Cristi Francis
PROTEIN ENERGY MALNUTRITION
DEFINITION• Inadequate intake of protein and energy either
because the dietary intakes of these 2 nutrients are less than required for normal growth are greater than can be by what would otherwise be adequate intake [Nelson 18E]
• Range of pathological conditions arising from coincident lack in varying proportions of protein and calories occurring mostly in infants and young children commonly associated with infections (WHO 2014)
WHO Spectrum of PEM
Marasmus : weight for age <60% expected
Kwashiorkor : weight for age <80% + edema
Marasmic Kwashiorkor :
Wt/Age <60% + edema
RISK FACTORS• Different
combinations of many aetiological factors can lead to PEM in children.They are:
• Social & Economic factors• Biological factors• Environmental factors• Role of Free Radicals &
Aflatoxin• Age of the Host
Amongst the Social,Economic ,Biological & Environmental Factors the common causes are:
Lack of breastfeeding and giving diluted formulaImproper complementary feedingIgnoranceIlliteracyLack of health educationPovertyInfectionFamilial Disharmony
Role of Free Radicals & Aflatoxins:
o Two new theories have been postulated recently to explain the pathogenesis of kwashiorkor.These include Free Radical Damage & Aflatoxin Piosoning.These may damage liver cells giving rise to kwashiorkor.
• Age Of Host• Frequent in Infants & young children whose
rapid growth increases nutritional requirement.
AETIOLOGY
• The causes of PEM can either be direct or indirect.
• Direct causes• The direct factors, which are commonly
referred to as immediate factors include:• (i) Inadequate food intake• (ii) Diseases
Direct Causes• (i) Inadequate food intake• Inadequate food intake is the result of limited access to
food in terms of quality and quantity.• (ii) Diseases• Diseases notably malaria and measles lead to loss of
appetite, increased rate of metabolism due to fevers thereby increasing the body’s nutrient demands. Diarrhoea reduces the absorption of food nutrients, whereas vomiting decreases food intake. Intestinal parasites compete for nutrients with the body e.g. hookworm competes for iron.
Indirect causes
• Indirect causes of PEM include:• (i) Food insecurity and limited access to
foodstuffs• (ii) Poor water / sanitation and inadequate
health services• (iii) Inadequate maternal and childcare
practice
PATHOPHYSIOLOGY - Theories
• Gopalan’s theory of adaptation and maladaptation
• Viteri’s theory – acute Vs chronic
• Free radical injury theory – Golden’s
• Pathophysiological changes associated with nutritional and energy deficits can be described as
• (1) body composition changes, • (2) metabolic changes, and • (3) anatomic changes.