Protein Energy Malnutrition

1. Faculty of Food Science & Technology.
Chittagong Veterinary and Animal Sciences University
Khulshi, Chittagong - 4202

2. An impairment of health resulting from a deficiency,
excess or imbalance of nutrients.
Major Nutritional Problems :
1. PEM
2. IDA
3. IDD
4. VADD
Awareness ribbon for Malnutrition

3.  PEM is a range of pathological condition arising
out of coincident lack of protein & energy in
varying proportions, must frequently seen in
infants & young children usually associated with
infections.
Types:
1.Marasmus
2.Kwashiorkor
3.Marasmic Kwashiorkor

4. 1.Low weight – < 60%
2. Muscle wasting
3.Old person’s face
4.Pot belly
5.Wheezing
6.Bony prominences
7.Hunger
8.Crying weak & shrill
9.Irritability
10.Skin appears loose

6. Skin appears looseBony Prominence Crying weak & shrill

7. 1.Oedema
2.Moon face
3.Moderately low weight
4.Poor appetite
5.Misery & apathy
6.Skin lesions
7.Depigmented hair, easy to pull
8.Enlarged liver
9.Swollen eyes

8. Pale hair
Oedema in leg
Poor Appetite
Moon face

9. Distended abdomen
Skin lesions

10. 1.Growth retardation
2.Muscle wasting
3.Oedema
4.Lethargy
5.Pale skin & hair
6.Loss of subcutaneous fat
Marasmic Kwashiorkor
Lethargy

11. Insufficient access to food
Inadequate maternal & child care
Inappropriate weaning practices
Inappropriate infant formula
Infections
Famine
Short interval between birth
Twin
Inadequate health services

12. 1. Diarrhoea
2. Dehydration
3. Infections
4. Hypoglycemia
5. Hypothermia
6. Hyponatremia
7. Heart failure
8. Anorexia
9. Anemia
10.Other nutritional deficiencies

13. 1. Medical
• Dehydration
• Infection
• Body temperature
2. Dietary
• Feeding
-Early recovery
-Catch-up growth
-Return to family food
• Vitamin & mineral
3. Social and emotional
4. Educational

14. F-75
75kcal or 315kj/100ml
Initial phase treatment, 130ml/kg/d
Feed q 2-3hr (8 meals/d)
F-100
100kcal or 420kj/100ml
Feed q 4-5 h (5-6 meals/d)
Rehabilitation phase (appetite returned)

15. F-75 F-100
 Dried skimmed milk 25g 80g
 Sugar 70g 50g
 Cereal flour 35g -
 Vegetable oil 27g 60g
 Mineral mix 20ml 20 ml
 Vitamin mix 140ml 140 ml
 Water 1l 1l
 Protein 0.9g 2.9g
 Lactose 1.3g 4.2g
 K 3.6mmol 5.9mmol
 Na 0.6mmol 1.9mmol
 Mg 0.43mmol 0.73mmol
 Zn 2.0mmol 2.3mmol
 Copper 0.25mg 0.25mg
 Osmolarity 333mOsmol/l 419mOsmol/l
 Energy from protein 5% 12%
 Energy from fat 32% 53%