Management of severe PEM is a staged process, especially in resource-limited settings.
Chronic infections (e.g., HIV/AIDS, tuberculosis) or frequent infections (e.g., diarrhea, measles) increase nutritional needs while decreasing intake.
Distinguishes between acute malnutrition (wasting) and chronic malnutrition (stunting):
| Feature | Kwashiorkor | Marasmus | | :--- | :--- | :--- | | | Predominantly Protein | Proteins and Calories (Energy) | | Edema | Present (pitting edema of feet, legs, face) | Absent | | Appearance | Some fat preserved; "Moon face" & swollen belly | Emaciated; "Skin and bones" appearance | | Subcutaneous Fat | Some preserved (sometimes feels doughy) | Completely absent | | Hair Changes | Silky, thin, coppery-red color, "flag sign" | Thin, sparse, but less discolored | | Skin Changes | "Flaky paint" dermatosis, raw exposed areas | Dry, wrinkled, loose (hanging skin) | | Appetite | Often present or voracious | Usually poor or absent | | Mental State | Apathetic, irritable, miserable | Lethargic, weak, but usually alert | | Age Group | 1-3 years | <1-2 years | | Prognosis | Rapid improvement with treatment (4-6 weeks), but high mortality if severe | Slower recovery |
Protein-energy malnutrition (PEM) refers to a range of pathological conditions resulting from a chronic deficiency in dietary protein and/or energy (calories). It is a major public health concern, particularly in developing nations, where it significantly contributes to childhood morbidity and mortality.
Edema (swelling) is the hallmark, particularly in the legs and abdomen, caused by low blood protein levels (hypoalbuminemia).
Enlarged, fatty liver caused by a lack of apolipoproteins required for lipid transport out of hepatocytes. 5. Diagnostic Evaluation and Assessment
While often associated with poverty and food insecurity in developing countries, PEM can also occur in developed nations due to chronic disease-related malnutrition or lack of nutritional support.
Find of the classification systems (like Gomez or Waterlow) Draft speaker notes for each section
Conditions causing malabsorption or increased metabolic rates. 4. Clinical Features and Diagnosis
Transition from F-75 to F-100 formula (100 kcal/100 ml) or Ready-to-Use Therapeutic Food ( RUTF ), such as peanut paste-based formulations.
Brittle, thinning, or "flag sign" (bands of different colors). Liver: Often enlarged and fatty (hepatomegaly). Marasmus (The "Wasting" Disease) Extreme Wasting: Loss of muscle mass and subcutaneous fat. Old Man Face: Shrunken, wrinkled appearance.
