Protein Energy Malnutrition

Protein-energy undernutrition (PEU) used to be called Protein-energy malnutrition (PEM) previously. In simple terms, this is when there is a deficit of energy in your body as a cause of deficiency of all macronutrients. This can also include a deficiency of micronutrients. Macronutrients in the body include carbohydrates, fat, and protein whereas micronutrients include vitamins and minerals; these are all needed for energy. 

As per the World Health Organization, protein energy malnutrition is a disparity between the supply of protein and energy and the body’s need for them to guarantee healthy development/ optimal growth. This can occur all of a sudden or it can occur gradually and can be graded as mind, moderate and severe. 

In this article, we will look at some of the protein energy malnutrition symptoms, causes, treatment options, prevention methods, and much more. This is a very common thing in children in developing countries like India and Tanzania where children are not getting the calories and proteins whereas in developed countries it's more common in the older generation. 

What are Some of the Protein Energy Malnutrition Symptoms?

Symptoms of secondary PEM can range from mild to severe and change the function of just about every organ within the body. The intensity and the type of symptom depend on the patient’s prior dietary status, nature of the disease, and the velocity at which it is progressing. Some of the protein energy malnutrition symptoms that can be noticed are:

• Weakened grip and incapability to do things that require high energy

• Physical changes in the body like weak arms and legs, hair colour change to red/yellow, hair loss, weight loss, skin becoming thin, pale, inelastic and dry, etc. 

• Apathy and irritability

• Temporary lactose absence 

• Liver, heart, or kidney failure

• The risk of hip fractures and ulcers is high in older patients

These are just a few of the symptoms, however, there are many more and they may differ from patient to patient.

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What are Some of the Protein Energy Malnutrition Causes?

Protein-energy malnutrition can be classified into two categories:

1. Primary PEM is usually found in children. It can be caused as a result of child/ elder abuse. Children can suffer from two types of PEM: 

a. Kwashiorkor: Children suffer from this because they leave breastfeeding before their age due to reasons like the birth of a younger sibling. Protein-energy malnutrition causes can also be caused by acute illnesses like gastroenteritis. This occurs in places like rural regions of Africa where the food consumed has too many carbohydrates and less protein. This leads to seepages of the cell membrane thus releasing the intravascular fluid and proteins which results in something called oedema. Oedema makes a person more susceptible to diseases and illnesses because it weakens their immunity.  

b. Marasmus: this is more common than kwashiorkor and also most common in developing countries. This causes a lot of weight loss and fast and muscle lessening. Marasmus is predominant in children smaller than those children that are affected by kwashiorkor and just like kwashiorkor, this also makes children highly susceptible to infections and diseases as their immunity gets impaired. 

2. Secondary PEM is caused as there are disorders in the gastrointestinal tract. The secondary protein energy malnutrition causes can be infections, trauma, hyperthyroidism, and other serious illnesses and as a result, it causes a loss of appetite and impairs nutrient metabolism. 

What is the Diagnosis Process?

Before the protein energy malnutrition treatment, Protein-energy undernutrition can be diagnosed to detect and know about the history of the patient’s diet. 

• Measurement of height and weight are taken 

• Fat distribution is checked and anthropometric measurements of the body mass are examined. 

• Also, the BMI is calculated so that the seriousness of the PEM can be known

• Lab tests as also done to measure serum albumin, response to skin antigens, lymphocyte count, and other such tests are done to detect the severity

• Many times, to diagnose it, low levels of hormones, lipids, cholesterol, calcium, magnesium, etc. can also be helpful. 

What is the Protein Energy Malnutrition Treatment?

There are many ways through which this can be treated. Some of the treatment options are:

• Avoiding lactose

• Oral feeding

• Improving nutritional education to educate and inform people of the various nutrients that are important for the human body and how a deficit can be fatal. 

• Providing multivitamin supplements

These are only a few of the protein energy malnutrition treatments however there are many more that doctors recommend and provide. 

Fun Facts 

• Did you know that protein energy malnutrition is the old name and it is now called Protein-energy undernutrition or PEU? 

• Did you know that poverty reduction and nutrition education can help to prevent and reduce this Protein-energy undernutrition?

• Did you know the clinical tool used to measure this is known as a Z-score which is used to describe someone’s weight for height and height for age relative to population?