What Are the Main Symptoms and Treatments for Protein Energy Malnutrition?
Protein-energy undernutrition (PEU) used to be called Protein-energy malnutrition (PEM) previously. In simple terms, this is when there is a deficit of energy in your body as a cause of deficiency of all macronutrients. This can also include a deficiency of micronutrients. Macronutrients in the body include carbohydrates, fat, and protein whereas micronutrients include vitamins and minerals; these are all needed for energy.
As per the World Health Organization, protein energy malnutrition is a disparity between the supply of protein and energy and the body’s need for them to guarantee healthy development/ optimal growth. This can occur all of a sudden or it can occur gradually and can be graded as mind, moderate and severe.
In this article, we will look at some of the protein energy malnutrition symptoms, causes, treatment options, prevention methods, and much more. This is a very common thing in children in developing countries like India and Tanzania where children are not getting the calories and proteins whereas in developed countries it's more common in the older generation.
What are Some of the Protein Energy Malnutrition Symptoms?
Symptoms of secondary PEM can range from mild to severe and change the function of just about every organ within the body. The intensity and the type of symptom depend on the patient’s prior dietary status, nature of the disease, and the velocity at which it is progressing. Some of the protein energy malnutrition symptoms that can be noticed are:
Weakened grip and incapability to do things that require high energy
Physical changes in the body like weak arms and legs, hair colour change to red/yellow, hair loss, weight loss, skin becoming thin, pale, inelastic and dry, etc.
Apathy and irritability
Temporary lactose absence
Liver, heart, or kidney failure
The risk of hip fractures and ulcers is high in older patients
These are just a few of the symptoms, however, there are many more and they may differ from patient to patient.
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What are Some of the Protein Energy Malnutrition Causes?
Protein-energy malnutrition can be classified into two categories:
Primary PEM is usually found in children. It can be caused as a result of child/ elder abuse. Children can suffer from two types of PEM:
a. Kwashiorkor: Children suffer from this because they leave breastfeeding before their age due to reasons like the birth of a younger sibling. Protein-energy malnutrition causes can also be caused by acute illnesses like gastroenteritis. This occurs in places like rural regions of Africa where the food consumed has too many carbohydrates and less protein. This leads to seepages of the cell membrane thus releasing the intravascular fluid and proteins which results in something called oedema. Oedema makes a person more susceptible to diseases and illnesses because it weakens their immunity.
b. Marasmus: this is more common than kwashiorkor and also most common in developing countries. This causes a lot of weight loss and fast and muscle lessening. Marasmus is predominant in children smaller than those children that are affected by kwashiorkor and just like kwashiorkor, this also makes children highly susceptible to infections and diseases as their immunity gets impaired.
Secondary PEM is caused as there are disorders in the gastrointestinal tract. The secondary protein energy malnutrition causes can be infections, trauma, hyperthyroidism, and other serious illnesses and as a result, it causes a loss of appetite and impairs nutrient metabolism.
What is the Diagnosis Process?
Before the protein energy malnutrition treatment, Protein-energy undernutrition can be diagnosed to detect and know about the history of the patient’s diet.
Measurement of height and weight are taken
Fat distribution is checked and anthropometric measurements of the body mass are examined.
Also, the BMI is calculated so that the seriousness of the PEM can be known
Lab tests as also done to measure serum albumin, response to skin antigens, lymphocyte count, and other such tests are done to detect the severity
Many times, to diagnose it, low levels of hormones, lipids, cholesterol, calcium, magnesium, etc. can also be helpful.
What is the Protein Energy Malnutrition Treatment?
There are many ways through which this can be treated. Some of the treatment options are:
Avoiding lactose
Oral feeding
Improving nutritional education to educate and inform people of the various nutrients that are important for the human body and how a deficit can be fatal.
Providing multivitamin supplements
These are only a few of the protein energy malnutrition treatments however there are many more that doctors recommend and provide.
Fun Facts
Did you know that protein energy malnutrition is the old name and it is now called Protein-energy undernutrition or PEU?
Did you know that poverty reduction and nutrition education can help to prevent and reduce this Protein-energy undernutrition?
Did you know the clinical tool used to measure this is known as a Z-score which is used to describe someone’s weight for height and height for age relative to population?
FAQs on Protein Energy Malnutrition: Key Facts and Prevention
1. What is Protein-Energy Malnutrition (PEM)?
Protein-Energy Malnutrition (PEM), also known as protein-calorie malnutrition, is a nutritional disorder resulting from an insufficient intake of protein, energy (calories), or both. It primarily affects infants and young children, leading to stunted growth and a range of health complications. The condition is most prevalent in regions with food scarcity and poverty.
2. How is Protein-Energy Malnutrition classified?
PEM is broadly classified into two severe forms based on the primary nutrient deficiency:
- Kwashiorkor: This condition results from a severe deficiency of dietary protein, even if calorie intake is adequate. It is characterised by oedema (swelling), particularly in the abdomen and legs.
- Marasmus: This is caused by a severe deficiency of both protein and calories. It leads to extreme muscle wasting, loss of subcutaneous fat, and a frail, emaciated appearance.
A mixed form, known as Marasmic-Kwashiorkor, exhibits symptoms of both conditions.
3. What are the primary causes of PEM?
The primary causes of PEM stem from inadequate food intake. This can be due to a variety of factors, including:
- Poverty and food insecurity, which limit access to sufficient and nutritious food.
- Lack of education about the nutritional needs of infants and children, especially during weaning.
- Political and environmental factors like drought, famine, or conflict that disrupt food supplies.
- Secondary causes include diseases that affect appetite, digestion, or nutrient absorption, such as chronic diarrhoea or infections.
4. What is the key difference between Kwashiorkor and Marasmus?
The key difference lies in the specific nutrient deficiency and the resulting symptoms. Kwashiorkor is primarily a protein deficiency, and its most distinct symptom is oedema (swelling due to fluid retention). In contrast, Marasmus is a deficiency of both protein and calories, leading to severe muscle and fat wasting without the presence of oedema, giving the child an emaciated, 'skin and bones' appearance.
5. What are the common symptoms that indicate PEM in children?
Common symptoms vary between the two main types of PEM. For Kwashiorkor, signs include swelling (oedema) of the feet, hands, and belly; brittle hair that may change colour; and skin rashes. For Marasmus, symptoms include severe weight loss, visible wasting of muscles and body fat, a wrinkled 'old person's' face, and chronic diarrhoea. In both cases, children may show irritability and apathy.
6. Why are young children, especially between 6 months and 3 years, more vulnerable to PEM?
This age group is particularly vulnerable for several reasons. Firstly, they have high nutritional requirements to support rapid growth and development. Secondly, this is the period when a child is often weaned from breast milk. If the replacement diet is low in protein and calories, like starchy gruels, PEM can develop. Thirdly, their developing immune systems make them more prone to infections, which can increase nutrient needs and decrease appetite, creating a vicious cycle of malnutrition and illness.
7. How can Protein-Energy Malnutrition be prevented?
Prevention of PEM requires a multi-faceted approach, focusing on:
- Nutritional Education: Educating mothers and caregivers about the importance of exclusive breastfeeding for the first six months, followed by the introduction of nutrient-rich complementary foods.
- Balanced Diet: Promoting the consumption of a diverse diet that includes sources of protein (like legumes, eggs, meat) and energy-rich foods.
- Public Health Measures: Improving sanitation and hygiene to prevent infections that contribute to malnutrition.
- Food Security: Implementing government and community programs to ensure stable access to affordable, nutritious food.
8. How does PEM affect a child's immune system and long-term development?
PEM severely compromises the immune system, particularly cell-mediated immunity, making a child highly susceptible to infections. This creates a dangerous cycle where infection worsens malnutrition, and malnutrition increases the risk of infection. Long-term, PEM can cause irreversible damage, including stunted physical growth (dwarfism) and impaired cognitive development, as the brain requires adequate protein and energy to develop properly during early childhood.
