PROTEIN ENERGY MALNUTRITION

What is Malnutrition?
WHO: the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions."

Protein-Energy Malnutrition
Develops in children and adults whose consumption of protein and energy (measured by calories) is insufficient to satisfy the body's nutritional needs. Also occur in persons who are unable to absorb vital nutrients or convert them to energy essential for healthy tissue formation and organ function.

Etiology
The most common cause of malnutrition is poverty. PEM is primarily due to:
An inadequate intake of food both in quantity and quality Infections Large family size Poor maternal health and nutritional status

Failure of lactation Premature termination of breast feeding Social and cultural feeding practices Low birth weight Malabsorption states

Early Detection of PEM

The first indicator of PEM is underweight for age.
Early stages of PEM : Failure to maintain weight or growth rate Progressive PEM : Loss of weight, loss of subcutaneous fat and muscle mass and dysfunction of many vital organs Severe PEM : increasing failure of homeostatic mechanisms of body and damage to immune defenses may lead to infection, shock and death.

Types of PEM
Primary PEM insufficient source of protein and energy. Secondary PEM- occurs as a complication of illnesses.

Kwashiorkor
AKA Wet Protein Energy Malnutrition Usually appears at the age of 12 months Common in very poor countries Due to inadequate protein in the diet despite an adequate caloric intake. If left untreated, can cause shock and coma

Signs and 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 damaged immune system Irritability Large belly that sticks out Loss of muscle mass Rash Shock Swelling (edema)

Treatment
Depends on severity of condition More calories and protein
Calories first, then Protein

Affected children will never reach full potential for height and growth Vitamins and supplements are essential

Marasmus
Caused by energy deficiency Consists of the chronic wasting away of fat, muscle, and other tissues in the body. Characterized by stunted growth Usually develops 6 months - 1 year

Signs and Symptoms

Chronic or persistent diarrhea Dizziness Fatigue Unexplained weight loss Loss of appetite Diarrhea Baggy, dry skin Sparse hair that is dull brown or reddish yellow Mental retardation, behavioral retardation Hypothermia Slow PR, RR

Treatment
Nutritious, well-balanced diet reduces the risk Special feeding and rehydration Close medical observation Intravenous fluids, oral rehydration solutions, and nasogastric feeding tubes are forms of treatment that may be used.

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