Protein Energy Malnutrition (PEM)

Normal and Therapeutic Nutrition 3(2+1)
Lesson 14:Nutritional and Food Requirements for Preschool Children

Protein Energy Malnutrition (PEM)

PEM is defined as a range of pathological conditions arising from lack of varying proportions of protein and calories

  • Occurs most frequently in infants and young children and often associated with infections (WHO 1973)Figure (Ecology of PEM)

Symptoms of different types of PEM:

Kwashiorkor: Oedema of face (moon face) and lower limbs, failure to thrive, anorexia, diahorroea, apathy, dermatosis (hypo & hyper pigmentation), flaky paint dermatitis, sparse, soft and thin hair, angular stomatitis, cheilosis and anaemia. (Figure)

Marasmus: Failure to thrive, irritability, frightfulness, apathy, diarrhoea, anorexia, dehydration

  • Child is shrunk (little or no subcutaneous fat)
  • Watery diarrhoea and acid stools
  • Muscles are weak and atrophic

Marasmic kwashiorkor: Mixture of some features of both marasmus and kwashiorkor.

Nutritional dwarfing:Some children adapt to prolonged insufficiency of food lacking in energy and protein leading a marked retardation of growth. Weight and height are both reduced.

Under weight child: These children are smaller than their genetic potential which is of greater importance as they are at risk of gastroenteritis, respiratory and other infections which can precipitate to malnutrition.

Treatment strategy can be divided into three stages.
Resolving life threatening conditions
Restoring nutritional status without disrupting homeostasis.
Children below 2 years require 200k cal/kg body weight, whereas children older than 2 years require energy 150 – 175k cal/kg body weight
Protein ---- 5g/kg body weight
Fats ------ 40% of total calories
Use locally available staple foods. Inexpensive, easily digestible and all 5 food groups to be included which are minimum of 100ml/milk with

  • Cereal: Pulse – 5:1 (evenly distributed throughout the day).
  • Number of feedings and quantity of food should be increased.
  • Concentrated sources of energy should be added like oil, butter, ghee etc.
Ensuring nutritional rehabilitation by establishing
  • Residential units
  • Day-care centres
  • Domiciliary rehabilitation.
Last modified: Monday, 24 October 2011, 9:03 AM