PEM Full Form

Protein-energy malnutrition is known for deficiency in the protein in the diet and there is less number of calories proportionate to it. Worldwide 250000 deaths are recorded annually in children and adults both. Most elderly people are having this disease. PEM is also considered a secondary condition related to chronic renal disease or cancer cachexia where protein is getting wasted and not producing energy. The people who do fad diets mostly found in children get this type of disease and where this is complete ignorance in the nutrition needs of a child, mostly milk allergy is responsible here and people choose to ignore other alternatives.

There are two types of Protein-energy malnutrition:-

1. Marasmus/ PEM without edema
2. Kwashiorkor/PEM with edema

Marasmus

Here PEM is defined as when there is the intake of all nutrients in an inadequate amount but there are no energy nutrients involved. In other words, you can say the wastage of muscle and also body fat depletion. This also includes hypothermia, hypotension, bradycardia, decreased metabolic rate, constipation and loss of skin turgor.

Kwashiorkor

Kwashiorkor comes under muscle atrophy, gain or maintenance of body fat. It is also described under peripheral edema, anasarca, dry and peeling skin, hypothermia, hepatomegaly, apathy and anorexia.

So there is no pathogenesis known for kwashiorkor. The word is derived from “the disease that occurs when the next baby is born” which is an African term originally. In the Initial days, it was considered that the diet consumption where protein is in less amount but the calories are in high amount. Now according to the recent evidence, dietary protein deficiency cannot be the only cause.

Patients who are suffering from hypoalbuminemia, consider this lack of protein is the reason for the disease. Other reasons for the Kwashiorkor can be immune system dysfunctioning, oxidative stress, aflatoxin poisoning and the unhealthy germs in the gut.

Mixed Marasmus-kwashiorkor

People who are having inadequate amounts of all nutrients in their diet can eventually increase the risk of infection or inflammatory state.

PEM affects not just one organ but many and this is the main cause of long term illness and also the death through micronutrient deficiencies, infection, sepsis and disease.

Evidence recorded

Currently Africa and south-central Asian countries have a high death rate from this disease including children who are aged under 5. In other countries, it is found in cancer, anorexia nervosa, dementia, chronic disease and hemodialysis. This condition is also found in newborns and infants who didn’t get enough diet through the mother’s womb itself. And 5% of people who went bypass surgery for the obesity control procedure were recorded to have this PEM disease.

Diagnosis

Diagnosis of the PEM disease is dependent on various factors. Earlier it used to be considered as there is a lack of nutrition proportion but as per the new guidelines, it indicates that it is not always the part of Protein-energy malnutrition disease. Altered Prealbumin levels and albumin levels are dependent on a number of factors i.e. how hydrated the body is, disease state, acute phase response, albumin leakages (intra-to-extra-vascular) spaces, zinc deficiency and clinical condition.

As per the latest study by the Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition, there are complete new stands to deal with malnutrition in adults. Which can be measured as weight loss, muscle loss, fat loss, fluid formation,  no handgrip strength and not enough energy.

Conclusion

So far there is no proper cause known for the PEM disease but it is considered that if there is a lack of nutrition in the diet or there is too much involvement of calories or there is too much protein and no calories in the diet can lead to PEM disease. Many people are advised at this time to take the help of the doctor and as this disease is simply due to the reason of natural behaviour and not much involvement of genes this can lead to being cured if taken care of in time.