Protein Energy Malnutrition PEM

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Protein Energy Malnutrition (PEM)

• Protein and energy deficiency go hand in hand.
• This combination, protein-energy malnutrition,
  is
• the worlds most widespread malnutrition
• problem.
• It includes
• I. Kwashiorkor
• II. Marasmus (starvation or wasting, extreme
  energy
• deprivation)

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Kwashiorkor

• Kwashiorkor is the Ghanian name for the evil
  spirit
• that infects the first born child when the second
  child is born.
• In countries where Kwashiorkor is prevalent, a
  young child is weaned from the breast milk, which
  contains high-quality protein designed perfectly
  to support growth, to a watery cereal with scant
  protein of low quality.
• Some experts believe that Kwashiorkor and
  Marasmus are two stages of the same disease.

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Symptoms of Kwashiorkor

• 1. Stunted growth
• 2. Edema (water imbalance)
• 3. Fatty liver (lack of protein to transport fat)
• 4. Infections (common due to lowered antibodies)
• Alcoholics also suffer from protein
  deficiency.
• Symptoms edema, liver degeneration, high
  blood
• NH3.
• Cirrhosis fatty liver cells eventually die
  from
• alcohol abuse and are replaced by the scar
  tissue.

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Protein Excess

• Diet high in proteins offer no benefits (more
  than
• 15 energy from proteins).
• Protein-rich foods are often fat-rich foods
  that
• contribute to obesity.
• Excess dietary protein can cause other
  problems,
• especially in small infant, when amino acids
  build
• up in the blood. The accumulation of amino acids
• stresses the kidneys and liver which have to
• metabolize and excrete the excess nitrogen.

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• Signs of protein overload include acidosis,
• dehydration, diarrhea, elevated blood
• ammonia, elevated blood urea, and fever.
• Diets high in purified protein dramatically
• increase Ca excretion. Ca losses are much
  smaller when high protein intakes are from
  natural foods.

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Protein Restricted Diets

• Omnivores People who have no formal
  restriction on the
• eating of any type or group of animal-derived
  foods.
• Vegetarians A general term used to describe
  people who
• exclude meat, poultry, fish, or other
  animal-derived from their
• diets.
• Lactovegetarians People who include milk or
  milk products,
• but exclude meat, poultry, fish, seafood and eggs
  from their
• diets.
• Lacto-ovo-vegetarians People who include milk
  or milk
• products and eggs, but exclude meat, poultry,
  fish, and seafood from their diets. (ovoeggs)
• Vegan exclude any animal derived foods from
  diet like dairy
• products, eggs, meat, poultry, fish-pure, strict,
  total.

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Health benefits of Vegetarian Diets(Highlight 6)

• Weight control Lower body weights correlate
  with higher intakes of fiber and low intakes of
  animal fat.
• Blood pressure Appropriate body weight helps
  to maintain a healthy blood pressure. Lifestyle
  factors also seem to influence blood pressure.

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• Coronary artery disease
• Fewer vegetarians than meat eaters suffer from
  diseases
• heart (CHD) and arteries (CVD).
• The dietary factors most directly related to
  CVD is
• saturated animal fat, and in general vegetarian
  diets are
• lower in total fat, saturated fat, and
  cholesterol than
• typical meat based diets.
• Cancer
• Some epidemiological studies indicate that
  vegetarian
• diets (high in fruits and vegetables) are
  associated not only with lower cancer mortality
  in general, but with lower incidence of cancer at
  specific sites as well, particularly colon cancer.

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Vegetarian Diet Planning

• Need a variety of foods that deliver all needed
• nutrients within energy allowance that maintains
  a
• healthy weight (see the Vegetarian Food Guide
• Pyramid).
• An added challenge is to do so with fewer
  foods.
• Vegetarians (lacto-ovo-veg.) who include milk
• products and eggs meet most recommendations
  easily
• Strict vegetarians need to pay attention to the
• following nutrients

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• Proteins
• A mix of legumes, nuts, grains and seeds can
  provide adequate quantity and quality of
  proteins.
• Iron
• Legumes, dark green leafy vegetables, iron
  fortified cereals.
• Iron absorption from plant foods is enhanced
  in the presence of vitamin C.
• Calcium
• Calcium fortified soymilk and juices,
  particularly for children and adolescents.
  Calcium fortified formula for infants.

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• Vitamin B12
• This vitamin is found only in animal-derived
  foods.
• Vitamin B12 fortified product like soymilk and
  breakfast cereals or supplements should by used.

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