Protein Energy Malnutrition (PEM)

Protein Energy Malnutrition (PEM)

Protein Energy Malnutrition is a form where there is inadequate from protein and energy intake. Marasmus and Kwashiokhor diseases very often attack in PEM case. Marasmus is a form of Protein energy malnutrition caused by energy and nutrients deficiency. While Kwashiorkhor is form condition caused by protein deficiency. Marasmic Kwashiorkor (marked protein deficiency and marked calorie insufficiency signs present, sometimes referred to as the most severe form of malnutrition).

Classification to diagnosis protein energy malnutrition :

1. Quac Stick.  The other perception to diagnosis malnutrition, The arm circumference was compared with the height of the individual and grades of malnutrition were identified in accordance with the percentage reduction in the arm circumference. A height measuring stick is marked off in arm circumference measurements (80% and 85% of normal) against height.  It compares mid-arm circumference with the height of the child.  
   
2. Wellcome classification is one such simple method for the diagnosis of clinical malnutrition.   
   
3. The Gomez classification (1950) as a method of diagnosing mild-moderate forms of malnutrition in the community and for the early identification of marasmus.
   The classification is based on weights of healthy American children under the age of 5 years, and the fiftieth percentile is taken as the standard. Malnutrition is graded into three degrees of increasing severity according to the percentage reduction in weight from the standard. First-degree malnutrition < 80% of the standard ,  Second-degree malnutrition < 70% of the standard, Third-degree malnutrition < 60% of the standard.
4. World Health Organization
   has developed a weight chart for international use.

 Diseases of Protein and energy malnutrition

1. Kwashiorkhor is form condition caused by protein deficiency. It presents with failure to thrive, edema, apathy, anorexia, diarrhoea and discoloration of the skin and hair. Sometimes they also called red baby. Edema is a clinical sign of kwashiorkhor. It appears first on the dorsum of the feet and ankles and spreads upwards to involve the rest of the body
   

   

   Kwasiorkhor

2. Marasmus  This usually occurs in younger children, with failure to thrive. Affected children are short and light for their age. In appearance they are shrinking and wizened due to lack of subcutaneous fat.

Marasmus

Source :
Mother and Child Nutrition in the Tropics and Subtropics. Chapter 7. Protein-energy Malnutrition
http://www.merckmanuals.com/professional/nutritional_disorders/undernutrition/protein-energy_undernutrition.html