Protein-energy Malnutrition

Protein-energy malnutrition (PEM), is a form of malnutrition defined as a series of disease condition that arises from the lack of dietary protein and energy (calories) in varying proportions.

It is an overall state of under-nutrition and a deficiency of energy and multiple nutrients.

The condition could be in mild, moderate, and severe degrees. It is sometimes referred to as protein-energy undernutrition or protein-calorie malnutrition. Protein-energy malnutrition can result in:

  • A high risk of infection.
  • Long-term and short-term health issues.
  • Lack of concentration at school or work.

Some deficiencies can trigger specific health problems, such as:

  • Scurvy: When the body lacks vitamin C, it can result in a condition known as scurvy. Scurvy develops when one doesn’t take enough fresh vegetables and fruits. Those at risk are young children, older adults, people with mental issues and those that consume alcohol in excess.
  • Vision Problems: A lack of vitamin A can lead to vision problems. A lot of children around the world develop this due to the lack of vitamin A.

An overall deficiency

The lack of all nutrients in the body can result in the following conditions:

  • Kwashiorkor: this is as a result of a deficiency in protein which is often characterized by infiltration of the liver, oedema, dermatosis, stunting and wasting (which is low-height-for-age and low-weight-for-height respectively).
  • Marasmus: marasmus results from both protein and energy deficiency, and it is usually characterized by general weakness, lack of interest and wasting.
  • Marasmic kwashiorkor: this is mainly as a result of an intense or chronic energy deficiency and chronic protein deficit that is often characterized by wasting, mild hepatomegaly, oedema, and stunting. Most times, it is difficult to distinguish between kwashiorkor and marasmus because a lot of children exhibit the symptoms of both conditions.

Protein-energy malnutrition is common around the world and can present itself in both children and adult. It has a record of six million death annually.

In the developed world, protein-energy malnutrition is primarily present in hospitals, associated with the disease, affecting mostly the elderly or aged (most times it isn’t suspected) and patient with certain disorders that reduce appetite, weaken the digestion of nutrients, metabolism or absorption.

However, in developing countries, protein-energy malnutrition affects children the most, especially those who do not consume adequate proteins or calories. A few cases discovered in the developing world were mostly in small children.

They were as a result of ignorance of the nutritional needs of the children, especially in cases of milk allergy.

Who is at risk of developing protein-energy malnutrition?

Fighting protein-energy malnutrition in all its form is one great global health challenge. Every country in the world is faced with one form of malnutrition or the other.

Infants, children, adolescents, and women are at high risk of protein-energy malnutrition. It is essential to get the most out of nutrition early in life – from conception to the child’s second birthday. This comes with long-term benefits, and it is the best start in life.

One factor that increases the risk of malnutrition is poverty. People who are poor have a higher chance of being affected by different forms of malnutrition.

Malnutrition also cuts down productivity, increases the cost of healthcare and reduces economic growth which can prolong ill-health and poverty circle.

Types of protein-energy malnutrition

There are four broad groups of protein-energy malnutrition:


Undernutrition is the insufficient intake of necessary nutrients and energy to meet an individual’s need to maintain good health.

Undernutrition can be divided into four broad sub-forms which are: stunting, wasting, underweight, and deficiencies in vitamins and minerals.

  • Stunting is also known as low height-for-age. It is caused by severe or recurrent undernutrition condition, that is associated with unsuitable infant and young child feeding and care during early life, poor maternal health and nutrition, and frequent illness. Stunting makes it difficult for children to attain their physical and cognitive potential.
  • Wasting is also known as low weight-for-height. Wasting usually signifies severe weight loss due to the fact that a person hasn’t had enough nutritious food to eat or have suffered an infectious disease such as diarrhoea which have made them lose weight. There is a high risk of death for a child who is moderately or severely wasted, but treatment is possible.

A child with low weight-for-age can also be known as underweight. A child who is underweight can be wasted, stunted, or both.

Diet-related non-communicable diseases

Diet-related non-communicable diseases (NCDs) include cardiovascular diseases (such as stroke, heart attacks, and often linked with high blood pressure), diabetes and certain cancers. Poor nutrition and unhealthy eating top as risk factors for these diseases globally.

Micronutrient-related malnutrition

Micronutrients aid the body in the production of hormones, enzymes, and other substances that are important for proper growth and development. Inadequate consumption of vitamins and minerals, often referred to as micronutrients can also be grouped together.

Iron, vitamin A, and iodine are the most essential in terms of global public health. A deficiency in these micronutrients poses a big threat to the health and development of the population worldwide, especially in pregnant women and children in developing countries.

Overweight and obesity

Being obese or overweight is used to describe a person who is too heavy for his or her height. Excess or abnormal fat accumulation can cause serious health challenges.

Overweight and obesity is as a result of an imbalance between energy taken (too much) and energy expended (too little).

All over the world, people consume foods and drinks that are high in sugar and fat and engage in less physical activity. This, therefore, causes those fats to accumulate in their body, causing them to be overweight or obese.

Causes of PEM

Protein-energy malnutrition can occur for diverse reasons. Here is an outline of the causes of PEM:

1. Inadequate Intake of Proteins and Caloric Foods

A number of people (both children and adult) develop malnutrition due to the unavailability of sufficient nutritious foods or the difficulty in eating and absorbing nutrients. This can be as a result of:

  • Drugs that make eating difficult- due to nausea, for instance.
  • Liver disease
  • Mouth problems like dentures that are poorly fitted can also be a contributing factor to PEM.
  • Cancer

2. Mobility and Social Issues

Another factor that can contribute to PEM is social and mobility problems such as:

  • Limited cooking skills
  • Inability to leave the house to buy food from a food store.
  • Staying alone – this affects one’s motivation to cook and eat.
  • Inadequate funds – not having enough money to purchase food
  • Difficulty in making meals by oneself

3. Mental Health Disorder

Undernutrition can also affect people suffering from any of these:

4. High Alcohol Use

High consumption of alcohol can result in long-term damage of the pancreas and gastritis. These problems, therefore, make it difficult to digest food, absorb vitamins, and produce the hormones that regulate metabolism.

There is a high content of calories in alcohol, so one may not feel the need to eat after drinking it. This may, therefore, cause them not to eat healthy foods to enrich the body with the necessary nutrients.

5. Stomach/digestive conditions

When the body doesn’t absorb nutrients properly, even a balanced diet won’t stop malnutrition. Stomach and digestive conditions that may cause this are:

Signs and Symptoms of PEM

There is no condition without signs and symptoms. The most common symptom of protein-energy malnutrition is weight loss. Other symptoms can include:

  • Depression
  • Lack of appetite in food
  • High risk of getting sick and taking longer to heal
  • High risk of after surgery complications
  • Irritability and general tiredness
  • Wounds take time to heal
  • Excessive loss of muscle mass, fat, and body tissue
  • Lack of concentration

A person may eventually begin to experience difficulty in breathing and heart failure. However, in children, there may be:

  • Irritability and anxiety.
  • Stunted growth and low body weight
  • Behavioural changes- reduced social responsiveness, apathy, and attention deficits
  • General weakness and lack of energy

The main symptom of overnutrition is obesity or overweight. However, patients suffering from undernutrition can also be overweight if they consume a diet that is high in calories and low in other nutrients.

Prevention of protein-energy malnutrition

When it comes to preventing protein-energy malnutrition, dieting matters a lot. A balanced and healthy eating habit is good for maintaining health and fitness.

People need to adjust their diet by consuming a range of nutrients from varieties of food in the primary food groups, including:

  • Meat, eggs, fish, legumes and other dairy products.
  • Lots of fruits and vegetables.
  • Some milk and dairy sources of protein
  • Plenty of pasta, bread, potatoes, rice, and other starchy foods

Anyone exhibiting signs of malnutrition should see a doctor for diagnosis and immediate treatment. Young children, older adults, people suffering from severe illnesses, and others may require extra care to enable them to get the necessary nutrients.

Prevention can be done on three levels:

1. Family Level

  • Exclusive breastfeeding
  • Vaccination
  • Spacing between pregnancies

2. Community Level

  • Enlightenment/Promotion of family planning program
  • Nutritional and health education.
  • Integrated health package
  • Promotion of literacy in the community

3. National Level

  • Nutritional planning- formulation of nutrition policies, improvement of food production and supplies, ensuring adequate distribution
  • Nutrition supplementation- fortification and iodination


Your doctor will be able to draft a sustainable treatment plan for you if you’ve been diagnosed with the condition. It may also help if you meet with a nutritionist.

Whatever treatment that would be given is based on the severity of the malnutrition and other underlying conditions. Treatments may include:

  • Making a dietary plan, which might include taking nutritional supplements
  • Treatment of any infection present
  • Undergoing screening and monitoring
  • Suggesting alternative eating utensils
  • Treatment of symptoms such as nausea
  • Checking for any mouth-related or swallowing issues

In severe cases, a person may need to:

  • Receive nutrients such as calcium and potassium through the veins.
  • Spend time in the hospital
  • Start taking nutrients slowly over a number of days.

The person will be monitored and kept under watch by their healthcare provider to ensure that they are getting the nutrition they need. The outlook and recovery time depend on the cause of the malnutrition.


  • Malnutrition – WHO
  • Kwashiorkor – NHS
  • Protein-energy Malnutrition – Wikipedia