Running Head: PROTEIN-ENERGY MALNUTRITION

Protein-Energy Malnutrition

Name

Institution

Professor

Course

Date
PROTEIN-ENERGY MALNUTRITION 2

Although there is increased knowledge on human nutritional requirement protein energy

malnutrition (PEM) is more prevalent in the world and is among the leading causes of death.

PEM is a state of poor nutrition due to a poor balanced diet to ill health. Ill health has contributes

to further poor nutritional status hence affecting the country’s economy (Soja & Saldanha, 2015).

There are two forms of PEM; moderate or severe. PEM has greatly affected developing

countries with over 149 million children estimated to be affected by it in 1990s. The numbers

were severe previously with over 177 million children affected in 1980s but it still remains to be

a huge problem globally. In one of the study by Soja 109 of below five years children of

Kottayan district 41.28% had grade I PEM. In 120 million children in India >75 million suffer

from PME (Soja & Saldanha, 2015).

The scope of effects of PME are large with the most common are reduced activity,

reduced growth, reduced intellectual capability, increased ability to get infections, reduced work

efficiency and mortality increase. In India PEM continues to affect not only children but also

adults. Thus it is better if PEM is detected early and treated. Anemia affects 1.62 billion people

worldly with alarming numbers of children, adolescent girls and pregnant women reported in

India. This is attributed to lack of iron, vitamin B12 and folic acid both in their body and their

diet. Causes of PEM are not just from nutritional basis but also behavioral too. In protein deficit

amino acids which assist in cell structure and function in the diet is below the required levels

thus there exist energy deficit to provide calorie to the body derived from these macro nutrients

such bas protein, fats and carbohydrates. Micronutrients are also essential in the diet with

vitamin A, B-complex, iron, zinc, calcium and others. Behavioral causes are due to breast
PROTEIN-ENERGY MALNUTRITION 3

feeding, complementary feeding, HH diet, low SES and poor education on the type of required

diet.

Post natal nutrition also severely affects a child early growth with its poor nutrition

resulting in mild growth deficit detectable by anthropometry or biochemical indices to severe

wasting malnutrition. Data was collected from 2-5 year children attending school in Angawadies

in 2013 with demographic proforma and observation records. Here family records and chi-square

value for severity of PEM with respect to child variables among the 109 children was done (Soja

& Saldanha, 2015). PEM affects children widely with data of 41.28% with grade I, 4.59% with

grade II PEM and 1.83% with grade III PEM reported by Soja in Kottayam district.

Mukhopadhyay results data also conceded with Soja in 2013 show that 15.9% were severely

stunted and 31.4 with mild stunting. 35.9% were underweight while 15.9 were severely

underweight (Soja & Saldanha, 2015). Anthropometric measurement of nutritional status is done

through measurement of weight, length/height, mid-upper harm circumference, chest

circumference, head circumference and skinfold measurement (Merialdi et al, 2014).

Severe childhood protein energy malnutrition is visible in 3 modes of deficiency disease

with the synergy with infection very devastating. Kwashiorkor is caused by deficiency of dietary

protein especially when a child is displaced from breast characterized by edema, irritability,

enlarged liver with fatty infiltrates. Marasmus is another mode of visible PEM in which the child

weight is 60% lower the required weight per his/her age; muscle loss, pyrexia, hypovolemic

shock are some of the symptoms (Agarwal et al, 2014)Marasmic-kwashiorkor is where the child

is affected by both the two modes of malnutrition. The synergy of the three modes of PEM and

infection threatens a child sight and life. Keratomalacia and xerophthalmia are example of one of
PROTEIN-ENERGY MALNUTRITION 4

the infections that go hand in hand with malnutrition. In rice eating countries especially

Indonesia where three-quarters of all kwashiorkor are also reported with xerophthalmia, 40% in

Thailand and Africa is 1% (Merialdi et al, 2014).

These three modes of PEM go along with other micronutrient deficiency disease such as

rickets (bending of legs). Here it is more common in young children suffering marasmus with

15-18% of cases reported in south-east Asia (Merialdi et al, 2014). It is due to lack of vitamin D

and if a child is without clinical rickets active form of vitamin D in blood is reported. Vitamin B

deficiency also manifests itself with PEM and is attributed to dissolution of the mineral in

enzyme form due to disruption of mucosal lining of mouth and gastrointestinal tract (Agarwal et

al 2014).

Since the nutrition of a fetus begins at the conception, the nutrition of the mother of the

mother is of much significance before conception even throughout the pregnancy period and

breast feeding. An effect of the nutrition of the mother will definitely affect the child risking the

upcoming of hypertension, cardiovascular diseases, cancer and diabetes throughout the life of the

mother. We do not talk about inadequate nutrition only but excessive intake of some nutrients

will definitely cause malformations or fetus medical problems to the fetus including neurological

disorders and handicaps are the upcoming risk of mothers who malnourished, its estimated that

23.8% of babies in the world are born with optimal weights at their birth due to lack of very

proper nutrition (Van der Pols-Vijlbrief et al, 2014).

There is an effect of personal habits such abuse of caffeine, alcohol, smoking, use of

drugs which, are not prescribed by any doctor can irreversibly greatly affect baby development

which always happens in the early stages of fetus development. Since the placenta is not fully
PROTEIN-ENERGY MALNUTRITION 5

formed during early stages of pregnancy and it is hard to hard to protect the embryo deficiencies

which is very inherent in the mother’s circulation. There is great need for multiple micronutrient

supplements taken together with iron and folic acid can definitely improve the birth outcome in

countries with low income. This supplements help to reduce the outcomes of low weight babies,

small gestational age babies and women stillbirths with low micronutrients in their diets. Those

women with undernourished will greatly benefit from having dietary education sessions and

protein supplements, this increases mothers protein intake and helps the baby to grow well in the

womb.

Supplementing the mother’s diet with foods that are rich in folic acid, such as dark green

leafy vegetables and oranges helps to protect neural tube birth problems in the fetus, to add on

these prenatal vitamins will typically always contain large amounts of folic acid, iron, vitamin A,

vitamin D, zinc, iodine and calcium in the standard amounts of multivitamins (Van der Pols-

Vijlbrief et al 2014). Zinc helps in prevention of preterm births in very low income countries

though the world health organization does not fully recommend zinc supplementation for the

pregnant women because is not of improved quality evidence. For those women with very low

calcium diets taking the calcium supplement will always reduce the risk of preeclampsia.

Calcium reduces the numbers of births that will happen only before the 37 th week of pregnancy.

In treatment of protein-energy malnutrition in both children and adults is to correct fluid and

electrolyte and abnormalities and treat all kinds of infections. For children with kwashiorkor use

of zinc paste is found to be effective in children oral zinc was found to be found to be effective.

In children also the treatment of protein-energy malnutrition is the supply of macronutrients by

use of dietary therapy this can really delay. Milk based formulas is a treatment of choice though
PROTEIN-ENERGY MALNUTRITION 6

in the beginning of this dietary treatment patients should be fed with libitum. A daily

multivitamin should be added.

It is good to give a snack enhanced with branched-chain amino acids to improve energy

to patients undergoing chemotherapy. There are also strategies of using appetite stimulants, anti-

inflammatory pharmacologic agents which are combined with other nutritional support to

subside the protein-energy malnutrition. Re-feeding programs in starving countries has helped

fight malnutrition to children and elderly who cannot work for themselves (Van der Pols-

Vijlbrief et al 2014).

The malnutrition is always a detrimental at any point of life malnutrition of protein

prenatally has always been very significantly in lifelong effects. One should always aim for a

diet that consist good and balanced protein during pregnancy for good development of fetus. The

elderly, children and pregnant women are the vulnerable group. Malnutrition can be caused by

lack of enough nutrition, lack of balanced diet or lack of special macronutrients in the body.

Good nutrition is very vital in brain development so in life there is a very significant stage in life

when some nutrients are greatly needed.

PROTEIN-ENERGY MALNUTRITION 7

Bibliography

Soja, S. L., & Kiran, N. U. (2016). Protein Energy Malnutrition among Children. International
Journal of Nursing Education, 8(2), 129-133.

Merialdi, M., Widmer, M., Gülmezoglu, A. M., Abdel-Aleem, H., Bega, G., Benachi, A., ... &

Hecher, K. (2014). WHO multicentre study for the development of growth standards

from fetal life to childhood: the fetal component. BMC pregnancy and childbirth, 14(1),

1.

Agarwal, E., Ferguson, M., Banks, M., Vivanti, A., Bauer, J., Capra, S., & Isenring, E. (2014).

Protein-energy malnutrition exists and is associated with negative outcomes in morbidly

obese hospital patients. Nutrition & Dietetics, 71(Supp. 1), 23.

Van der Pols-Vijlbrief, R., Wijnhoven, H. A., Schaap, L. A., Terwee, C. B., & Visser, M.

(2014). Determinants of protein–energy malnutrition in community-dwelling older

adults: A systematic review of observational studies. Ageing research reviews, 18, 112-

131.