Protein-Energy Malnutrition Health Article

Definition

Protein-energy malnutrition (PEM) is a potentially fatal body-depletion disorder. It is the leading cause of death in children in developing countries.

Description

PEM is also referred to as protein-calorie malnutrition. It develops in children whose consumption of protein and energy (measured by calories) is insufficient to satisfy their nutritional needs. While pure protein deficiency can occur when a person's diet provides enough energy but lacks an adequate amount of protein, in most cases deficiency will exist in both total calorie and protein intake. PEM may also occur in children with illnesses that leave them unable to absorb vital nutrients or convert them to the energy essential for healthy tissue formation and organ function.

Types of PEM

Primary PEM results from a diet that lacks sufficient sources of protein. Secondary PEM is more common in the United States, where it usually occurs as a complication of AIDS, cancer, chronic kidney failure, inflammatory bowel disease, and other illnesses that impair the body's ability to absorb or use nutrients or to compensate for nutrient losses. PEM can develop gradually in a child who has a chronic illness or experiences chronic semi-starvation. It may appear suddenly in a patient who has an acute illness.

Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM characterized primarily by protein deficiency. This condition usually appears at about the age of 12 months when breast-feeding is discontinued, but it can develop at any time during a child's formative years. It causes fluid retention (edema); dry, peeling skin; and hair discoloration.

Marasmus, a PEM disorder, is caused by total calorie/energy depletion rather than primarily protein calorie/energy depletion. Marasmus is characterized by stunted growth and wasting of muscle and tissue. Marasmus usually develops between the ages of six months and one year in children who have been weaned from breast milk or who suffer from weakening conditions such as chronic diarrhea.

Demographics

It is not entirely clear how common PEM is in the United States. Primary PEM is common in impoverished areas of developing countries. In the United States, secondary PEM is more common. Children at particular risk for secondary PEM are those who have diseases that involve diarrhea or that otherwise interfere with nutrient absorption. Children with chronic illnesses that require frequent hospitalization are more likely to develop PEM.