This is the manifestation of a deficit in protein and calories, commonly among children. It is a form of under nutrition characterized by both stunting and wasting. It usually develops as kwashiorkor, marasmus or a combination of the two namely; marasmic kwarshiorkor.
The most susceptible group is children below 5 years, particularly those between 6 months and 36 months. Once a child completes exclusive breastfeeding, and the weaning period begins, they become more at risk of this deficiency. This is because then they are starting to consume food , and if food is scarce, their likelihood of deficiency is elevated. Also, at this age, they are more physically active and can easily come into contact with parasites or communicable infections from their peers, through their interactions. Generally the causal factors of protein energy malnutrition constitute the inadequate intake of protein, infections –i.e. parasitic infections, poor development within the first months, poor care and feeding during pregnancy.
Complications of PEM
PEM presents as follows;
- A decrease in muscle mass is evident especially for marasmic patients. The protein mass and body fat undergo a significant decrease.There is also great loss of subcutaneous fat.
- Oedema– there is an increase in water weight, initially on the feet and then the rest of the body. This is particularly for kwashiorkor patients.
- Poor development-The child fails to grow properly and even experiences stunting.
- Hypoglycemia-low blood sugar levels
- Hypothermia
- Micro-nutrient deficiencies -As a result of deficiencies in minerals i.e. iron, the child becomes anaemic and has low blood calcium levels. In addition, while serum potassium levels may remain constant, there is a notable decrease in intracellular potassium. Magnesium serum levels may also experience a decrease. Electrolyte imbalances may also be observed. Usually supplements of these minerals help in managing the deficiencies.
- The effects on various organs are observable. Skin and hair changes are a common feature for both marasmus and kwashiorkor patients.The skin becomes flaky and the hair undergoes thinning.
- Renal impairment may render it difficult for normal excretion to take place, leading to reduced absorption and excretion rates.
- Increased risk of infections
- Neurological changes though they are reversible. The marasmic patients may seem to be alert though they are in distress.
- Reduced cardiac function
- Lactose intolerance
- Reduced enzymatic activity
- Liver dysfunction, especially for kwarshiorkor patients
If a deficiency continues over time, its severity increases and later manifests as marasmus and kwashiorkor. In the long term, growth retardation and mental retardation may occur.
Marasmus
Clinical symptoms that present include:
- Severe wasting with loss of subcutaneous fat
- Thinning of hair
- Constant hunger
- Skin hanging loosely
Kwashiorkor
Usually occurs in children above one year (older than marasmic patients).
General characteristics include:
- Oedema
- Abdominal distension
- Skin and hair changes
- Lethargy
- Varying degrees of wasting or absence of it
- Liver changes
PEM can be prevented with adequate intake of nutrients, proper feeding during pregnancy, treating infections in children, and is treated by the use of supplements, and the management of underlying conditions.
In our next post, we will discuss the management and treatment of PEM.