Protein-Energy malnutrition – An introduction
The protein-energy malnutrition or PEM is a condition that includes marasmus and kwashiorkor. Marasmus is a condition in which dry form with extreme emaciation occurs and kwashiorkor usually occurs in children. The marasmus indicates the deficiency of proteins in the body along with the calorie deficiency.
Marasmus results in severe retardation in the growth. Kwashiorkor occurs in children due to the protein deficiency. But, the protein deficiency is not the sole cause for the occurrence of edema in kwashiorkor. Kwashiorkor can also result in the insufficient or poor quality of the proteins, pregnancy, gastrointestinal loss or tissue injury. The protein deficiency is also noted in adults.
Vitamin A deficiency is also severe in about 30 % of the children suffering from kwashiorkor. They also exhibit xerosis, bitot’s spot and keratomalacia. This deficiency of the vitamin A is not because of the malabsorption but of the intake. For this vitamin supplement are administered orally. The best way to avoid these deficiencies is to consume a high protein diet.
Dietetic management for PEM
Kwashiorkor is a disease that is primarily occurring due to the protein deficiency and hence the best way to compensate can only be with the diet. The dietetic management for PEM is framed in such a way that it should fulfill the protein and calorie needs and should eradicate any infection that is present in the body.
For fulfilling the need of proteins, adequate milk and milk products are necessary as this helps a lot in the prevention of kwashiorkor in children and in infants. Whole milk is also not tolerated so, skimmed milk or milk treated with lactose is given to prevent diarrhea. The protein diet that supplies 20% of the calorie is usually favored. So, a child of 2 years of age should who is requiring 1000 kcal of energy should get 200 kcal of energy by 50 g of proteins.
The administration of protein rich foods like skimmed milk products and Bengal gram proved to be a lot valuable. Fats should be given in usual amount to ensure necessary calorie intake. Multivitamin preparations can help a lot and can be administered orally. In kwashiorkor, minerals like potassium can also be low so, in order to compensate the mineral loss, minerals are administered orally to ensure the normal level of potassium.
The food stuffs that are allowed for a high protein diet are milk and milk products, bread made of wheat or rice, butter, sugar, fruits, ghee, wheat flour, bananas and vegetable protein mixture. The daily nutritional requirement for a child with kwashiorkor is 90 to 100 kcal per kg of the standard body weight at that stage.