Protein-energy malnutrition (PEM) and obesity are both types of malnutrition that result from imbalances in nutrient intake and energy expenditure. PEM specifically refers to deficiencies in protein and calories over long periods and can manifest as kwashiorkor or marasmus. Obesity is defined as abnormal or excessive fat accumulation that presents health risks. Groups vulnerable to PEM include children, pregnant/lactating women, older adults, and those with chronic illnesses. PEM is diagnosed based on growth monitoring, dietary history, and anthropometric measurements. Prevention focuses on nutrition education, supplementation, and treating infections early. Risk factors for obesity include age, genetics, physical inactivity, diet, and socioeconomic status. Obesity is assessed using body mass index

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Topic : Protein Energy Malnutrition &
Obesity
By:
Priyanka Das
&
Dethangring Nunisa
(4th B.H.M.S)
Assam Homoeopathic Medical College and Hospital, Nagaon
Dept. of Community Medicine

2. MALNUTRITION
Definition: Excess or deficiency of nutrient rich food in diet is called malnutrition.
According to WHO, Malnutrition is define as "the cellular imbalance
between the supply of nutrients and energy and the body's demand for them to
ensure growth, maintenance and specific functions
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3. Malnutrition
Under Nutrition
Protein Energy
Malnutrition
Marasmus Kwashiorkor
Over Nutrition
Obesity
Flow chart of malnutrition:
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Protein-Energy Malnutrition
Protein-energy malnutrition is a type of malnutrition resulting from deficiency of
proteins and calories in the food over a long period of time.
The most serious forms of PEM are kwashiorkor and marasmus. Nutritional
marasmus is more frequent than kwashiorkor.
Causes:
• Decreased intake of food
• Excessive loss of proteins and calories
• Increased demand and decreased absorption and utilization.
• Infection contributes to malnutrition & malnutrition pre- disposes to causation of
infection
• Social factors: such as poverty, illiteracy, ignorance, overcrowding, large family size,
poor maternal health, failure of lactation.

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Features Marasmus Kwashiorkor
CLINICAL ALWAYS PRESENT
Muscle wasting Obvious Sometimes hidden by oedema and fat
Fat wasting Severe loss of subcutaneous fat Fat often retained but not firm
Oedema None Present in lower legs, and usually in face and lower
arms
Weight for height Very low Lower but may be masked by oedema
Mental changes Sometimes quiet and apathetic Irritable, moaning, apathetic
CLINICAL SOMETIMES PRESENT
Appetite Usually good Poor
Diarrhoea Often (current and part) Often (current and past)
Skin changes Usually none Diffuse pigmentation, sometimes flaky paint
dermatosis
Hair changes seldom Sparse, silky, easily pulled out
Hepatic enlargement None Sometimes, due to accumulation of fat
Principal Features of Severe PEM:
Cont.

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Features Marasmus Kwashiorkor
BIOCHEMICAL
Serum albumin Normal or slightly decreased Low ( <3g/100 ml blood)
Urinary urea per g creatinine Normal or decreased Low
Hydroxyproline /creatinine ratio Low Low
Plasma / amino acid ratio Normal Elevated
Principal Features of Severe PEM:

7. Who is vulnerable to under nutrition?
1. Groups vulnerable to under nutrition
typically include those with increased
nutrient requirements : children,
pregnant and lactating women.
2. Older people, the disabled, people with
chronic illness and People living with
HIV & AIDS.
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Malnutrition
(Decreased intake
of food)
Growth failure
(Lowered
immunity)
Infection
(increased
morbidity)
Anorexia, loss
of nutrient

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Diagnosis of PEM
The first indicator of PEM is underweight for age.
This can be measured by comparing growth
charts for different age groups.
It can be diagnosed by identifying dietary history
of the patient.
Anthropometric measurement of body should
be examined.
Mid-arm circumference (MAC) has been
extensively used at 1-5 years of age as an age-
independent indicator of protein-energy
malnutrition (PEM).

9. Prevention and control of protein-energy malnutrition in the community
 Health promotion:
• Nutritional care of pregnant mothers to prevent LBW.
• Nutritional care of lactating mothers to prevent subsequent malnutrition
during infancy and childhood.
• Promotion of correct breastfeeding practices.
• Frequent feeds to a growing child.
• Improvement in the living condition.
• Supplementary feeding program for mothers and children.
 Specific protection:
• Protein- and energy-rich diet for a growing child (i.e. diet containing milk, egg,
fruits, etc.)
• Immunization
• Fortification of food
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10.  Early diagnosis and treatment of PEM:
• Periodic surveillance
• Early diagnosis of any lag in growth
• Early diagnosis and treatment of infections and diarrhoea
• Development of programmes for early rehydration of children's with
diarrhoea.
• Development of supplementary feeding programmes during epidemics.
• Deworming of heavily infested children.
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11. OBESITY
Definition: it is a type of nutritional disorder, due to imbalance between energy
intake and energy expenditure, resulting in positive energy balance, characterized
by the abnormal growth of the adipose tissue, resulting in an increase in the body
weight to the extent of 20% or more of the standard weight for the person's age,
sex, and height.
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12. Risk Factors:
• Non modifiable:
1. Age: obesity can occur in any age-group, generally it increases with age.
2. Sex: obesity is more among the women, especially during the postmenopausal age,
between 45 years and 49 years.
3. Genetic factors: obesity tends to run in families, with obese children frequently having
obese parents.
• Modifiable
1. Physical activity: The physical activity pattern (including occupational work, household
work, and leisure time activity, such as sports and exercise) determines the food intake
and fat balance.)
5. Socioeconomic status: high socioeconomic status correlates positively with obesity in
the developing countries.
6. Eating habit: the composition of the diet, the periodicity of eating, and the amount of
energy obtained are relevant to the development of obesity.
7. Psychological factors: People who are under constant emotional strain find satisfaction
in eating the food.
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13. Assessment of obesity:
• Corpulence Index:
• Body Mass index:
Note: Indian cut-off point for obesity is N=BMI=22.5 and globally 25
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Corpulence Index=
𝐴𝑐𝑡𝑢𝑙 𝑤𝑒𝑖𝑔ℎ𝑡 𝑜𝑓 𝑡ℎ𝑒 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙
Exp𝑒𝑐𝑡𝑒𝑑 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 (𝐸𝐵𝑊)
BMI =
𝑊𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑘𝑔
(𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚)2

14. • Waist Circumference:
This helps to measure abdominal fat. It is measured at a midpoint between
the lower border of the rib cage and the iliac crest. Waist circumference is
observed to be high among men with a waist circumference >102 cm and among
women >88cm.
• Waist-Hip Ratio:
It is accepted that WHR of more than 1.0 in men and 0.85 in women
indicates abdominal fat accumulation.
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15. Health problem associated with obesity:
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Greatly increased Moderately increased Slightly increased
(RR>3)
NIDDM
(RR 2-3)
Coronary Heart disease
(RR 1-2)
Cancer
Gallbladder disease Hypertension Impaired fertility
Dyslipidaemia Osteoarthritis Low back pain
Insulin resistance Hyperuricemia and gout Fatal defects associated
with maternal obesity

16. Prevention and control:
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1. Dietary changes:
• Refrain from over consumption of fats and carbohydrates.
• Diet should contains suitable proportion of cereals, legumes and vegetables,
fibre content should be increased.
• Food energy intake should not be greater than what is necessary for energy
expenditure.
2. Physical activity:
• Regular physical activity helps in increasing the energy expenditure, so
sedentary lifestyle should be discouraged.
3. Health Education:
• People are educated about hazard of obesity and its prevention by healthy diet
and lifestyle diet and lifestyle, to be promoted from early age.
4. Bariatric Surgery:
• Among those whose BMI is>40 & is not possible to control obesity with the
routine measures of exercise and change in the lifestyle practices.

17. EAT WELL FEEL WELL LOOK WELL
THANK YOU
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