Lesson 8 : Protein Energy Malnutrition


  1. Age: Preschool age children are most seriously affected because of their increased nutritional requirements compared to adults.
    • Infections occur more frequently in this age group.
    • The long term intake of insufficient food can result in marasmus before one year.
    • Kwashiorkor is common after 18 months.

  2. Diet related factors:
    • Diluted milk formula which is grossely deficient in energy.
    • Prolonged breast feeding
    • Delayed introduction and inadequate amount of supplementary feeds.
    • Introduction of adult diet after prolonged breast feeding. Inability of child to eat sufficient quantity, due to the bulk of adult/family diet.
    • Diets low in energy & protein.

  3. Role of free radicals and aflotoxins: Free oxygen radicals produced in the body during various infections and the aflotoxin poisoning from food are usually buffered by protein and neutralized by antioxidants such as Vitamin A, C and E and selenium.
    A child on protein & energy deficient diets in the presence of infection or aflotoxin accumulates toxic, free oxygen radicals, which in turn damage liver cells, leading to kwashiorkor.

  4. Infections:
    • A overcrowded and an unsanitary living conditions lead to frequent infections like diarrohoea.
    • Kwashiorkar is often preceded by an episode of infection, diarrhea and respiratory infections being the most common precipitating factors.
    • Repeated attacks of diarrhea are responsible for poor growth of children.
    • Acute diarrhea leads to mal absorption of fat and protein.
    • Infections arouse negative nitrogen balance.
    • Measles is the other common infectious diseases that occurs during childhood.
    • The impact of measles is more than that of other infections because of secondary complications and prolonged illness.
    • During acute infections, appetite is often impaired and the food intake is reduced. Apart from low intake, dietary restriction is often imposed by the mother or family or community.
    • Mal absorption of nutrient and metabolic losses during infection can also aggravate malnutrition.

  5. Socio-economic factors
    • Poor economic status, faulty feeding habits due to ignorance and prejudice
    • Larger families and high birth rate
    • Superstitions and taboos concerning food are powerful social factors,
    • Deprivation of maternal care and attention due to work pressure away from home by the mothers.
    • PEM is basically a problem of poverty
      Inadequate diet
      Poor environment
      High incidence of infections results – in PEM.
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Last modified: Friday, 2 December 2011, 10:26 AM