Protein energy malnutrition (PEM) is a major health problem in India, commonly affecting preschool children. PEM occurs in two forms: kwashiorkor, characterized by edema and a protein deficiency; and marasmus, involving deficiencies of both protein and calories leading to severe muscle wasting. Prevention and treatment of PEM focuses on nutritional education for mothers, immunizing children, oral rehydration therapy for diarrhea, growth monitoring, and dietary management including adequate protein, calories, fats, vitamins, and minerals.

1. AMIR NAZIR
PEM
Protein Energy
Malnutrition

2. Protein energy malnutrition:-
It is a major health and nutritional problem
in India.
PEM is common in preschool children and
incidence is 1-2%.

3. PEM occurs in two clinical forms
1)Kwashiorkor: In this, there is a deficiency of
protein only. It occurs in children of age 1-3 years
after arrival of next sibling. The older child is put
on high carbohydrates and low-protein diet.
2) Marasmus: There is deficiency of protein as well
as carbohydrate due to lack of protein as well as
enough food to eat for meeting caloric requirement

6. PEM
Characteristics Kwashiorkor Marasmus
EDEMA Present on lower limbs, lower
arms and face, potbelly
Not present
MUSCLE WASTING Muscle wasting is there but
may be hidden by edema and
fat
Severe muscle wasting is present.
FAT LOSS No fat loss .Severe loss of subcutaneous fat due to
lack of calories
APPEARANCE OF FACE Moon face due to edema,
cheeks may be swollen due
to accumulation of fluid and
fatty tissue.
Monkey like face appearance, wrinkled
face giving appearance like old man.

7. Appetite Poor Usually good, but child does not get sufficient
food to eat
ANEMIA Anemia is present
due to deficiency of
protein, iron and vit A
and B Complex
deficiency are also
found
Anemia present along with the
deficiency of some other micro
nutrients, e.g. vit A, and vit B
deficiency.
MENTAL CHANGES
Mental
development
arrested, child may
loose interest,
becomes irritable
and apathetic.
Mental development arrested
along with physical growth,
child becomes irritable and
apathetic

8. Weight or height Retarded growth Severe growth retardation
Skin changes
Dry, flaky,
peeling and
pigmented
skin
Skin changes rare
● HAIR CHANGES Thin, dry,
brown hair,
easily plucked
Hair changes are common

9. Liver Enlarged with fatty
changes
Liver mildly enlarged but no fatty changes.
Biochemical changes Low serum
albumen, low
immune system
response, reduced
enzyme activity,
moderate
deficiency of
potassium
Severe potassium deficiency, normal enzyme activity, normal immune
system, response slightly, decreased serum albumen
● Treatment response Fairly good and
rapid recovery with
increase in protein
intake in diet
Takes longer time to recover.

10. Prevention and treatment of PEM:
Nutritional education to the mothers about child's
nutrition: Mothers should be taught during
micronut the antenatal periods about the
importance of exclusive breastfeeding up to 6
months of age and Diseases thereafter introduction
of supplementary foods along with breastfeeding.
Immunization of children: Infants and children
must be immunized at prescribed age

11. Treatment of diarrhea: Use of oral rehydration
therapy. Mothers should be taught how to prepare
ORS at home and give to child in case of diarrhea
to prevent dehydration.
Maintain growth chart at home: Mothers should be
educated to make record of height and weight
according to the growth chart, So that they can
recognize the signs of malnutrition

12. Nutritional management: Daily diet in case of PEM
should contain:
.Protein: 3-4 g/kg body weight. Foods. Eggs, milk,
pulses, soybean and nuts, cereal and fats should be
included in diet.
.Energy: 170-200 kcal/kg body weight/day.
.Fats: 15-20% of total calories should be from fats
such as milk, butter, coconut, oil, etc.
Vitamin and mineral should be given liberally

13. THANK YOU