PEM

Proteins are essential macronutrients in food because they provide essential amino acids as well as non-essential amino acids, which are required for the growth, repair, and preservation of tissues. Protein can be obtained from a variety of sources, and it is used to supply amino acids for the purposes of growth and repair. Nine amino acids out of the twenty amino acids found in protein cannot be synthesised by humans. Nonessential amino acids are created in the body by converting essential amino acids into non-essential amino acids. 

The daily protein requirement of males and females (approximately 65 and 50 g in food, respectively) provides approximately 10 percent – 15 percent of total energy in a balanced diet; however, under normal circumstances, only about 5 percent of body energy comes from the catabolism of protein. It has been discovered that protein is the most satiating of the macronutrients, particularly for people who consume a low-protein diet on a regular basis, and that it may have an impact on body weight when consumed ad libitum under low-fat conditions. It has been suggested that increasing protein intake may be beneficial for some people in terms of weight control, but the amount of protein in a person’s diet is unlikely to be a significant determinant of the prevalence of obesity.

Protein–Energy Malnutrition

Nutritional protein–energy malnutrition (PEM) encompasses a wide range of biological disorders that are caused by a lack of food. A deficiency in total energy, rather than a lack of protein, is required for affected individuals to be diagnosed with this condition, despite the name. Dietary proteins that would normally be used for tissue repair or growth are now being used as a source of energy. PEM is uncommon in the developed world, and it is generally associated with children who have been neglected or with elderly patients who are solitary and malnourished. The severity and clinical features of PEM suggest that the patient is suffering from a food deficiency, which manifests itself as marasmus and kwashiorkor. It is possible that PEM will become life threatening if a person’s susceptibility to infectious diseases increases that are not normally fatal.

Unintentional weight loss of 10% or more of body weight in a period of less than six months, as well as serum albumin levels less than 3.5 grams per decilitre (g/dl), are considered to be signs of protein energy malnutrition (PEM).

Protein-Energy Malnutrition Is Divided Into Several Categories

It is possible to divide PEM into two types:

• Primary PEM

• Secondary PEM

Primary PEM

When it comes to children, this type of protein-energy malnutrition is common. It is rarely found in older people, with depression being the most common cause. It can also be caused by the abuse of children or the elderly. PEM is primarily classified into two types in children:

• Kwashiorkor

• Marasmus

Kwashiorkor

This occurs as a result of the birth of a younger sibling, which causes the mother to stop breastfeeding before the child reaches the appropriate age.

Kwashiorkor can also occur as a result of an acute illness, such as gastroenteritis, which can be fatal. It is only found in a few regions of the world, such as rural areas of Africa, the Pacific Islands, and the Caribbean, among other places. The protein content of the food in these establishments is low, while the carbohydrate content is high.

It results in the leakage of the cell membrane, which allows the intravascular fluid and proteins to escape. Oedema is the result of this.

It has the effect of lowering a person’s immunity, making him more susceptible to disease.

Marasmus

• Loss of weight

• Depletion of fat and muscle mass

• The majority of cases occur in developing countries.

• Kwashiorkor is more common than Kwashiorkor.

• Children younger than those who have been affected by Kwashiorkor are more likely to be affected.

• Because of the impairment of cell-mediated immunity, the children are more susceptible to infections.

Secondary PEM 

• It is brought on by disorders of the gastrointestinal tract, among other things.

• It can be caused by infections, hyperthyroidism, trauma, burns, and other critical illnesses, amongst other things,

• It has been shown to reduce appetite and impair nutrient metabolism.

Consequences of Protein and Energy Deficiency

• Irritability.

• The patient becomes weak and inefficient as a result of this.

• Cognitive and conscious abilities are impaired.

• Lactose intolerance (temporary condition).

• Diarrhoea

• Loss of weight

• Muscles begin to shrink.

• Bone protrusions are common.

• Skin becomes thin, pale, dry, inelastic, and cold as a result of the disease.

• Hair fall is a common occurrence.

• Wound healing is impaired.

• In the elderly, the risk of hip fractures and ulcers increases significantly.

• In severe cases, the size of the heart and the output of the heart both decrease.

• A decrease in the rate of respiration and the amount of oxygen available to the body

• Failure of the liver, kidneys, or heart.

Diagnosis of Protein and Energy Malnutrition

The diagnosis of PEM can be made by looking at the patient’s dietary history.

• Height and weight measurements, fat distribution measurements, and anthropometric measurements of lean body mass should all be taken into consideration.

• The Body Mass Index, also known as the BMI, is calculated to determine the severity of the PEM.

• Laboratory tests, such as the measurement of serum albumin, total lymphocyte count, transferrin, and response to skin antigens, can aid in the diagnosis of Protein Energy Malnutrition at various stages.

• PEM can be diagnosed by a decrease in the levels of hormones, lipids, fats, cholesterol, prealbumin, insulin-like growth factor, fibronectin, calcium, magnesium, and phosphate in the blood, among other biomarkers of the disease.

Conclusion

Defining protein–energy malnutrition (PEM), is a type of malnutrition caused by a simultaneous deficiency in dietary protein and/or energy (calories) in varying proportions. There are three levels of severity for this condition: mild, moderate, and severe. Kwashiorkor (in which protein malnutrition is predominant) and Marasmus (deficiency in calorie intake) are two types of PEM.