Topic

Protein-Calorie Malnutrition
(PCM)
Presented By

Sajjad Khan: Roll No. CC530963

Hafiza Waddeha: CB569978
Afshan: CD527064
Areeha Tariq: CD527007

Msc Nutrition

Course Code 3643

 MALNUTRITIO
 N state resulting from relative or absolute
A pathological
deficiency of one or more essential nutrients
Comprises four forms:
a) Undernutrition
b) Overnutrition
c) Imbalance
d) Malabsorption
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."
 Protein-Calorie Malnutrition

• PCM is the single most

important cause of childhood
morbidity and mortality.
• Severe form of PCM is
“ A range of pathological
conditions arising from found in about 5% children
simultaneous deficiency below the age of 5 yrs .
of “proteins & energy”
and commonly • About 50-60% have mild to
associated with moderate PCM.
infections”.
 Epidemiology
The term Protein-Calorie Malnutrition
(PCM) has been adopted by WHO in
1976.
Highly prevalent in developing
countries among <5 children; severe
forms 1-10% & underweight 20-40%.

All children with PEM have one or

more micronutrient deficiency.
 Protein-Calorie Malnutrition (PCM) (PEM) or Protein Calorie
Malnutrition (PCM ) is the name given to various degrees of
nutritional disorders caused by inadequate quantities of protein
and energy in the diet. This is one of the most widespread
deficiency disease in India and Nepal
The term marasmus is derived from the Greek word “marasmos”, which
means “withering or wasting away”. Marasmus involves inadequate intake
of protein and calories and is characterized by emaciation.

The term kwashiorkor is taken from the Ga language of Ghana and means
"the sickness of the weaning." Williams first used the term in 1933, and it
refers to an inadequate protein intake with reasonable caloric (energy)
intake. Edema is characteristic of kwashiorkor but is absent in marasmus.

Children may present with a mixed picture of marasmus and kwashiorkor,

and children may present with milder forms of malnutrition. For this reason,
Jelliffe suggested the term protein-calorie (energy) malnutrition to include
both manifestations.
 Classification of PEM
(FAO/WHO)
Body weight as
percentage of
Oedema Deficit in weight
for height
standard

Kwashiorkor 60 – 80 + +

Marasmic < 60 + ++
kwashiorkor

Marasmus < 60 0 ++

Nutritional < 60 0 Minimal

dwarfing

Underweight child 60 – 80 0 +
The other main factors causing
PCM
Poor hygiene and poor environmental conditions

Large family size

Poor maternal health and nutritional status
Poor maternal nutrition during Pregnancy Failure of Lactation

Premature termination of breast feeding Delayed weaning

Social and cultural feeding practices

Low birth weight

Mal-absorption states like- Short bowel syndrome (small intestine

insufficiency)
 ETIOLOGY / CAUSES OF Protein-
Calorie Malnutrition (PCM)

most common cause of malnutrition is

poverty.
PEM is primarily due to two factors
• An inadequate intake of food both in quantity and quality
• Infections like – Diarrhoea, Respiratory Infections,
Measles, Intestinal worm infestation
• These infections increase requirements for calories,
proteins and other nutrients, while decreasing their
absorption and utilization.
 EPIDEMIOLOGY &
ETIOLOGY

∗ Seen most commonly in the first

year of life due to
lack of breast feeding and
the use of dilute animal
milk.
∗ Poverty or famine and diarrhoea
are the usual precipitating factors
∗ Ignorance & poor maternal nutrition
are also contributory.
PCM(Clinical
diagnosis)
 Etiolog
y
Kwashiorkor can occur in infancy but its maximal incidence is in the 2nd
yr of life following abrupt weaning

Kwashiorkor is not only dietary in origin. Infective,psycho-socical, and

cultural factors are also operative.

Kwashiorkor is an example of lack of physiological adaptation to

unbalanced deficiency where the body utilized proteins and conserves
S/C fat.

Food toxins like aflatoxins have been suggested as precipitating

factors.
CLINICAL FEATURES
OF
KWASHIORKOR
 Prevention and control of PCM
∗ “Prevention of PCM is the fight
against poverty and ignorance”.
∗ It must be appreciated that there is no single shotsolution
the
treatment or prevention of PCM. to
∗ It is a complex problem involving
each of the social, economic, educational,
political, administrative, medical and health
dimensions.
An integrated effort involving all these and
also awareness and a positive
attitude towards the condition might help to limit it.
A) Health
Promotion
B)Specific Health
Protection