Protein Energy Malnutrition.

Byline: Mehwish Idrees

Protein-energy undernutrition (PEU), previously called protein-energy malnutrition, is an energy deficit disorder due to deficiency of all macronutrients. It commonly includes deficiencies of micronutrients. PEM can be sudden and total (starvation) or gradual. Severity ranges from subclinical deficiencies to obvious wasting (with edema, hair loss, and skin atrophy) to starvation. Multiple organ systems are often impaired. Diagnosis usually involves laboratory testing, including serum albumin.

In developed countries, PEM is common among institutionalized older patients (although often not suspected) and among patients with disorders that decrease appetite or impair nutrient digestion, absorption, or metabolism. In developing countries, PEM affects children who do not consume enough calories or protein. Protein-energy Malnutrition is graded as mild, moderate, or severe. Grade is determined by calculating weight as a percentage of expected weight for length or height using international standards (normal, 90 to 110%; mild PEM, 85 to 90%; moderate, 75 to 85%; severe

* Primary: Caused by inadequate nutrient intake

* Secondary: Results from disorders or drugs that interfere with nutrient use.

Primary PEM

Worldwide, primary PEM occurs mostly in children and older people who lack access to nutrients, although a common cause in older people is depression. PEM can also result from fasting or anorexia nervosa. Child or elder abuse may be a cause.

In children, chronic primary PEM has 2 common forms:

* Marasmus

* Kwashiorkor

The form depends on the balance of non-protein and protein sources of energy. Starvation is an acute severe form of primary PEU

Marasmus (also called the dry form of PEM) causes weight loss and depletion of fat and muscle. In developing countries, marasmus is the most common form of PEM in children.

Kwashiorkor (also called the wet, swollen, or edematous form) is a risk after premature abandonment of breastfeeding, which typically occurs when a younger sibling is born, displacing the older child from the breast. So children with kwashiorkor tend to be older than those with marasmus. Kwashiorkor may also result from an acute illness, often gastroenteritis or another infection (probably secondary to cytokine release), in a child who already has PEM.

A diet that is more deficient in protein than energy may be more likely to cause kwashiorkor than marasmus. Less common than marasmus, kwashiorkor tends to be...