Protein energy malnutrition or protein energy deficiency is a condition in which the body lacks macronutrients which are a source of energy, including protein. The most common types of protein energy malnutrition in children are kwashiorkor and marasmus.
Protein energy malnutrition is commonly known as protein energy deficiency (PEM). Symptoms of this condition usually appear slowly. Protein energy malnutrition needs to be treated immediately so that complications do not occur.
Symptoms of Protein Energy Malnutrition
To be able to work optimally, the body needs adequate nutrition. When the body lacks protein energy for a long time, various complaints and symptoms can appear. Symptoms that generally appear are:
- Below normal body weight with a body mass index (BMI) of less than 18.5 kg/m2
- Constant tiredness and weakness
- Easy to get cold
- Decreased appetite
- Muscle wasting or muscle atrophy, and body fat
- Changes in attitude and emotions, for example being apathetic (not caring about the environment), often restless, irritable, difficult to concentrate or constantly sad
- Dry and paler skin
- Often sick and wounds take longer to heal
- Hair fall to bald
- Numbness or tingling
- Chronic diarrhea (prolonged diarrhea)
Children are more susceptible to protein energy malnutrition. In addition to the above symptoms, some of the symptoms of protein energy malnutrition that can occur in children are:
- Experiencing a delay in growth and development, when compared to children his age
- Inactive and easily tired
- More fussy
- Vulnerable to disease, including infectious diseases
Other symptoms can also appear depending on the type of protein energy malnutrition that occurs. If there is marasmus (lack of energy and protein), the sufferer is prone to dehydration and intestinal shrinkage.
While in kwashiorkor (lack of protein alone), sufferers will generally experience fluid buildup (edema) in the abdomen or other body parts, such as the hands and feet.
When malnutrition is severe, the respiratory rate and pulse rate will slow down. Not only that, the function of body organs, such as the heart, kidneys, and liver, can also be disrupted.
When to go to the doctor
Immediately consult a doctor if you or your child experience the symptoms of protein energy malnutrition as mentioned above. Examination and treatment by a doctor is necessary to prevent complications.
Regular check-ups to the doctor also need to be carried out by people with anorexia, depression, dementia, or cancer. This is because these conditions can trigger protein energy malnutrition.
Causes of Protein Energy Malnutrition
Protein energy malnutrition occurs due to lack of intake of protein and other macronutrients which are a source of energy or calories, namely carbohydrates and fats.
Based on the type of nutrient deficiency, protein energy malnutrition can be divided into:
- Kwashiorkor, which is a form of malnutrition caused by a lack of protein intake over a long period of time.
- Marasmus, which is a form of malnutrition caused by a lack of protein and calorie intake.
- Marasmus-kwashiorkor, which is a form of severe protein energy malnutrition which is a combination of both.
Several factors that can increase a person's risk of experiencing protein energy malnutrition are:
Social factors
Social factors are the most common cause of protein energy malnutrition in developing countries. These factors include:
- Lack of food, for example due to living in an isolated environment.
- Have physical or mental limitations that make it difficult to prepare food.
- Having dependence on others for food.
- Have less knowledge about nutrition and how to process good food.
- Drug abuse and alcohol addiction.
Certain diseases
Protein energy malnutrition can also occur because a person suffers from a disease, including:
- Infection in the digestive tract that causes diarrhea.
- Hookworm infection that absorbs nutrients from and blood from the intestines
- Diseases that interfere with the digestive tract's ability to digest or absorb food, such as colitis and celiac disease.
- Diseases that weaken the immune system, such as HIV/AIDS and cancer.
- Mental disorders, such as depression, schizophrenia.
- Eating disorders, such as anorexia nervosa and bulimia.
- Dementia, because it can make sufferers forget to eat.
- Diseases that increase metabolism and energy requirements, such as fever, accident, severe burns, or hyperthyroidism.
- Have malabsorption or malabsorption syndrome.
In addition, there are also several diseases or conditions that can increase the risk of malnutrition, such as congenital heart disease, chronic kidney failure, cystic fibrosis, and the use of certain medications.
Diagnosis of Protein Energy Malnutrition
To diagnose protein energy malnutrition, the doctor will ask and answer questions to the patient and the patient's family about complaints, diet, as well as medical and medication history.
Next, the doctor will perform a thorough physical examination, including checking vital signs (blood pressure, pulse, respiration, temperature), as well as anthropometry and nutritional status (height/length and weight, BMI, and body fat percentage).
To determine the cause of malnutrition, the doctor will ask the patient to do a number of supporting tests, the following:
- Blood tests, to identify causes of malnutrition, such as HIV infection, as well as to assess the levels of glucose, protein (albumin), vitamins, and minerals in the patient's body.
- Stool test, to see the presence of parasites or worms that can cause protein energy malnutrition.
- Chest X-ray, to see whether there is inflammation and infection in the lungs.
Protein Energy Malnutrition Treatment
Management of protein energy malnutrition includes providing nutrition by mouth or intravenously, handling conditions that cause malnutrition, and administering drugs according to the patient's complaints or condition. Management of protein energy malnutrition requires time and discipline from the patient and the patient's family.
Increase calorie and protein intake
This nutrition can be done according to the patient's condition. If they can eat and drink, the patient will be advised to eat and drink more often, with an intake that contains balanced nutrition. If it is difficult to eat solid food, the patient can be given liquid food first.
If the patient cannot eat or drink, the doctor will provide nutrition through a feeding tube or IV. The feeding tube can be inserted into the stomach through the mouth or nose.
At the beginning of therapy, nutritional intake is generally still in the form of liquid food and supplements given 6-12 times per day. When the condition of the body is judged to be ready, the patient will be given solid food. The food provided must be nutritionally balanced, which contains carbohydrates, proteins, fats, vitamins and minerals.
During this therapy period, the doctor will also provide multivitamins and certain drugs to increase appetite.
Overcoming the causes of malnutrition
Malnutrition can be caused by several medical conditions, such as gastrointestinal infections, HIV/AIDS, cancer, or depression. If malnutrition is caused by a disease, the doctor will provide treatment to overcome the disease.
During the treatment period, doctors and medical staff will also teach things about nutritional needs and techniques for processing good food. After the treatment period, the patient is still recommended for regular check-ups to the doctor until the malnutrition is completely cured.
Complications of Protein Energy Malnutrition
There are several complications that can arise due to protein energy malnutrition (kwashiorkor and marasmus), namely:
- Hypothermia (decreased body temperature)
- Anemia and hypoglycemia (decreased blood sugar levels)
- Encephalopathy (damage to brain tissue)
- Hypoalbuminemia (lack of the protein albumin in the blood)
- Impaired organ function, such as kidney failure and heart disease
- Failure to thrive or stunting in children
- Learning disorders
- Coma
In addition, people with malnutrition are also susceptible to various diseases, such as beriberi, seborrheic dermatitis, dementia, or bone disorders, such as osteomalacia.
Prevention of Protein Energy Malnutrition
Protein energy malnutrition can be prevented by adopting a healthy diet with balanced nutrition that includes:
- Carbohydrate sources, such as rice, bread, or potatoes
- Sources of protein and fat, such as meat, fish, eggs, or poultry
- Sources of minerals and vitamins, such as fruits, vegetables, and milk and dairy products, such as cheese or yogurt
In addition to eating healthy foods, don't forget to meet your fluid needs by drinking 8 glasses of water per day and checking with your doctor regularly if you have a medical condition or disease that can increase your risk of protein energy malnutrition.