PROTEIN-ENERGY MALNUTRITION
PEM is also referred to as protein-calorie malnutrition. It is considered the primary nutritional problem in India. Also called the 1st national nutritional disorder. The term protein–energy malnutrition applies to a group of related disorders that include marasmus, kwashiorkor, and intermediate states of marasmus-kwashiorkor. PEM is due to the ‘food gap’ between intake and requirement.
AETIOLOGY
Different combinations of many aetiological factors can lead to PEM in children. They are:
- Social and economic factors
- Biological factors
- Environmental factors
- Age of the host
- Among the social, economic, biological, and environmental factors, the common cause is:
- Lack of breastfeeding and giving diluted formula
- Improper complementary feeding
- Overcrowding in family
- Ignorance
- Illiteracy
- Lack of health education
- Poverty
- Infection
- Familial disharmony
- Age of host:
- Frequent in infants and young children whose rapid growth increases nutritional requirements.
- PEM in pregnant and lactating women can affect the growth, nutritional status, and survival rates of their fetuses, newborns, and infants.
- The Elderly can also suffer from PEM due to alteration of the GI system.
- Clinical features
The clinical presentation depends upon the type, severity, and duration of the dietary deficiencies. The five forms of PEM are:
- Kwashiorkor
- Marasmic-kwashiorkor
- Marasmus
- Nutritional dwarfing
- Underweight child
KWASHIORKOR
Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM characterized primarily by protein deficiency. This condition usually appears at the age of about 12 months when breastfeeding is discontinued, but it can develop at any time during a child’s formative years. It causes fluid retention (edema); dry, peeling skin; and hair discoloration. Kwashiorkor was thought to be caused by insufficient protein consumption but with sufficient calorie intake, distinguishing it from marasmus.
SYMPTOMS
- Changes in skin pigment
- Decreased muscle mass
- Diarrhea
- Failure to gain weight and grow
- Fatigue
- Hair changes
- Increased and more severe infections due to the damaged immune system
- Irritability
- The large belly that sticks out
- Lethargy
- Rash
- Shock (late stage)
- Swelling
MARASMUS
Marasmus is a form of severe protein-energy malnutrition characterized by an energy deficiency and emaciation. Primarily caused by energy deficiency, marasmus is characterized by stunted growth and wasting of muscle and tissue. Marasmus usually develops between the ages of six months and one year in children who have been weaned from breast milk or who suffer from weakening conditions like chronic diarrhea.
SYMPTOMS
- Severe growth retardation
- Loss of subcutaneous fat
- Severe muscle wasting
- The child looks appallingly thin and limbs appear as skin and bone
- Shriveled body
- Wrinkled skin
- Bony prominence
- Irritability and apathy
- Dehydration
MARASMIC-KWASHIORKOR
A severely malnourished child with features of both marasmus and kwashiorkor.
The features of kwashiorkor are severe edema of feet and legs and also hands, lower arms, abdomen, and face. Also, there is pale skin and hair, and the child is unhappy. There are also signs of marasmus, wasting of the muscles of the upper arms, shoulders, and chest.
NUTRITIONAL DWARFING AND STUNTING
Some children adapt to prolonged insufficiency of food energy and protein by a marked retardation of growth. Weight and height are both reduced and in the same proportion, so they appear superficially normal.
UNDERWEIGHT CHILD
Children with subclinical PEM can be detected by their weight for age or weight for height, which are significantly below normal. They may have reduced plasma albumin. They are at risk for respiratory and gastric infections.
TREATMENTS
Treatment strategies can be divided into three stages:
- Resolving life-threatening conditions
- Restoring nutritional status
- Ensuring nutritional rehabilitation
There are three stages of treatment
HOSPITAL TREATMENT
The following conditions should be corrected. Hypothermia, hypoglycemia, infection, dehydration, electrolyte imbalance, anemia, and other vitamin and mineral deficiencies.
DIETARY MANAGEMENT
The diet should be from locally available stable foods- inexpensive, easily digestible, evenly distributed throughout the day, and increased number of feedings to increase the quality of food.
REHABILITATION
The concept of nutritional rehabilitation is based on practical nutritional training for mothers in which they learn by feeding their children back to health under the supervision and using local foods.
PREVENTION
- Promotion of breastfeeding
- Development of low-cost weaning
- Nutrition education and promotion of correct feeding practices
- Family planning and spacing of births
- Immunization
- Food fortification
- Early diagnosis and treatment
