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.