Protein energy malnutrition

It is important topic which needs to be understand by students and i am using for teaching to VI semester mbbs students. i think it will give a brief idea about protein energy malnutrition.

1. PROTEIN ENERGY MALNUTRITION
Class by Dr.BikashDebbarma
PGT, Community Medicine Department, RIMS
21/10/2019

2. MALNUTRITION
UNDER
NUTRITION
OVER
NUTRITION
PROTEIN ENERGY
MALNUTRITION (PEM)

3. •PEM is a type of malnutrition resulting
from deficiencies of proteins and calories
in the food over a long period of time
•It is also referred as Protein caloric
malnutrition
•In India-1
st
National Nutritional Disorder
•PEM is due to ‘food gap’ between the
intake and requirement
•Mainly problem of all developing nations

4. •In India, the incidence of extreme forms of
PEM is 2%
•It accounts for 5% of deaths among pre-
school children
•Vulnerable population-Infant & young
child, under five, pregnant mother,
Lactating mother and elderly
•Infants & under 5 children are hit hardest
(they are in the stage of rapid growth and
development)

5. CAUSES of PEM
•PEM is not only the health problem but also a
social and economic problem
•Multifactorial in origin
Food (inadequate diet both in quantity and
quality)
Social and economic factors
Biological factors
Environmental factors
Role of free radicals and aflatoxin
Age of the host

6. Fig. 2: Vicious cycle of malnutrition
Growth failure
(Lowered
immunity)
Anorexia, loss
of nutrient
Infection
(Increased
morbidity)
Malnutrition
(Decrease in
take of food)
PEM

7. Decreased intake of food
-Inadequate diet both in quantity and quality
Excessive loss of proteins and calories
-Because of vomiting, diarrhoea
Increased demand and deceased absorption
and utilization
-Infections and infestations
Causes-Mechanism of PEM

8. Causes-Social and economic, Biological
and Environmental factors
Poverty
Illiteracy
Ignorance
Overcrowding
Large family
Poor maternal
health
Failure of lactation
Faulty feeding
Improper weaning
Food taboos
Fault belief
Cooking & cultural
practices

9. Adverse effects of PEM
Growth failure
Breakdown of immunity
Increased susceptibility to infection
Delayed recovery
Impaired mental of mental capacity and
motor skills
Decreased alertness and physical capacity

10. Classification of PEM
•A. Clinical classification
1.Kwashiorkor
2.Marasmus
3.Marasmic-kwashiorkor
•B. Anthropometric methods of grading
malnutrition
1.Grade I –mild malnutrition
2.Grade II –moderate malnutrition
3.Grade III –severe malnutrition
4.Grade IV –very severe malnutrition

11. Different methods of grading of malnutrition
1.Welcome’s classification
2.Gomez classification
3.Jellife’sclassification
4.Indian Academic of Paediatrics
5.Waterlow’sclassification

12. Features Kwashiorkor Marasmus
Cause (deficiencies) Mainly proteins Mainly calories
General conditionDull, disinterest, slow Active, alert but irritable
Face Bloated moon like Shrivelled monkey like
Weight loss Moderate Very severe
Muscle wasting Masked (present but not seen)Obvious(skin & bone)
Fat wasting Nowasting (retained) Severe (loss of SC fat)
Edema Always present Absent
Hair changes Flag sign+ve, loss of curliness,
easily pluckable, sparse
Change in texture, thin &
silky, flag sign -ve
Skin changes Paint like patches (flaky)Absent (normal appearance)
Mental changes Present Absent
Liverchange Often enlarge Absent
Serum total proteinsReduced Normal
Serum cholesterolReduced Normal
Urinary nitrogen Reduced Raised
Prognosis Bad Good
Table 1: clinical presentation of Kwashiorkor vs Marasmus

13. KWASHIORKOR vs MARASMUS

14. Table 2: Welcome’s classification of PEM
Body weight (% of
referenceweight for
age)
Edema
Present Absent
80-60 Kwashiorkor Undernutrition
<60 Marasmic-
kwashiorkor
Marasmus
Table 3: Master chart of classification of PEM
Grade/
Degree
Weight forage in percentage Waterlow(%)
Gomez Jelliffe IAP Ht. for ageWt. for ht.
Normal 90-110 >90 100-80 >95 >90
Mild (1
0
) 89-75 90-81 79-70 94-87.5 90-80
Moderate (2
0
) 74-60 80-71 69-60 87.4-80 80-70
Severe (3
0
) <60 70-61 59-50 <80 <70
Very severe (4
0
) - <60 <50 - -

15. •A drop ‘height for age’ ratio indicates-
stunted growth or ‘Chronic malnutrition’
•A drop in ‘weight for height’ ratio indicates
–wasting or ‘Acute malnutrition’
According to Waterlow’s
MALNUTRITION
Weight for age to assess degree of
‘underweight’ –an indicator of
Acute malnutrition

16. Laboratory investigations
1.Serum protein (albumin)
2.Urine albumin and sugar, Urine R/E, C & S
3.Serum electrolytes
4.Haemoglobin estimation
5.Blood sugar estimation
6.Stool for ova and cyst
7.Mantouxtest
8.X-ray chest
9.ECG and Scanning if necessary

17. Management of a case of PEM
A)Early diagnosis & prompt treatment:
1.Underlying infection & infestation
2.Adequate diet -150 Kcal energy/day, 3 to 4
gm protein/ kg body weight/day and small
& frequent amounts
3.Others underlying causes

18. Management of a case of PEM
B) Advice to the mother for prevention of
recurrence of malnutrition in the child
1.Growth monitoring regularly
2.Oral rehydration therapy for diarrhoea
3.Breastfeeding –exclusively
4.Immunization –to be complete
5.Family planning -use appropriate methods
6.Health education-hygiene, illness, diet

19. Prevention
& control of
PEM in the
community
Health promotion
1.Nutritional care PW
& Lactating
2.Family planning
3.Breast feeding
4.Supplement feeding
5.Frequent feeds
6.Improvement of
living conditions
7.Hygiene
Rehabilitation (mother oriented)
1.Local diets & preparation
2.NIN recommended the mixture of
wheat, roasted Bengal gram,
groundnuts & jaggery(it provides 11.3
g & 330 kcals energy per day)
Disability Limitation
1.Giving intensive
treatment
2.Hospitalization
3.Follow-up
Specific protection
1.Protein & energy rich
diet for growing child
(milk, egg, fruits etc)
2.Immunization
3.Fortification of food
Early diagnosis & treatment of PEM
1.Maintenance of ‘Road to Health’
2.Infections & infestations
3.Periodical deworming
1
2
3
4
5

20. Thank You