Malnutrition; forms, causes, signs and symptoms, treatment and prevention

Protein energy malnutrition (PEM)

The term PEM is a broad term referring to a group of disorders related to inadequate intake of protein and carbohydrates.

There are 3 forms of PEM which include;

  1. Kwashiorkor (protein deficiency); characterized by tissues oedema and damage.
  2. Marasmus (protein and calorie deficiency); characterized by growth failure and wasting.
  3. Marasmic kwashiorkor; the combination of kwashiorkor and marasmus.


Kwashiorkor is a disease caused by protein deficiency when the weaned child is given only starchy foods but low' or no protein diet. It is a Ga work describing the condition the older gets when next baby is born. A paediatrician by name Cicely Williams in 1933 introduced this term into medicine.


  • Poverty
  • Poor food choices
  • Infections
  • Ignorance
  • Impaired digestive & absorption of nutrition
  • Insufficient dietary intake
  • Poor family planning

Signs and Symptoms

  • Diminished adipose tissue
  • Oedema of legs, arms and face
  • Misery and apathy
  • Alopecia
  • Moon face appearance
  • Lack of appetite
  • Enlarged liver
  • Muscle wasting
  • Muscle wasting
  • Dry peeling skin
  • Diarrhea


Lack of both protein and carbohydrates (calorie) which is characterized by extreme wasting. The term marasmus come from Greek word ‘marasoms’ meaning wasting.


  • Poverty
  • Wars
  • Natural disaster
  • Bottle feeding
  • Breast disease
  • Failure of breastfeeding
  • Infections

Signs and Symptoms

  • Old man’s face
  • Extreme wasting
  • Pot belly
  • Irritability
  • Sparse, dull hair
  • Good appetite
  • Diarrhea
  • Oedema is absent
  • Red swollen lips
  • Growth retardation
  • Extremely low weight

Diagnosis of PEM

  • Weight -for -age
  • Presence or absence of oedema
    • If the child's weight is 60-80% of the standard weight with oedema, then it’s kwashiorkor.
    • If the child’s weight is < 60% of standard with no oedema, then it’s marasmus.

Treatment for PEM

  1. The aim of treatment is to provide proteins, calories and other nutritional elements’
  2. If there is secondary bacterial infection like gastro - enteritis, you treat with appropriate antibiotics
  3. Assist patients to eat, if necessary
  4. Provide skin care & ensure that patient does not develop bed sores.
  5. Encourage prolong breastfeeding
  6. Educate family about family planning
  7. Give small, frequent meals
  8. You must ensure that child receives love, attention and affection from parents.
  9. Refer child to a nutritional rehabilitation center if there is no improvement


  • Health education on nutrition
  • Establishment of nutritional rehabilitation centers
  • Health education on family planning
  • Health education on immunization
  • Government intervention


  • Anaemia
  • Dehydration
  • Mental retardation

Read Also

General Nursing Management of Patients with Medical Pathology

Post a Comment