Protein Energy Malnutrition

Protein-energy malnutrition or PEM is the condition of lack of energy due to the deficiency of all the macronutrients and many micronutrients. It
can occur suddenly or gradually. It can be graded as mild, moderate or severe. In developing countries, it affects children who are not provided with
calories and proteins. In developed countries, it affects the older generation.
Classification Of Protein Energy Malnutrition
PEM can be classified into two types:
1. Primary PEM 2. Secondary PEM
Primary PEM
This type of protein-energy malnutrition is found in children. It is rarely found in the elders, the main cause being depression. It can also be caused
due to child or elder abuse. In children, PEM is primarily of two types:
1. Kwashiorkor 2. Marasmus
Secondary PEM
 It is caused due to disorders in the gastrointestinal tract.
 It can be caused due to infections, hyperthyroidism, trauma, burns, and other critical illnesses.
 It decreases appetite and impairs nutrient metabolism.
The following steps are suggested by FAO/WHO nutrition expert committee for prevention PEM.

Health promotion
1. Measures directed to pregnant and lactating women (education, distribution of supplements).
2. Promotion of breast feeding.
3. Development of low cost complementary foods. The child should be made to eat more food at frequent intervals.
4. Measures to improve family diet.
5. Nutrition education, promotion of correct feeding practices.
6. Home economics.
7. Family planning and spacing of births.
8.Improving family environment.
Specific protection
1. The child’s diet must contain protein and energy rich foods, milk, eggs, fresh fruits should be given if possible.
2. Immunization schedule should be followed.
3. Food fortification may help the child in meeting requirements.
Early diagnosis and treatment
1. Periodic surveillance.
2. Early diagnosis of any lag in growth.
3. Early diagnosis and treatment of infections and diarrhea.
4. Development of programmes for early rehydration of children with diarrhea.
5. Development of supplementary feeding programmes during epidemics.
6. Deworming of heavily infested children.
Integrated child development services (ICDS): Isolated feeding programmes will not be effective unless efforts are made simultaneously to
improve the environment and control infections.
Supplementary food is therefore integrated with other health activities like
1. Immunization
2. Treatment of minor illness
3. Growth monitoring
4. Health education
5. Supplementary feeding.

Nutrition Education: Education to improve child nutrition should stress

1. The importance of breast feeding
2. Timely introduction of supplements. Use of local available foods.
Feeding sufficient quantity
Maintenance of hygiene.
3. Feeding balanced diets for children