Protein energy malnutrition or serum albumin malnutrition refers to a form of malnutrition where there is inadequate intake of calories or proteins. The nutritional problem of a Community, state, or nation are identified by many interrelated studies including data on food production and consumption, morbidity, mortality, level of income and surveys of nutritional status. Malnutrition is an inclusive term that involves the lack, imbalance or excess of one or more of nutrients that are required by the body. It is the world’s most serious nutritional problem and it is fairly common in both children and adults. 

PEM mostly is associated with diseases which are often found in the elderly people.

TYPES OF PEM:

  • KWASHIORKOR (protein malnutrition)
  • MARASMUS (deficiency in calorie intake)
  • MARASMUS KWASHIORKOR (marked protein deficiency and calorie deficiency and sometimes refers to the severe form of malnutrition)

CAUSES:

PEM is more common in low income countries and sometimes higher income group also affected. This may also occur in children with chronic disease and children who are hospitalized for different diagnosis.

  • Malignancy
  • Cardiovascular disease
  • Cancer disease
  • End stage renal disease
  • Genetic disease
  • Poverty
  • Diarrhea

SYMPTOMS OF PEM:

  • EDEMA (usually severe resulting in a large pot belly and swollen legs & face and muscle wasting)
  • SKIN (especially in the pelvic region and the thighs often become dry and flaky peeling and sometimes ulcerated)
  • HAIR (easily plucked out and takes on a reddish color)
  • Lack of subcutaneous fat and growth retardation.

“One of the more striking features of the deficiencies is the profound apathy and general misery of the child, he whimpers but does not cry or scream’’

BIOCHEMICAL CHANGES:

  • Fatty infiltration of the liver is usually extensive. The serum level of triglyceride, phospholipids and cholesterol are reduced indicating an inability of the liver to manufacture and release this substance to the circulation.
  • Pancreas reduces the production of Amylase, Lipase and Trypsin.
  • The total serum protein and albumin fraction are reduced thus resulting severe edema and muscle wasting.
  • Hemoglobin levels are low especially if parasitism is also present.
  • Serum vitamin A levels are usually reduced.

MANY PROGRAMS ARE BEING LAUNCHED BY THE GOVERNMENT TO CURB MALNUTRITION :

  • Nutrition education training
  • Mid-day meal
  • Food distribution program
  • Special supplemental nutrition program
  • Aaganwari

DIETARY KNOWLEDGE IS ESSENTIAL:

  • Food mixture that contain sufficient quantities of essential amino acid to meet the growth needs of the child (3-4 gram protein per kilogram)
  • Food is made up of different nutrient needed for health and growth.
  • Protein perform a wide range of function and also provide energy (1 gram protein provides 4 kilocalorie)
  • Animal Protein like meat, milk, fish, egg and plant Protein such as pulses and legumes are rich source of protein.
  • Animal protein are of high quality as they provide all the essential amino acid in right proportion , while plant and vegetable protein are not of the same quality because of their low content of some of the essential amino acid ( Histidine, Lysine, Tryptophan, Phenylalanine, Methionine, Threonine, Leucine, Isoleucine, Valine )
  • Include in diet (paneer, tofu, sprouts, jaggery, beetroot, soya bean, soy milk, milk, curd, buttermilk, shakes, pulses and lentils, cereals and millets, meat, fish, egg )

“A COMBINATION OF CEREALS , MILLETS AND PULSES PROVIDE MOST OF THE AMINO ACID WHICH COMPLEMENT EACH OTHER TO PROVIDE BETTER QUALITY OF PROTEINS’.’