PEM in Adults. PEM in Children.

1. Protein-Energy Malnutrition
(PEM)
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2. PEM in adults:
Predominantly
NUTRITIONAL FORM
(negative energy balance)
Starvation Malabsorption Anorexia Energy
requierment
Energy
loss
loss of
appetite thyrotoxicosis,
trauma
glucosuria
GIT diseasesnutrients
uptake

3. PEM in young children
 Malnutrition in young children
is endemic in many developing
countries.
 The clinical presentation of
two severe PEM may be:
 Kwashiorkor
 Marasmus
 Marasmic kwashiorkor

4. Kwashiorkor
 The child may have a “ moon
face” and “pot belly” due to
weakness of the abdominal
muscles.
 Kwashiorkor describes
childhood malnutrition
manifesting with edema.
 The term means “the
sickness of the older child
when the next baby is born”
 It occurs most often in the
second year of life in a child
weaned from the breast on to
a carbohydrate rich diet with
very low in protein.

5. Such diet leads:
insulin & cortisol
uptake of AAs by muscles &
uptake of AAs by the liver
synthesis of
albumin
synthesis of lipoproteins
accumulation of fat
(fatty liver)
hypoalbuminemia
(edema) - " moon face"

6. Clinical implications:
 Infections due to
vitamin deficiency
 Accumulation of toxic
oxygen species leads
skin lesions with
zones of hypo-and
hyperpigmentation
 Body weight: 60-80%
of standard.
 High mortality (20-
50%)

7. Marasmus
“ Marasmic infant
lives on his own meat”
 The term marasmus is derived from
the Greek word marasmus, meaning
“dying away” and is applied to severe
malnutrition in infants.
 When energy in the diet is limited due
to inadequate food intake, a hormonal
response opposite to that seen in
Kwashiorkor.

8. Pathogenesis of Marasmus
 High plasma cortisol result in AAs
released from muscle. Results in severe
muscle-wasting with normal albumin
levels and hence no edema.
Nutrient
deficiency
(carbo-rich diet)
cortisol,
insulin
Muscle breakdown
Adequate AAs metabolism
in the liver
Normal
albumin synthesis
and Acute phase
proteins
MARASMUS

9. Clinical implications:
 “ Monkey-like face”
 Infections
 Immune deficiency
 Body weight: < 60%
of standard
 High mortality (20-
50%)

10. Clinical implications:
 “ Monkey-like face”
 Infections
 Immune deficiency
 Body weight: < 60%
of standard
 High mortality (20-
50%)