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Protein-Energy Malnutrition (PEM)

Protein-Energy Malnutrition (PEM): Causes, Classification, and Management

Protein-energy malnutrition (PEM), also termed protein-energy undernutrition (PEU), arises from inadequate intake of protein and calories, leading to systemic dysfunction. It affects vulnerable populations globally, with distinct clinical forms and management strategies.

Classification of PEM

PEM is categorized based on etiology and clinical presentation:

Type	Key Features	Primary Deficiency
Kwashiorkor	Edema, hepatomegaly, “moon facies,” dry skin, and thin hair.	Protein (calorie intake may be normal).
Marasmus	Severe wasting, stunted growth, and loss of subcutaneous fat.	Calories (protein intake may be adequate).
Marasmic Kwashiorkor	Combines features of both (edema + wasting).	Both protein and calories.

Causes and Risk Factors

1. Primary Causes:
   • Food insecurity: Common in developing nations, particularly in children post-weaning34.
   • Chronic diseases: Cancer, HIV/AIDS, and gastrointestinal disorders impair nutrient absorption15.
2. Secondary Causes:
   • Aging: Institutionalized elderly often experience undiagnosed PEM due to poor appetite or dysphagia14.
   • Psychological factors: Anorexia nervosa or fad diets in children48.

Symptoms and Signs

General Features

• Constitutional: Apathy, irritability, weakness, and impaired cognition12.
• Physical:
  • Skin: Thin, dry, inelastic, and cold; poor wound healing12.
  • Hair: Dry, brittle, and sparse13.
  • Muscle wasting: Protruding bones (e.g., ribs, hips)14.
• Organ dysfunction: Reduced cardiac output, hypothermia, and liver/kidney failure in severe cases15.

Type-Specific Signs

Kwashiorkor	Marasmus
Edema (abdominal, peripheral)	Severe weight loss (≥20% of expected)36.
Hepatomegaly	Stunted growth
“Moon facies”	Loss of subcutaneous fat

Diagnosis

1. Clinical Assessment:
   • Anthropometrics: BMI, mid-upper arm circumference, and weight-for-height13.
   • Physical exam: Edema, muscle wasting, and skin/hair changes16.
2. Laboratory Tests:
   • Serum albumin: <3.5 g/dL indicates moderate PEM; <2.8 g/dL suggests severe PEM15.
   • Total lymphocyte count: Low levels correlate with immune suppression1.
   • Micronutrient panels: Zinc, vitamin D, and iron deficiencies are common18.

Management

1. Acute Phase:
   • Rehydration: Oral rehydration solutions (ORS) or IV fluids for severe dehydration18.
   • Electrolyte correction: Prevent hypokalemia and hypophosphatemia during refeeding15.
2. Nutritional Rehabilitation:
   • Gradual refeeding: Start with small, frequent meals to avoid refeeding syndrome18.
   • High-calorie, high-protein diets: Target 1.2–1.5 g protein/kg/day and 35–40 kcal/kg/day13.

• Supplements: Micronutrients (e.g., zinc, vitamin B12) and probiotics to restore gut health18.

3. Long-Term Care:

• Monitoring: Regular weight checks and serum albumin levels15.
• Addressing comorbidities: Treat infections or chronic diseases exacerbating PEM58.

Prognosis

Early intervention improves outcomes, but severe PEM carries high mortality. Marasmic kwashiorkor has the poorest prognosis due to combined deficiencies34.

Conclusion
PEM is a preventable yet life-threatening condition requiring prompt diagnosis and tailored nutritional support. Its management hinges on correcting deficiencies, restoring organ function, and addressing underlying causes.

Consult Our Experts
At DrStemCellsThailand (DRSCT)‘s Anti-Aging and Regenerative Medicine Center of Thailand, we integrate nutritional therapies with regenerative approaches to address PEM-related complications. For personalized care, contact our specialists today.

Consult with Our Team of Experts Now!

References

1. MSD Manual: PEU
2. BYJU’S: PEM
3. Children’s Health: PCM
4. Wikipedia: PEU
5. Medscape: PEM
6. Cleveland Clinic: Kwashiorkor
7. Siloam Hospitals: PEM