Protein-energy Malnutrition

(PEM)

The Third Affiliated Hospital of

Zhengzhou University
Wangdiao
 Definition
 PEM is a kind of malnutrition caused by
inadequate dietary intake or some diseases,
occurs commonly in children under 3 years
of age.

Kwashiorkor

Marasmus
 Etiology
 The Primary PEM
Inadequate food intake
Inadequate food absorption

 The Secondary causes

Increased nutrient needs
Disorder in nutrient absorption
Increased body metabolism
Certain metabolic abnormality
 Pathophysiology
 Metabolic disorder
 Protein metabolism
anabolism & catabolism ; hypoalbuminemia
 Fat metabolism
mobilized fat store, acetone body ;
metabolic acidosis; fatty liver
 Carbohydrate: low hepatin, hypoglycemia
 Fluid & electrolyte disorders
hypernatremia; edema; potassium disorder;
acid-base disturbances
 Pathophysiology
 Disorders of Organ & Tissue function
 Failure to thrive
 Lower digested function ： diarrhea
 Central nerve system: apathy or irritability
 Cardiovascular system ： pulse slow, Low BP
 Low renal function: urine amount decrease
 Low immunologic function: easy to be infected
 Clinical Manifestations
 Marasmus
• Failure to gain weight
• Weight loss and listlessness
• skin become wrinkled and loose
• Subcutaneous fat disappear (sequence :abdomen→trunk →
buttocks → extremities →face)
• Muscle: atrophy, hypotonia
• Constipation, a starvation diarrhea
• Pulse slow
• Irritability
 Clinical Manifestations
 Edematous PEM (Kwashiorkor)
• Lethargy, apathy, or irritability
• Inadequate growth
• Increased susceptibility to infection
• Vomiting, diarrhea, anorexia
• Flabby subcutaneous tissue
• Edema
• Liver enlargement
• Dermatitis
• Hair sparse and thin
 Complications of Malnutrition
• Nutritional deficiency anemia
• Deficiencies of vitamins and minerals
• Infections
• Infantile diarrhea
• Hypotonic dehydration
 Physical Measurement
WHO Z-
 underweight
score
chronic or acute malnutrition system
X － 3SD≤W/A<X － 2SD moderate
W/A<X － 3SD severe
 stunting
long-term chronic malnutrition
X － 3SD≤H/A<X － 2SD moderate
H/A<X － 3SD severe
 wasting
recent acute malnutrition
X － 3SD≤W/H<X － 2SD moderate
W/H<X － 3SD severe
 Laboratory Examination
 Serum albumin concentration
Normal: >35g/L; Diagnose:< 25g/L

 Serum Pre-albumin concentration

Normal: 150 ～ 296mg/L;
Mild deficiency: 100 ～ 150mg/L;
Moderate:50 ～ 100mg/L; Severe:<50mg/L

 Urine hydroxy-proling concentration

 Diagnosis
 History

 Clinical manifestations

 Anthropometric indicators

 Laboratory examination
 Principles of Treatment
 To treat the primary disease
 To provide adequate nutrients intakes
 To supply energy and protein
 To keep the Fluid & electrolyte balance
 To supply multi-vitamins

To provide the accelerant for protein synthesize

 Supporting therapy
 Management of malnutrition
• Provision of Optimum Nutrition and Energy
 The mild : 60~80kcal/kg/day→--→
 The moderate to severe : 45~60kcal/kg/day→
-- →-- →140kcal/kg/day

• Supplement of Vitamin and Minerals

• Establish Appropriate Diet Habit

 Prevention
 promoting the skills for breast-feeding

and the introduction of supplementary

 Food Nutrition education
 Growth monitoring
 Prevention and treatment of infectious
diseases