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What is Protein Energy Malnutrition?

Protein-energy malnutrition or PEM is the condition of lack of energy due to the deficiency of all the macronutrients and many micronutrients. It can occur suddenly or gradually. In developing countries, it affects children who are not provided with calories and proteins. In developed countries, it affects the older generation.

Classification Of Protein Energy Malnutrition
It can be classified into two types:

  • Primary PEM
  • Secondary PEM

Protein Energy Malnutrition

Primary PEM

This type of protein-energy malnutrition is found in children. It is rarely found in the elders, the main cause being depression. It can also be caused due to child or elder abuse. In children, PEM is primarily of two types:

  • Kwashiorkor
  • Marasmus


  • This occurs due to the abandonment of breastfeeding before the actual age due to the birth of a younger sibling.
  • It is confined only to a few parts of the world such as rural regions of Africa, the Pacific Islands, and the Caribbean. In these places, the food is low in protein and high in carbohydrates.
  • It causes leakage of the┬ácell membrane, releasing the intravascular fluid and proteins. This results in edema.
  • It weakens the immunity of a person, making him susceptible to diseases.

Secondary PEM

  • Caused due to disorders in the gastrointestinal tract.
  • It can be caused due to infections, hyperthyroidism, trauma, and other critical illnesses.
  • Decreases appetite and impairs nutrient metabolism.

Symptoms of Protein Energy Malnutrition

The symptoms of protein-energy malnutrition or PEM are as follows:

  • Apathy and irritability
  • The patient becomes weak and inefficient.
  • Impaired cognition and consciousness.
  • Temporary lactose deficiency
  • Diarrhea
  • Gonadal tissues atrophy
  • Causes amenorrhea in women
  • Causes libido in both men and women
  • Weight loss
  • Shrinking of muscles
  • Protrusion of bones
  • The skin gets thin, pale, dry, inelastic, and cold
  • Hair fall
  • Impaired wound healing
  • Risk of hip fractures and ulcers increases in elderly patients
  • Heart size and cardiac output decreases in severe cases
  • A decrease in respiratory rate and vital capacity
  • Liver, kidney, or heart failure
  • Acute PEM might also prove fatal

Treatment of Protein Energy Malnutrition

  • Oral feeding.
  • Avoiding lactose.
  • Supportive care.
  • Poverty reduction.
  • Improving nutritional education and public health measures.
  • Multivitamin supplements.
  • Treat infections and fluid and electrolyte abnormalities, in severe cases.