Protein-energy Malnutrition (PEM)
Protein-energy Malnutrition (PEM)
Definition PEM is manifested primarily by inadequate dietary intakes of protein and energy. PEM is almost always accompanied by deficiencies of other nutrient PEM can be divided as primary pem and secondary pEM
Definition ➢ PEM is manifested primarily by inadequate dietary intakes of protein and energy. ➢ PEM is almost always accompanied by deficiencies of other nutrient. ➢ PEM can be divided as primary PEM and secondary PEM
Causes Causes of Primary PEM Inadequate food intake Inadequate infant and child feeding practices Secondary causes Increased nutrient needs Decreased nutrient absorption Increased nutrient losses
➢ Causes of Primary PEM Inadequate food intake Inadequate infant and child feeding practices ➢ Secondary causes Increased nutrient needs Decreased nutrient absorption Increased nutrient losses Causes
Pathophysiology of PEM Disorder of metabolism o Protein: Protein catabolism, hypoalbuminemia Fat: mobilized fat store, emaciation, fatty infiltration fatty liver Carbohydrate: low hepatin, hypoglycemia ● Water、 minerals: dehydration, low serum ca concentration
Pathophysiology of PEM ➢ Disorder of metabolism ⚫ Protein: Protein catabolism、hypoalbuminemia ⚫ Fat: mobilized fat store, emaciation, fatty infiltration, fatty liver ⚫ Carbohydrate: low hepatin, hypoglycemia ⚫ Water、minerals：dehydration，low serum Ca concentration
Disorder of organs and tissues l、 failure to thrive 2. lower digested function: diarrhea 3. Central nerve system: apathy, or irrita bility 4, Cardiovascular system: pulse slow, Low BP 5 lower renal function: urine amount decrease 6, low immunologic function: easy to infect
1、Failure to thrive 2、lower digested function：diarrhea 3、Central nerve system: apathy, or irritability 4、Cardiovascular system：pulse slow, Low BP 5、lower renal function: urine amount decrease 6、low immunologic function: easy to infect ➢ Disorder of organs and tissues
Clinical manifestations Nonedematous PEM (marasmus) Failure to gain weight Irrita bility Weight loss and listlessness skin become wrinkled and loose Subcutaneous fat disappear Muscle: atrophy, hypotonia Pulse slow Constipation, a starvation diarrhea
Clinical manifestations Nonedematous PEM (marasmus) ➢ Failure to gain weight ➢ Irritability ➢ Weight loss and listlessness ➢ skin become wrinkled and loose ➢ Subcutaneous fat disappear ➢ Muscle: atrophy, hypotonia ➢ Pulse slow ➢ Constipation, a starvation diarrhea
Edematous PEM (Kwashiorkor) Vague manifestations Lethargy, apathy, or irritability Inadequate growth Increased susceptibility to infectious Vomiting, diarrhea, anorexia Flabby subcutaneous tissue y Edema Liver enlargement Dermatitis Hair sparse and thin
Vague manifestations ➢ Lethargy, apathy, or irritability ➢ Inadequate growth ➢ Increased susceptibility to infectious ➢ Vomiting, diarrhea, anorexia ➢ Flabby subcutaneous tissue ➢ Edema ➢ Liver enlargement ➢ Dermatitis ➢ Hair sparse and thin Edematous PEM (Kwashiorkor)
Laboratory examination Serum albumin concentration Retinal combined protein Pre-albumin transferrin > IGF-I
Laboratory examination ➢ Serum albumin concentration ➢ Retinal combined protein ➢ Pre-albumin ➢ transferrin ➢ IGF-I
Diagnosis history Clinical manifestations laboratory examination Anthropometric indicators
Diagnosis ➢ History ➢ Clinical manifestations ➢ Laboratory examination ➢ Anthropometric indicators
WHO Z-score Ystemeight chronic or acute malnutrition X-3sD≤W/A<X-2sD moderate W/A<X-3SD severe stunting long-term chronic maLnutrition X-3sD≤H/A<X-2sD moderate H/A<X-3SD severe wasting recent acute malnutrition X-3sD≤W/H<X-2SD
WHO Z-score ➢ system underweight chronic or acute malnutrition X－3SD≤W/A<X－2SD moderate W/A<X－3SD severe ➢ stunting long-term chronic malnutrition X－3SD≤H/A<X－2SD moderate H/A<X－3SD severe ➢ wasting recent acute malnutrition X－3SD≤W/H<X－2SD moderate