what is protein energy malnutrition? definition Protein calorie malnutrition epidemiology and prevalence types classification sign and symptoms treatment

1. PROTEIN ENERGY MALNUTRITION

2. Contents:
• Introduction
• Definition
• PCM
• Epidemiology in Pakistan
• Types
• Classification
• sign and symptoms
• Treatment
• reference

3. Malnutrition
Mild, moderate, severe
(kwashiorkor)
Poverty
Insufficient supply of protein,
energy or micronutrient
Unhealthy environment
Severe or frequent infection,
diarrhea or pneumonia
lack of awareness
among women
Insufficient household
security
Insufficient
Maternal care
Malfunctioning of
society
Injustices, war, famine,
natural disasters like
earthquake, floods etchttps://data.unicef.org/topic/nutrition/malnutrition/

4. Definition of PEM:
“A condition resulting from long-term inadequate
intakes of energy and proteins that can lead to
wasting of body tissues and
increase susceptibility to infection.”
Therapeutic pediatric nutrition

5. Protein calorie Malnutrition:
• It is called protein calorie malnutrition
• Children between 6 to 36 are more at risk
• Electrolyte imbalance, hypothermia and complicating infection of
some of the causes of mortality

6. USAID survey 2013

8. Acute PEM Chronic PEM
Children who are thin for their
height may be suffering from acute
PEM.
children who are short for their age
have experienced
Types:
Understanding normal and clinical NUTRITION

10. Appearance Signs and symptoms
Body Especially buttocks, arms and legs
Subcutaneous fat layer
Hairs Thin, sparse, brittle, turns dull brown, red
giving flag sign appearance
Nail Fissures or ridges and increased fragility
Abdomen Edema, hepatomegaly and abdomen appear
distended
Mouth Signs of vitamin b deficiency-cheilosis,
angular stomatitis
Skin Dry, hyper-pigmented plaques
Nutrition and Growth

12. Classification:
• Marasmus
• Khawashirkor
• Marasmus and kwashiorkor

13. Marasmus:
• Derived from marasmos “Greek word”
• Gross wasting of muscles subcutaneous tissues
• Marked stunting but no edema
• Growth: <60% weight-for-age
• Infancy (less than 2 yr)

14. Marasmus
Prolonged
starvation
chronic
Infections
Limited food
intake

15. Kwashiorkor
• Kwashiorkor is a Ghanaian word that refers to the birth position of
a child.
• sets in between 18 months and two years
• develops rapidly as a result of protein deficiency
• Older infants and young children (1 to 3 years)

16. Kwashiorkor
Sudden
(acute PEM)
Edema
Inadequate
Protein intake

19. Marasmus-Kwashiorkor Mix:
• characterized by the edema of kwashiorkor with the wasting of
marasmus.
• the child suffers the effects of both malnutrition and infections.
• marasmus represents the body’s adaptation to starvation and that
kwashiorkor develops when adaptation fails.

20. Rehabilitation:
 The life of starving child may be saved with rehydration and
nutrition intervention.
 During first 24-48 hours, fluid and mineral losses are replaced to
help raise the blood pressure and strengthen the heartbeat.
 The child should be kept in warm and practiced “bedding in” with
the mother.

21. Treatment:
Vitamin deficiencies:
• Vitamin A supplements can be given in all cases
• Vitamin k supplements can be given in diarrhea condition
• All B-complex vitamins, vitamin C,E,D are too administered along
with calcium

22. Energy:
 Diet should have enough calories ,otherwise protein will be utilized
for energy and not for building the tissue.
 For children less than 2 years, 200kcal/kg body weight should be
given.
 For older children, 150 to 175kcal/kg body weight.
 50% of Total calories should be from carbohydrates.

23. Proteins:
Animals protein: 10% of total calories
 Legumes and cereals protein: 13-14% of total calories
 Protein and food energy may given in small amounts several times
a day, with intakes gradually increases as tolerated.
 Severely malnourished people recover better with an initial diet that
is relatively low in protein.

24. Fats:
 40% of total calories can be from fat which can be tolerated by
children.
 Saturated fat like butter, milk, coconut oil are preferred.
 Unsaturated fat worsen diarrhea.

25. Dietary Management:
• High energy intake to fulfill protein requirement
• Milk protein powder
• Oil for energy along with sugar
• Medium chain triglyceride
• Calories 150-200 per kg/d

26. Stabilization phase:(initial phase)
• Small frequent feed so flow osmolarity (<350) mOsm/L
• F-75 formula to provide 75 cals /100mland 0.9g protein per 100 ml of feed
• Should be feed by cup and spoon
• Low lactose (<2-3g/kg/d)
• Oral or naso-gastric feed
• 100cal/kg/d (not to exceed in initial phase)
• 1.0-1.5gprotein/kg/d
• 130ml/kg/do liquid(maybeginwith100ml/kg/d if edema present)
• Feed should be of low viscosity, easy to prepare and socially acceptable
• Continue breast-feeding if already doing so

27. Catch-up growth phase:
• Rehabilitation phase
• Replace F-75 by F-100 which contain 100/cal and 2.9g protein per 100ml
• Increase feed by 10-20ml and finally25-30ml/kg/feed
• Monitor respiration and pulse rate
• Increase F-100 at least 3-4hourly
• Calories given-150-200kg/d
• Protein in creased4-6g/kg/d
• Continue breast-feeding
• Vitamin A does for 6months