Protein Energy Malnutrition

Introduction

Since inception, ‘nutrition’ remained essential for human life, especially for growth and development and to be healthy (Tanaka, 2017). The word ‘nutrition’ is derived from the Latin word ‘nutrire’ which means to ‘nourish’ or ‘feed’. Scientifically, nutrition involves a combination of biochemical and physiological processes which supports the life of an organism by using food and its nutrients (Basic Nutrition and Healthy Eating, n.d.).

World Health Organization (WHO) emphasizes on nutrition for better health and development during the life cycle (infancy, childhood, adolescence, youth, adulthood, pre-conception, pregnancy, post-pregnancy and old age) for providing better immunity to fight both communicable and non-communicable diseases and for expanding longevity of life. Henceforth, nutrition lies somewhere in between health and disease. A healthy childhood leads to better learning, similarly, healthy adults have better productivity, accelerating social-economic developments of a nation than its counterparts. The conditions of inadequate intake of carbohydrate, protein, vitamins, and minerals lead to wasting (low weight as per height), stunting (low height as per age), diet-related non-communicable diseases and can lead to death. On the other hand, excessive intake of food leads to over-weight and obesity that leads to many diseases (Nutrition, n.d.-b). Malnutrition is a global public health issue, though low and middle income countries (LMIC) are mostly affected, particularly, Sub-Saharan Africa and South Asia (Zhang et al., 2022).

Protein Energy Malnutrition (PEM) denotes to poor or no energy, a condition that arises due to deficiency of macronutrients (carbohydrates, proteins, and fats) and micronutrients (vitamins and minerals). This is also termed as Protein Energy Undernutrition (PEU) (Protein Energy Undernutrition, n.d.). The World Health Organization defines Protein-Energy Malnutrition (PEM) as “an imbalance between the supply of protein and energy and the body's demand for them to ensure optimal growth and function” (De Onis & Blössner, 1997). PEM is also defined as an unintentional loss of 10% or more of body weight in a period of six months or less and/or serum albumin levels of less than 3.5 grams per deciliter (g/dl) (Hudson et al., 2000). It usually occurs gradually in three different stages such as mild, moderate and severe but sometimes may occur suddenly too. The clinical manifestation of related disorder and series of disease is known as marasmus- a condition of muscle wasting that happens primarily due to lack of protein and overall calorie intake, or as kwashiorkor- a condition due to primary protein malnutrition along with edema and intermediate state that is combination of marasmus-kwashiorkor having symptoms of both wasting and edema (Rasheed et al., 2023). Most children suffer from PEM due to socio-economic-political conditions, women’s poor status/education, inaccessibility, conflict zone, geographical situation, resource inaccessibility and sanitation constraints, etc. The morbidity and mortality among malnourished children are much higher as they get easily exposed to gastroenteritis issues, chronic diarrhea, malabsorption, pneumonia and TB/HIV infections. On the other hand, senior citizens suffer from PEM, due to inadequate nutrition and children with obesity due to excess intake of junk foods (Müller & Krawinkel, 2005).

The global estimation shows that 462 million people are underweight whereas among adults, 1.9 billion are overweight. Among under-5 years’ children (U-5), almost 170 millions are suffering with PEM (Rasheed et al., 2023), 149 million are stunted, 45 million wasted, 38.9 million overweight/obese and almost 50% deaths among this age group of children are directly or indirectly attributed to undernutrition. Women are made nutritionally vulnerable due to cultural taboos, gender bias and specific physiological needs (Malnutrition, 2021; Nutrition in developing countries, n.d.). There are many programs related to nutrition operational in various countries, few examples are given below.