Protein energy malnutrition in children

March 2013
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What is protein energy malnutrition?
Also known as protein-calorie malnutrition, this type of malnutrition results from the acute insufficiency of both dietary energy and proteins.
Considering the time and origin its cause can be primarily due to lack of amino acids and energy nutrients in the diet or secondarily due to debilitating health conditions. In children losing up to 10% of body weight is considered as mild, whereas losing 10-20% is moderate and above 20% is severe malnutrition.

Causes of protein energy malnutrition in children

The primary malnutrition develops in children when their intake of proteins and energy sources is grossly insufficient to support their metabolic needs. This type of malnutrition is seen mostly in developing countries and also in regions ravaged by wars, famines and natural calamities.

The secondary type of malnutrition in children is prevalent even in developed countries. It is usually concurrent with major health problems like AIDS, chronic diarrhea, cancer, chronic kidney failure, chronic obstructive pulmonary disease (COPD), liver cirrhosis, Crohn disease and ulcerative colitis. In these debilitating illnesses, the body's ability to digest, absorb or use the nutrients is impaired. Severe malnutrition may occur in persons on long-term hemodialysis and in those affected by acute illness, severe burns, trauma, or sepsis.

When malnutrition syndrome reaches an advanced disease stage, depending upon the type of deficiency, it is variously named as Kwashiorkor or marasmus.


This is an advanced disease stage of malnutrition wherein there is acute protein deficiency. Symptoms of kwashiorkor include, protruding belly, liver enlargement and ascites, edema, dry and peeling skin, changes in skin pigment, loss of muscle mass, diarrhea, anemia, change in hair color and texture, apathy, irritability, dermatitis and severe infections. Delay in treatment can lead to permanent mental and physical disability, coma, shock and death. This condition is seen in children feeding on highly amino acid deficit diet after stoppage of breast feeding.


Unlike kwashiorkor, in marasmus there is severe protein and also calorie/energy deficiency. There is no edema. Marasmus is characterized by wasted muscles and tissues. Marasmus may appear in children who have very little to eat after stoppage of breast feeding. The symptoms include profound weakness, emaciation, baggy, wrinkled skin, lack of energy, extremely thin arms and legs, weakened immune system, low body temperature and mental and behavioral retardation. In children with marasmus if severe infections and complications occur, edema may be caused and the malnutrition syndrome is now termed as marasmic kwashiorkor.

Like children, elderly people are also dependent on others for getting the right type of nutrition and in addition their digestive and absorptive capacities are reduced. Like children, they are also at the high risk of developing the secondary malnutrition.


Malnutrition can be recognized by correlating the symptoms with the visual observation and physical examination of body fat, eating habits, appetite, weight loss, edema and muscle strength. The history of general illnesses, diarrhea and gastrointestinal ailments can give an idea on the patients nutritional status. Blood and urine analysis will further help in the diagnosis.


Immediate step in the treatment of malnutrition is correcting fluid and electrolyte imbalances. Antibiotics are given for treating infections. Gradually essential nutrients are replenished, first the carbohydrates and then the amino acids and micronutrients. Physiotherapy is given to make the patient gain the muscle strength. Once the affected children are free from complications energy dense dietary formulas are used to restore normal weight for the height. If the treatment is delayed, protein energy malnutrition can leave lasting effects on physical and mental health of children and they may not reach their full growth potential.

Related topics:
Carbohydrate Deficiency Diseases.
Protein deficiency diseases.
Protein-energy malnutrition (PEM).
Vitamin deficiency diseases.
Fat deficiency diseases.
Mineral deficiency diseases.
Image 1 source:
Content Providers: CDC/ Dr. Lyle Conrad
License: Public domain
Image 2 source:
Content Providers: CDC/ Don Eddins
License: Public domain

Reference: Alderman H, Shekar M. Nutrition, food security, and health.In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 43.
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