INTRODUCTION TO PEM.pptx

1. Presented By :
Mr:Abdirahman
Yusuf ALi.
Master Public health(Nutrition)
Abdirahman Yusuf Ali
1

2.  Food is anything edible that provides the body
with nutrients.
 Nutrients are chemical substances in food that are
released during digestion and provide energy to
maintain, repair or build body tissues. Nutrients
include macronutrients and micronutrients.
– Macronutrients include carbohydrates, protein and
fat (needed in large amounts).
– Micronutrients include vitamins and minerals
(needed only in small amounts).
DEFINITION OF FOOD
2
Abdirshman Yusuf

3. DEFINITION OF NUTRITION
 Nutrition is The
process of
providing or
obtaining the
nutrients
necessary for
health and
growth.
3
Abdirshman Yusuf

4. MALNUTRITION
Malnutrition is the condition that
develops when the body does not get
the right amount of the vitamins,
minerals, and other nutrients it needs
to maintain healthy tissues and organ
function.
Definitions

Abdirahman Yusuf Ali
4

5. Meaning of Malnutrition
Malnutrition refers to deficiencies, excesses, or
imbalances in a person’s intake of energy and/or
nutrients.
The term malnutrition addresses 3 broad forms:
• Undernutrition, which includes wasting (low
weight-for- height), stunting (low height-for-age)
and underweight (low weight-for-age);
• Micronutrient-related malnutrition, which
includes deficiencies or excessive vitamins and
minerals
• Over-nutrition which includes overweight and
5
Abdirahman Yusuf Ali

6. 6
Abdirshman Yusuf

7. In other words; malnutrition is when the
body does not have enough of the required
nutrients (under-nutrition) or has excess of
the required nutrients (over-nutrition).
Under-nutrition Over-nutrition
7
Abdirahman Yusuf Ali

8. Categories of Malnutrition
 There are two categories of malnutrition:
a. Acute Malnutrition
b. Chronic Malnutrition
Children can have a combination of
malnutrition both acute and
chronic
8
Abdirahman Yusuf Ali

9. • Acute malnutrition is a form of under-nutrition
caused by a decrease in food consumption and/or
illness that results in sudden weight loss or oedema
(fluid retention).
• Acute malnutrition can be moderate (MAM) or
severe (SAM)
• MAM and SAM are determined by the patient’s
degree of wasting and presence of bi-lateral oedema.
• SAM is further classified into: Marasmus and
Kwashiorkor. Patients may present with a
combination, known as Marasmic Kwashiorkor
a. Acute Malnutrition
Abdirahman Yusuf Ali
9

10. b. Chronic Malnutrition
Abdirahman Yusuf Ali
10
 Refers to prolonged malnutrition that may begin
in the prenatal period and continue over the
lifetime of a child. This can lead to significant
developmental and cognitive deficits and
significantly increases the risk of death.
 Chronic undernutrition is manifested as
stunting and underweight
 Chronic malnutrition is determined by a patient’s
expected height for a given age

11. Causes of Malnutrition
 Infection and disease
 Commonly seen in children in low socio-economical areas
 E.g. malaria, whooping cough, diarrhoea
 Inadequate food supply
 Impacts vulnerable groups [children, lactating female, elderly] on
their body composition
 Inappropriate feeding – cessation of breast feeding due to
having to return to work/caring for the family
 Child becomes malnourished as doesn’t get essential nutrients
from the milk
 Milk supplies can dry up if the mother isn’t getting enough
nutrition
 Milk powders would be mixed with unclean water – making the
child unwell
11
Abdirahman Yusuf Ali

12. Factors contributing to malnutrition
 Poverty
 Poor feeding practises [stopping feeding baby via breast]
 Lack of land
 Insufficient food production
 Ignorance on part of mothers
 Exploitation
 Diarrhoea
 No potable water
 High price of fertiliser
 Drought
 Measles
 Too many children to feed
 Lack of credit or credit too expensive to buy food
 Health care too far away
12
Abdirahman Yusuf Ali

13. Terms
 Under nutrition = inadequate food intake
[precursor of PEM]
 Protein energy malnutrition [PEM] = a
deficiency of both protein and energy [world’s
most widespread malnutrition problem] including
Kwashiorkor and Marasmus types [and possible
overlap of the two]
 Acute PEM = caused by recent severe food
restriction and characterised in children by
thinness for height [WASTING]
 Chronic PEM = caused by long term food
shortage and characterised in children by short
height for age [STUNTING]
13
Abdirahman Yusuf Ali

14. What Is Protein Energy Malnutrition?
 Protein-energy malnutrition or PEM is the
condition of lack of energy due to the
deficiency of all the macronutrients and
many micronutrients. It can occur suddenly
or gradually. It can be graded as mild,
moderate or severe. In developing countries, it
affects children who are not provided with
calories and proteins. In developed countries,
it affects the older generation.
14
Abdirahman Yusuf Ali

15. Classification Of Protein Energy
Malnutrition
 PEM can be classified into two types:
 Primary PEM
 Secondary PEM
15
Abdirahman Yusuf Ali

16. Primary PEM
 This type of protein-energy malnutrition is
found in children. It is rarely found in the
elders, the main cause being depression. It
can also be caused due to child or elder
abuse. In children, PEM is primarily of two
types:
 Kwashiorkor
 Marasmus
16
Abdirahman Yusuf Ali

17. Kwashiorkor
 Kwashiorkor is acute malnutrition that
occurs mostly in children. This condition
results from severe protein deficiencies. It
is also known as “edematous malnutrition”
because it is associated with oedema. The
patients suffering from Kwashiorkor have
an emaciated appearance all over the
body. The ankles, feet and belly swell with
liquid.
17
Abdirahman Yusuf Ali

18.  Kwashiorkor is most common in rural
areas, especially in the sub-Saharan
regions. The famine struck areas or
the areas with low food supply are
more prone to this disease. Also, the
areas where people are unaware of
proper diet and nutrition have more
cases of Kwashiorkor.
Kwashiorkor
18
Abdirahman Yusuf Ali

19. Causes of Kwashiorkor
 Protein is required by our body to repair the
cells and make new cells. It is an important
nutrient during pregnancy and a child’s growth.
Lack of proteins shuts down the growth and
normal body functions, and this leads to
Kwashiorkor. Kwashiorkor is mostly found in
countries with a limited food supply. Lack of
knowledge on a balanced diet and regional
dependence on low protein food can also
develop this condition.
19
Abdirahman Yusuf Ali

20. Symptoms of Kwashiorkor
 Following symptoms indicate the presence of
Kwashiorkor:
 Change in skin and hair colour and texture
 Loss of weight
 Swelling (oedema) of the ankles, feet, and belly
 Irritation
 Compromised immune system
 Failure to gain muscle mass
 Fatigue
 Diarrhoea
20
Abdirahman Yusuf Ali

21. Marasmus
 Weight Loss
 Fat and muscle depletion
 Most common in developing countries.
 More common than Kwashiorkor
 Prevalent in children younger than those
affected by Kwashiorkor
 Cell-mediated immunity is impaired, making
the children more susceptible to infections.
21
Abdirahman Yusuf Ali

22. Secondary PEM
 It is caused due to disorders in the
gastrointestinal tract.
 It can be caused due to infections,
hyperthyroidism, trauma, burns, and other
critical illnesses.
 It decreases appetite and impairs nutrient
metabolism.
22
Abdirahman Yusuf Ali

23. Symptoms of Protein Energy Malnutrition
The symptoms of protein-energy
malnutrition or PEM are as follows:
 Apathy and irritability
 The patient becomes weak and
inefficient.
 Impaired cognition and
consciousness.
 Temporary lactose deficiency
 Diarrhoea
 Gonadal tissues atrophy
 Causes amenorrhea in women
 Causes libido in both men and
women
 Weight loss
 Shrinking of muscles
 Protrusion of bones
 The skin gets thin, pale, dry,
inelastic and cold
 Hair fall
 Impaired wound healing
 Risk of hip fractures and ulcers
increases in elderly patients
 Heart size and cardiac output
decreases in severe cases
 A decrease in respiratory rate and
vital capacity
 Liver, kidney or heart failure
 Acute PEM might also prove fatal

24. Treatment of Protein Energy Malnutrition
Protein Energy Malnutrition can be treated in the
following ways:
 Oral feeding
 Avoiding lactose
 Supportive care
 Reduction in poverty
 Improving nutritional education and public health
measures
 Starvation can be treated by providing a balanced diet
 Multivitamin supplements
 Treat infections and fluid and electrolyte
abnormalities, in severe cases
24
Abdirahman Yusuf Ali

25.  PEM can be treated by providing a balanced
diet. The micronutrients should be taken twice,
the daily recommended allowance until
recovery.
Treatment of Protein Energy Malnutrition
25
Abdirahman Yusuf Ali