Protein-energy malnutrition is a group of disorders caused by lack of protein or calories. It includes kwashiorkor, marasmus, and marasmic kwashiorkor. Kwashiorkor is caused mainly by lack of protein and is characterized by edema and moon face in children over 1 year old. Marasmus is caused mainly by lack of calories and results in emaciation and a simian face in children under 1 year. Marasmic kwashiorkor shows features of both. Treatment involves managing infections, providing nutrient-rich foods, and educating mothers.

1. Protein - Energy Malnutrition
Md. Sajib Al Reza
Lecturer
Nutrition and dietetics
College of Nursing Science Dinajpur
Dinajpur, Bangladesh
Email: sajib.ftns2010@gmail.com

2. PROTEIN ENERGY MALNUTRITION
It is a group of body depletion disorders which include
kwashiorkor, marasmus and marasmic kwashiorkor.
* KWASHIORKOR:
Mainly due to lack of protein intake
* MARASMUS:
Mainly due to lack of primarily calorie/energy intake
and secondarily protein intake.
* MARASMIC KWASHIORKOR:
• Children have both features of kwashiorkor and
marasmus.

3. Early abrupt weaning
Dilute dirty formula
Repeated infections
[gastroenteritis-
inflammation/lesion of the stomach
due to salmonella]
Starvation therapy
Marasmus
BIRTH Breast feeding
Urbanizing influences
pregnancies in rapid
succession
Late gradual weaning
Starchy family diet
Acute infections
Kwashiorkor
Marasmic
kwashiorkor
12 or >12 months
 5-12 months

4. • Mainly protein deficiency
• It effects children more than one year.
• Mainly characterized by edema and moon face.
CAUSES:
1. Early weaning with low protein diet (starchy diet no
protein, milk)
2. Repeated infections. eg. communicable disease like
diarrhea.
3. Ineffective weaning

5. 1. Edema
2. Moon face
3. Skin changes / flaky paint
dermatitis
4. Hair changes
5. Fatty infiltration in liver
6. Diarrhea
7. Poor growth
8. Wasting
9. Anemia
10. Apathetic / lethargic

7.  Accumulation of fluid causes
swelling
 Starts with a light swelling in the
feet and spread up to the legs.
 Later hands and face also swell.
Detection procedure:
 Pressing the skin with fingers.
 A depression can be seen at the
place where pressure is applied.

8. • Puffy or swollen face because of accumulation of
fluid/edema or fatty tissue.
• Appears round like so called moon face.

9.  Characterized by extensive flaking and
pigmentation mostly in sun unexpected areas.
 The skin becomes thick and varnished.
 It gets peeled off.
 The skin lesion first occur in areas subject to
friction or pressure. eg The groin, behind the
kness, on the buttocks, and at the elbows.
 Darkly pigmented patches form and these
may peel rather like sun baked blistered paint.
 This has leading to the term peeling paint or
flaky paint dermatosis.

10.  Hair of normal asian child is dark, black, coarse in
texture and reflects light.
 In kwashiorkor hair become –
- thin
- lack of luster
- dull and lifeless
- Easily pluckable without pain
- Change to raddish color

11. • Liver becomes enlarged
(hepatomegaly)
• Fatty liver has yellow greasy
appearance and is often enlarged
and swollen with fat.
• Fatty liver occurs when excess fat
accumulates inside liver cell.
• The healthy liver replaced with
fatty tissue.
• Cause: the liver burns fat less
efficiently resulting the liver to
enlarged.

12.  Stools are frequently loose.
 Contain undigested particle of food.
 Have offensive smell
 Have watery and tinged with blood

13.  A child loses weight and fails to grow.
 Loss in weight is less severe than in marasmus.
 Weight loss and growth failure can not marked due to
edema.

14.  Muscle wasting is present but not be evident because
of edema.
 Childs arm and legs are thin because of muscle
wasting.

15. • Mainly primarily calorie / energy deficiency and secondarily
protein deficiency
• It effects children less than one year.
• Mainly characterized by muscle wasting/ emaciated (skin &
bone) and monkey face / simian..
CAUSES:
1. Early weaning with very low calorie diet (rice water, gaggary
dilute milk)
2. Repeated infections. eg. communicable disease like diarrhea.
3. Ineffective weaning

16. 1. Wasting
2. Appetite
3. Poor growth
4. Alertness/irritable
5. Diarrhea
6. Anemia
7. Skin sores/wrinkles
8. Hair changes

18.  The loss of flesh is obvious. so skin becomes wrinkled
 The belly is contrast to the rest of the body
 Looks highly emaciated with all skin & bone
appearance sunken eyes, prominent ribs.
 Hence it is called wasting disease.
 The face has a characteristics simian (monkey like)
appearance.

19.  The child has a good/increased appetite.
 Children violently suck their hands or clothing or
noises.

20.  Child becomes irritable.
 The child cries continuously due to extremely
weakness.

21. * In all cases the Childs fails to grow properly due to
protein and energy deficiency.
* Weight will be found to be extremely low by normal
due to loss of muscle.

22.  A marasmus child has frequent watery stools.
 Child gets dehydrated.

23.  There is no flaky pain dermatosis.
 Skin are wrinkled.
 There may be pressure sores over bony prominence.

24.  Hair are normal in child of marasmus.
 Marked change in texture than of color.

27. Features Kwashiorkor Marasmus
Age of onset More than 1 year Less than 1 year
Deficiency Protein Calorie , protein
Edema Present Absent
Cause Early weaning with low protein
food
Early weaning with low
calorie food
Appearance Look plump (sufficiently fatty)
, moon face
Emaciated, all skin &
bone, Monkey face
Appetite Decrease Increase
Skin and hair Skin: Lesion are seen/ flaky
paint darmatosis.
HAIR: pale, thin, brown
Normal
Muscle wasting Present but cannot make out
due to edema.
Marked
Liver Enlarged, hepatomegaly Normal
Serum albumin Decrease Normal

28.  Treat the associated infection.
 Provide energy and protein rich food.
 Proper educating the mother
 Provide protein & calorie : 2g/ kg BW/ day & 150
kcal/ kg BW/ day.
 .

30. The End
. . .