Protein Energy Malnutrition

This chapter discusses severe form of malnutrition in children. Protein-energy malnutrition (PEM) is the term most frequently used to embrace the severe forms of malnutrition seen in childhood and the nutritionally determined growth failure that precedes clinical syndromes. It is easy to recognize gross abnormality in the severe forms of PEM. It is much more difficult to decide the boundary between mild malnutrition and normal light weight or short stature. The effects of infection in children from malnourishing environments exacerbate the effects of the poor nutrition as infection leads to anorexia, pyrexia with increased metabolic rate, toxicity affecting metabolic reactions, and often tissue loss because of diarrhea. Nutrition deteriorates in these children during infection and is insufficient in between the episodes of infection to allow complete catch-up growth. Increased susceptibility to infection resulting from poor nutrition leads to further deterioration in nutritional status. The management of protein energy malnutrition depends largely on the severity of the illness and the facilities available for investigation and treatment. Unfortunately, severe PEM is commonly found in areas where investigative and therapeutic facilities are very limited, and management may be dependent on feeding the children locally available foods prepared so as to provide optimum nutritional benefit.