Protein Energy Malnutrition (PEM)
The deficiency of proteins accompanied by that of energy is one of the most common nutritional deficiencies in India. PEM generally encompasses both Kwashiorkor and Marasmas.
Kwashiorkor
The term Kwashiorkor means, the disease the child gets when the next baby is born, i.e. sickness of the deposed milk and can be cured by milk. Kwashiorkor results principally due to the lack of protein in the diet. The clinical signs and symptoms are given below:
- Growth failure
- Mental changes – apathy, listlessness, disinterest in the surroundings.
- Oedema – Due to low serum albumin, high sodium and low potassium levels are visible in the legs, hands and face.
- Muscle wasting and reduction in the circumference of the upper arm.
- Moon face – the face becomes full and well rounded.
- Liver changes – liver is enlarged and there is fatty infiltration of the liver.
- Gastrointestinal tract – loss of appetite, vomiting and diarrhoea.
- Skin and hair changes – crazy pavement dermatosis of the skin and dark hyperpigmental brownish black areas of hair, flag sign, sparse hair, easy pluckability of hair.
- Anaemia – due to iron and folic acid deficiency.
- Vitamin Deficiency – Xerophthalmia and keratomalacia (vitamin A deficiency). Angular stomatitis and glossitis (Riboflavin deficiency).
Biochemical changes
The serum albumin level is lowered, the level of enzymes is lowered (choline esterase, and alkaline phosphatase), low level of digestive juice such as amylase and lipase, lipid metabolism is affected – leading to fatty infiltration of liver, blood glucose level is lowered, magnesium and potassium deficiency results due to diarrhoea. Marasmus
- Nutritional Marasmus is principally due to the consumption of diets markedly deficient in both proteins and calories and is most common in weaned infants of about one year of age, in contrast to Kwashiorkor which occurs more often in children in the age groups of 2-4 years.
- Marasmus is usually precipitated as a result of diarrhoeal diseases.
- Causes Poverty, ignorance, superstitious belief, lack of food, inadequate hygiene, infectious diseases and family size leads to marasmus.
- Other factors include failure of breast feeding, late introduction or wrong choice of supplementary foods, unhygienic feeding practices, withholding foods in an attempt to cure diarrhoea, poverty, poor care of children, infectious diseases – diarrhoea, whooping cough, measles etc.
Clinical Features
- Growth retardation – the child is usually 60% below weight. There is severe muscle wasting, arms are thin, skin is loose – subcutaneous fat is absent.
- The skin is dry and atrophic, signs of dehydration and presence of vitamin A deficiency and anemia.
- Low serum albumin and low serum vitamin A levels.
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