Protein-Energy Malnutrition (PEM): Causes, Symptoms, Treatment and More

This article focuses on the causes, symptoms, diagnosis, treatment, prognosis, and prevention of protein-energy malnutrition (PEM). PEM occurs in children and adults when protein consumption does not meet the body's needs. There are four types of PEM: Primary, Secondary, Kwashiorkor, and Marasmus. PEM is what causes abdominal distension prevalent in some third world countries.

Primary PEM results when the diet does not provide adequate protein. Secondary PEM, common in the US, is related to cancer, kidney failure, AIDS, inflammatory bowel disease, and illnesses reducing absorption and use of nutrients; depending on the patient's health, every body organ may be negatively affected. Chronic illnesses and starvation can gradually lead to PEM or quickly with acute illness. (Haggerty & Longe, 2006)

Kwashiorkor is seen in children around 12-months, but may develop anytime during formative years. Kwashiorkor is usually due to breastfeeding cessation. Kwashiorkor is evidenced by overly thin extremities, liver enlargement, edema, dry or peeling skin, hair discoloration, abdomenal distention due to accumulation of fluid, anemia, diarrhea, electrolyte disorder, weak immune system, slow behavior development, and mental retardation. (Haggerty & Longe, 2006)

Marasmus is usually due to energy deficiency and is recognized by inhibited growth, loss of muscle and tissue, skeletal appearance, frequent infections, loss of appetite, diarrhea, dry skin, loose skin, thin hair, discolored hair, mental and behavioral retardation, hypothermia, and slow breathing and pulse rates. Marasmus typically develops in six months to one-year-old children not being breastfed or a weakened immune system due to chronic diarrhea. (Haggerty & Longe, 2006)

PEM can occur in patients who have been hospitalized due to pain, loss of appetite, nausea, and problems swallowing, chewing, or digesting food. Diarrhea, bleeding, burns, trauma, infection, fever, certain medications, benign or malignant tumors, malabsorption disorders, bariatric surgeries, kidney disease, and abnormally high blood glucose levels (glycosuria) can hasten the loss of nutrients. PEM can also occur in anorexic or bulimic individuals.

PEM is identified or diagnosed through a physical exam and thorough history that investigates weight changes, eating habits, body fat, muscle strength, illnesses, gastrointestinal issues, blood tests to determine nutritional status, and urinalyses to identify abnormalities.

Loss of 10% of body weight may occur with no side effects, but more than 40% loss is usually fatal due to hypothermia, heart failure, or electrolyte imbalance. Treatment involves providing adequate nutrition, primarily adequate protein intake. Breastfeeding for the first six months and having access to nutritious food are the main prevention steps. PEM can be prevented through adequate protein consumption. (Haggerty & Longe, 2006)

References

Haggerty, M. & Longe, J. L. (2006). Protein-energy malnutrition. The Gale Encyclopedia of Medicine. Ed. 3^rd ed.