Protein Energy Malnutrition

Protein Energy Malnutrition

Protein energy malnutrition is a condition when the body lacks the intake of food sources of energy, including protein. This condition often occurs in children. Types of protein energy malnutrition that often occur in children are kwashiorkor and marasmus.

Protein energy malnutrition is also known as protein energy deficiency (PEE). In children, protein energy malnutrition is also called malnutrition .

Symptoms of protein energy malnutrition usually appear slowly. This condition needs to be treated immediately to prevent complications.

Causes of Protein Energy Malnutrition

As mentioned above, protein energy malnutrition is caused by a lack of food intake of energy sources or calories, including protein.

Based on the type of nutrition that is lacking, protein energy malnutrition can be divided into several types including:

  • 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 heavy protein energy malnutrition which is a combination of the two

Some factors that can increase the risk of a person experiencing protein energy malnutrition are:

Social factors

Social factors can increase the risk of protein energy malnutrition, especially in poor and developing countries. These factors include:

  • Lack of food, for example due to living in an isolated environment
  • Physical or mental limitations that make it difficult to prepare food
  • Dependence to get food from others
  • Lack of knowledge about nutrition and how to process good food
  • Drug abuse and alcohol addiction

Certain diseases

The risk of protein energy malnutrition can also increase as a result of suffering from certain diseases, such as:

  • An infection in the digestive tract that causes diarrhea
  • Hookworm infection that absorbs nutrients from the blood and intestines
  • Diseases that interfere with the digestive tract's ability to digest or absorb food, such as intestinal inflammation and celiac disease
  • Diseases that can disrupt metabolism or reduce appetite, such as tuberculosis (TB), HIV/AIDS and cancer
  • Mental disorders, such as depression and schizophrenia
  • Eating disorders, including anorexia nervosa and bulimia
  • Dementia , because it can make the sufferer forget to eat
  • Conditions that can increase metabolism and energy needs, such as chronic diseases, accidents, severe burns , or hyperthyroidism
  • Malabsorption or malabsorption syndrome

In addition, there are also some 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 drugs.

Symptoms of Protein Energy Malnutrition

To be able to work optimally, the body needs sufficient nutritional intake. If the body lacks protein energy in the long term, then various complaints can appear. Common symptoms are:

  • Body weight below normal with a body mass index ( IMT ) less than 18.5 kg/m 2
  • Persistent fatigue or weakness
  • Easy to catch cold
  • Loss of appetite
  • Muscle shrinkage or atrophy of muscles and body fat
  • Changes in attitude and emotions, for example becoming apathetic (not caring about the environment), often restless, irritable, difficult to concentrate or persistently sad
  • Dry and paler skin
  • Often sick and wounds take longer to heal
  • Hair loss to baldness
  • Numbness or tingling
  • Chronic diarrhea

In children, some of the symptoms of protein energy malnutrition other than those mentioned above are:

  • Delayed growth and development when compared to children his age
  • Inactive and easily tired
  • More fussy
  • Susceptible to diseases, including infectious diseases

Other symptoms can also appear depending on the type of protein energy malnutrition that occurs. If there is a lack of energy and protein (marasmus), sufferers are prone to dehydration and intestinal shrinkage.

While patients who only lack protein (kwashiorkor) will generally experience accumulation of fluid (edema) in the abdomen or other parts of the body, such as hands and feet.

When malnutrition gets worse, breathing rate and pulse will slow down. In addition, there can be disturbances in the function of the heart, kidneys, and liver.

When should you go to the doctor?

Go to the doctor immediately if you or your child experiences symptoms of protein energy malnutrition. Examination and handling by a doctor is necessary to prevent complications.

Routine examination to the doctor also needs to be done by sufferers of anorexia, depression, dementia, or cancer. This is because these conditions can trigger protein energy malnutrition.

Parents are also advised to immediately take their child to the doctor if the child's weight is below the red line of the growth curve. Examination and handling should be done immediately if the child's weight does not increase for 2 months in a row.

Diagnosis of Protein Energy Malnutrition

To diagnose protein energy malnutrition, the doctor will ask and answer the patient and his family about complaints, eating patterns, as well as health and treatment history.

Next, the doctor will perform a comprehensive physical examination, including vital signs such as blood pressure, pulse, breathing, and body temperature.

The doctor will also perform an anthropometric examination and nutritional status in the form of height/length and weight, upper arm circumference, BMI, and body fat percentage.

To determine the cause of malnutrition, the doctor will ask the patient to undergo a number of the following supporting tests:

  • Blood tests , to determine the cause of malnutrition, for example as a result of HIV infection, as well as to assess the level of glucose, protein ( albumin ), vitamins, and minerals in the patient's body
  • Stool test (faeces), to see the presence of parasites or worms that can cause protein energy malnutrition
  • Chest X- ray , to detect inflammation and infection in the lungs, including TB

In children's patients, the doctor will also evaluate how the child's growth and development graph is.

Treatment of Protein Energy Malnutrition

To deal with protein energy malnutrition, doctors can give nutrition by mouth or infusion, deal with conditions that cause malnutrition, and give medicines according to the patient's complaint or condition.

Treatment of protein energy malnutrition requires time and discipline from the patient and his family. Handling methods for protein energy malnutrition can be by:

Increase calorie and protein intake

The provision of this nutrition can be done according to the patient's condition. If the patient can still eat and drink, the doctor will recommend to eat and drink more often. If the patient finds it difficult to consume solid food, the doctor will give liquid food first.

If the patient cannot eat or drink, the doctor will provide nutritional intake through a feeding tube or infusion. A 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 slowly 6-12 times per day. Giving slowly aims to prevent the occurrence of refeeding syndrome .

When the condition of his body is judged to be ready, the patient will be given solid food. It should be noted that the food provided is nutritionally balanced food, which contains carbohydrates, proteins, fats, vitamins, and minerals.

If protein energy malnutrition is very severe, especially in children, the doctor will give special food in the form of ready-to-use therapeutic food (RUTF). During this therapy, the doctor will also give multivitamins and certain medicines to increase appetite.

Addressing the causes of malnutrition

Malnutrition can be caused by several medical conditions, such as gastrointestinal infections, HIV/AIDS, tuberculosis, cancer, or severe depression. Therefore, the doctor will overcome the disease.

During treatment, doctors and medical personnel will also teach about nutritional needs and good food processing techniques. After the treatment period, the patient is still recommended for routine check-ups to the doctor until the malnutrition is completely cured.

Complications of Protein Energy Malnutrition

There are several complications that can occur due to protein energy malnutrition, both kwashiorkor and marasmus, namely:

  • Hypothermia or a drop in body temperature
  • Lack of blood (anemia) and hypoglycemia (low blood sugar levels)
  • Encephalopathy or brain tissue damage
  • Hypoalbuminemia , which is a lack of blood albumin protein
  • Organ dysfunction, such as kidney failure and heart disease
  • Failure to grow or stunting in children
  • Learning disorders
  • Coma

Malnutrition sufferers are also susceptible to various diseases, such as beriberi, seborrheic dermatitis, dementia, or bone disorders, such as osteomalacia .

In addition, giving excessive nutrition suddenly can also increase the risk of protein energy malnutrition sufferers experiencing refeeding syndrome .

Prevention of Protein Energy Malnutrition

Protein energy malnutrition can be prevented by adopting a healthy balanced nutritional diet that includes:

  • Carbohydrate sources , such as rice, bread, or potatoes
  • Sources of protein and fat, such as red meat, fish, eggs, or poultry
  • Sources of minerals and vitamins, such as fruit, vegetables, as well as milk and processed products, such as cheese or yoghurt

In addition to eating healthy food, don't forget to drink water as needed. You are also recommended to undergo treatment to completion if you suffer from a disease that can increase the risk of protein energy malnutrition.

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