PROTEIN ENERGY

MALNUTRITION
Ayu Kusuma
Ningrum

Protein Energy
Malnutrition
Ayu Kusuma Ningrum
(030.08.048)

Abstract

Protein-energy malnutrition (PEM) is generally

a nutritional problem that results from varying
proportions of protein and calorie deficiency in
infants and young children of developing
countries . The major risk factors that can
predispose a child to having PEM include
poverty, lack of access to quality food,
cultural, poor maternal education, inadequate
breast feeding, and lack of quality healthcare

INTRODUCTION

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." The term
protein-energy malnutrition (PEM) applies to a group of related disorders that
include marasmus, kwashiorkor

In 2000, the WHO estimated that malnourished children numbered 181.9 million
(32%) in developing countries. In addition, an estimated 149.6 million children
younger than 5 years are malnourished when measured in terms of weight for
age. In south central Asia and eastern Africa, about half the children have
growth retardation due to protein-energy malnutrition. This figure is 5 times the
prevalence in the western world.

Malnutrition diseases

Marasmus, kwashiorkor
are the malnutrition
diseases which occur
as a result of protein
energy malnutrition.
Intermediate states of
marasmus-kwashiorkor
also are referred to as
PEM which involve an
inadequate intake of
many essential
nutrients

ETIOLOGY
The most common cause of malnutrition :
inadequate food intake.
immature immune systems causing a greater susceptibility to infection
exposure to nonhygienic conditions.
The major risk factors :
Poverty

lack

Adaptive Starvation
Negative Energy Balance-expending more energy than taking in

of access to quality food

Cultural
poor maternal education
inadequate breast feeding
lack of quality healthcare

SIGN AND SYMPTOMS

SIGNS AND SYMPTOMS

1. Growth Failure

The first effect of PEM is on growth, as manifest by :

The most useful indices in practice are weight and height particularly if the age of
the child is accurately known.

Can caused by :

acute loss due to the sudden restriction of energy intake or alternatively due to

effects of acute infection such as gastroenteritis or measles.

Chronic disease apart from nutritional deficiency may also be the cause of
this pattern. Infection
2. The high rate of infection, particularly of gastroenteritis, measles, and pneumonia.
3. Anaemia
4. Diminished activity

Diminution of activity, so uncharacteristic of healthy child, occurs in PEM. The

occurrence of listless children is common in developing countries. For school children
and older individuals there is a definite falling off in work capacity and mental function.
(7)
5. Oedema (mostly in kwashiorkor)
6. Skin and hair changes

PATHOPHYSIOLOGY
A. PROTEIN
METABOLISM

PATHOPHYSIOLOGY
B. ENERGY
METABOLISM

MARASMUS
Marasmus is caused by a severe nutritional deficiency in general. It is usually
found in very young infants and very young children. It can be prevented by
breastfeeding. It is actually caused by the total or partial lack of nutritional
elements in the food over a period of time
Children with marasmus are small for their age. (6)

The Etiology

an inadequate caloric intake due to insufficient diet

the child does not get adequate supplies of breastmilk or of any alternative
food

to improper feeding habit such as those of disturbed parent-child relations,

(feeding dificulties)

metabolic abnormalities, digestive upsets such as malabsorption or vomiting

When the immune systems are weakened they suffer from frequent
infections and parasitic diseases.

MARASMUS
The clinical manifestations
marasmus manifests as a starved
appearance. A kid who is suffering from
marasmus can be identified at a glance.
A.

B.

Presenting symptoms :
initially there is failure to gain weight
Failure to thrive accompanied by irritable
crying or apathy (7)
Chronic diarrhea with or without vomitting
(the most frequent complaint) (7)
General Appearance
loss of weight until emaciation results,
with loss of turgor in skin that becomes
wrinkled and loose as subcutaneous fat
disappears (have dry and lose skin
hanging over )
the infants face may retain a relatively
normal appearance for some time before
becoming shrunken and wizened.
(Because fat is lost last from the sucking
pads of the cheeks) (6)

MARASMUS
Growth and muskuloskeletal changes
Mid-arm circumfrences,skin fold thickness, and
the chest. Head circumfrence ratios are all
markedly reduced
Marked muscle wasting and weakness
D. Anaemia
C.

KWASHIORKOR
What causes kwashiorkor?
Kwashiorkor is a clinical syndrome that result from a severe
deficiency of protein and inadequate caloric intake.
Kwashiorkor often manifests in an affected person as a wellnourished appearance, and affects slightly older children.
kwashiorkor can occur rapidly (9)
Either from lack of intake or from excessive losses or increases
in metabolic rate caused by chronic infections, secondary vitamin
and mineral deficiency may contribute to the signs and
symptoms (6) and also suffers from damaged absorption.

KWASHIORKOR
Kwashiorkor, is a clinical syndrome
that result from a severe deficiency of
protein and inadequate caloric intake.

1.
2.
3.

4.

5.

edema
Failure to thrive
Loss of muscular tissue,
increased susceptibility to
infections, flabbinesss of
subcutaneous tissues, loss of
muscle tone.
Renal plasma flow, glomerular
filtration rate, and renal tubular
function are decreased (it can
cause edema)
Infections, both acute and chronic
(TB and HIV) and parasitic
infestations are common, as are
anorexia, vomiting and continued
diarrhea.(6)

KWASHIORKOR
6.

7.

8.

9.

The liver may enlarge early

or late, fatty infiltration os
common, and hepatic export
proteins are reduced.
Dermatosis and
dyspigmentation skin.
The hair is often sparse and
thin and loses its elasticity,
in darked-haired children,
dyspigmentation may result
in sreaky red or gray color
(hypochromotrichia).
Anaemia.

TREATMENT
1. Stabilization
It consists of treatment and prevention of hypoglycemia, hypothermia,
dehydration (rehydration treatment) and infection; correction of electrolyte
imbalance and micronutrient deficiencies; and a cautious feeding regimen
Ambulatory treatment, which is mainly dietary

Kwashiorkor is usually treated with the addition of protein in the diet, and
supplementation (these supplements is to improve the biological value of the protein
and the energy content of the staple foods)
Protein diets, is usually in the form of dried skimmed milk. It also includes a nutritious
diet where at least 12% of the calories come from protein and 10% from fat.
Marasmus is usually treated by adding vitamin B and following a nutritious diet in
general. (9)

2. Treatment of the hospitalized child (for the severe protein energy malnutrition)
resuscitation and treatment of complications
For example : dehydration, hypothermia, infection, and anaemia

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Young H, Borrel A, Holland D, Salama P: Public nutrition in complex

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Christopher Duggan,John B. Watkins,W. Allan Walker ,Protein Energy
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Hamilton,Ontario; BC Decker ; 2008 ; 13:127-138
Scheinfeld Noah. Newyork : Emedicine; [updated 2010 Aug 24]. Available at :
http://emedicine.medscape.com/article/1104623-overview
Reilly JJ: Understanding chronic malnutrition in childhood and old age: role of
energy balance research. Proc Nutr Soc 2002, 61:321-327
Nelson WE. Malnutrition. In: Arvin AM, Behrman RE, Kliegman RM, Nelson
WE. Nelson Textbook of pediatrics. 18th ed. Philadelphia ; Saunders
company; 2000; p.169-171
Torun Benjamin,Chew Fransisco. Protein-Energy Malnutrition [updated 2011
Jan 3]. Available at :
http://drugswell.com/wowo/blog1.php/2011/01/03/protein-energy-malnutrition?
page=3

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