM have one or more
micronutrient deficiency.
Epidemiology

9. The term marasmus is derived from the Greek word “marasmos”, which means
“withering or wasting away”. Marasmus involves inadequate intake of protein
and calories and is characterized by emaciation.
The term kwashiorkor is taken from the Ga language of Ghana and means "the
sickness of the weaning." Williams first used the term in 1933, and it refers to an
inadequate protein intake with reasonable caloric (energy) intake. Edema is
characteristic of kwashiorkor but is absent in marasmus.
Children may present with a mixed picture of marasmus and kwashiorkor, and
children may present with milder forms of malnutrition. For this reason, Jelliffe
suggested the term protein-calorie (energy) malnutrition to include both
manifestations.
Protein Energy Malnutrition (PEM) or Protein Calorie Malnutrition (PCM ) is the
name given to various degrees of nutritional disorders caused by inadequate
quantities of protein and energy in the diet. This is one of the most widespread
deficiency disease in India and Nepal

11. Classification of PEM (FAO/WHO)
Body weight as
percentage of
standard
Oedema Deficit in weight
for height
Kwashiorkor 60 – 80 + +
Marasmic
kwashiorkor
< 60 + ++
Marasmus < 60 0 ++
Nutritional
dwarfing
< 60 0 Minimal
Underweight
child
60 – 80 0 +

12. PEM(Clinical diagnosis)

14. The most common cause of malnutrition is poverty.
PEM is primarily due to two factors:
• An inadequate intake of food both in quantity and quality
• Infections like – Diarrhoea, Respiratory Infections, Measles,
Intestinal worm infestation
• These infections increase requirements for calories, proteins
and other nutrients, while decreasing their absorption and
utilization.
ETIOLOGY / CAUSES OF PROTEIN ENERGY
MALNUTRITION

15. Malnutrition is a serious problem in Nepal, as in
other countries of South Asia, and is a major threat
to the health of infants, adolescent girls and
pregnant & lactating mothers.
National studies over the last 50 years show
malnutrition rates in children under 5 years of age
persist at rates around 50%.
Malnutrition in Nepal

16. Malnutrition glance in Nepal
57
57
49
41
36
15
11
13
11
10
42 43
39
29
27
0
10
20
30
40
50
60
NDHS 1996 (1991-1995) NDHS 2001 (1996-2000) NDHS 2006 (2001-2005) NDHS 20011 (2006-2010) NDHS 20016 (2012-2016)
Stunting Wasting Underweight

19. Poor hygiene and poor environmental conditions
Large familysize
Poor maternal health and nutritional status
Poor maternal nutrition during Pregnancy
Failure of Lactation
Premature termination of breast feeding
Delayedweaning
Social and cultural feedingpractices
Low birth weight
Mal-absorption states like- Short bowel syndrome (small intestineinsufficiency)
The other main factors causing PEM

20. Protein energy
malnutrition(PEM)
manifests intwo
differentforms:
NutritionalMarasmus
Protein and calorie
deficiency
Common in infants
and childrenbelow
3 years of age.
Onset is more
between 6-18
months of age.
Kwashiorkor
Common in
childrenbelow
3yrs
Onset is more
between18months
to 24months
Protein deficiency
only

24. MARASMUS
 The term marasmus is derived from the Greek marasmos,
which means wasting.
 Marasmus involves inadequate intake of protein and
calories and is characterized by emaciation.
 Marasmus represents the end result of starvation where
both proteins and calories are deficient.
 Marasmus represents an adaptive response to starvation.
 In Marasmus the body utilizes all fat stores before using
muscles.

25.  Seen most commonly in the first year of life due
to lack of breast feeding and the use of dilute
animal milk.
 Poverty or famine and diarrhoea are the usual
precipitating factors
 Ignorance & poor maternal nutrition are also
contributory.
EPIDEMIOLOGY & ETIOLOGY

30. Kwashiorkor can occur in infancy but its maximal incidence is in the 2nd yr of
life following abrupt weaning
Kwashiorkor is not only dietary in origin. Infective,psycho-socical, and cultural
factors are also operative.
Kwashiorkor is an example of lack of physiological adaptation to
unbalanced deficiency where the body utilized proteins and conserves S/C
fat.
One theory says Kwashiorkor is a result of liver insult with
hypoproteinemia and oedema.
Food toxins like aflatoxins have been suggested as precipitating factors.
Etiology

31. CLINICAL FEATURES OF
KWASHIORKOR

44.  “Prevention of PEM is the fight against poverty and
ignorance”.
 It must be appreciated that there is no single shot solution to
the treatment or prevention of PEM.
 It is a complex problem involving each of the social,
economic, educational, political, administrative, medical and
health dimensions.
An integrated effort involving all these and also awareness
and a positive attitude towards the condition might help to
limit it.
Prevention and control of PEM

45. A) Health Promotion

46. B)Specific Health Protection