Protein-Energy Malnutrition (PEM) | Marasmus and Kwashiorkor

According to WHO protein-energy malnutrition (PEM) refers to “an imbalance between the supply of protein and energy and the body’s demand for them to ensure optimal growth and function”.

PEM is classified into two types:

  • Primary PEM
  • Secondary PEM

Primary PEM

Primary PEM is a type of protein-energy malnutrition which is found in children in the initial few years after birth. In children, PEM is primarily of two types:
(a) Kwashiorkor
(b) Marasmus

Dietary deficiency of proteins and total food calories results in malnutrition which is widespread in many underdeveloped countries of South-East Asia, South America, West, and Central Africa. The effect of malnutrition is more prominent in children than in adults.

Protein-energy malnutrition (PEM) may affect large sections of the population during drought, famine, political turmoil, chaos, disorder, disturbance, mess. A case study from Bangladesh during the liberation war and in Ethiopia during the severe drought in the mid-’80s. PEM affects infants and children resulting in Marasmus and Kwashiorkor.

It has been observed that in both Kwashiorkor and Marasmus, physical and mental development is affected, emerging in serious illness and severe health issues.


Marasmus is produced by a simultaneous deficiency of proteins and calories. It occurs in infants having an age of less than a year if mother’s milk is replaced too early by other foods which are poor in both proteins and calorific value.

Related:  8 Amazing Health Benefits of Apple Cider vinegar and Related Side Effects

This often happens if the mother has second pregnancy or childbirth when the older infant is still too young. In marasmus, protein deficiency impairs growth and replacement of tissue proteins, extreme emaciation of the body, and thinning of limbs occurred; the skin becomes dry, thin, and wrinkled.

Growth rate and bodyweight decline considerably, The growth and development of the brain and mental faculties are also impaired.

Symptoms of marasmus

  • Children become weak and get fatigued easily
  • Depressed eye
  • Old man’s face
  • Wasted muscles
  • Very little fat
  • Prominent ribs
  • Very underweight
  • No subcutaneous fat
  • Severely emaciated (abnormally thin)


Bulging eye symptom of Kwashiorkor | Protein-energy malnutrition
Bulging eye symptom of Kwashiorkor

Kwashiorkor is also known as edematous malnutrition in medical terms. It generally happens in the child having more than one year old.

Kwashiorkor is produced by protein deficiency unaccompanied by calorie deficiency. It results from the early replacement of mother’s milk by the high-calorie and low protein diet in a child.

Like marasmus, kwashiorkor shows wasting of muscles, thinning of limbs, failure of body growth, and brain development. But unlike marasmus, some fat is still left moreover, extensive edema and swelling of body parts are seen.

In this condition, extensive edema can be observed. Subcutaneous fat is still present below the surface of the skin. Wasting of muscles and thinking of limbs also occur in children having Kwashiorkor. Muscle wasting decreases body strength and the ability to move. Skin appears to be swollen and children remain underweight in this disease.

Symptoms of kwashiorkor

  • Retarted mental and physical growth
  • Loss of appetite
  • Bulging eye
  • Protruding bellies
  • The skin becomes dry, lustureless, and appearance of black spots
  • Hair feel dry, textureless, lustreless and may turn reddish yellow to white in color which results in sparse, brittle, and can be pulled out easily
  • Nail plates are thin and soft, fissured, or ridged
  • Wasted muscles can be observed which means a weakening, shrinking, and loss of muscle
  • Enlarged liver with fatty infiltrates
  • Fat present beneath the subcutaneous layer of skin
  • Underweight
  • Edema (Swelling caused by excess fluid trapped in your body’s tissues) of ankles, feet, and belly
  • Children become lazy and irritated
Related:  19 Amazing Health Benefits of Ginger, Side Effects, and More

Difference between marasmus and kwashiorkor

1.Occurs in a child below one year of ageOccurs in a child more than one year of age
2.Deficiency of protein and calories bothDeficiency of protein only
3.Skin is dry and wrinkledSkin appears swollen
4.Subcutaneous fat disappearSubcutaneous fat is still present
5.Extreme emaciation of the body and thinning of limbs occursWarring of muscles and thinning of limbs occur
6.No edemaExtreme edema observed
7.Severely emaciatedUnderweight children
8.Children become weak and get fatigued easilyChildren become lazy and irritated
Protein Energy Malnutrition (PEM)

Secondary PEM

It is caused due to disorders of the gastrointestinal tract (GIT). It may also be caused due to infections, hyperthyroidism, trauma, burns, and other critical illnesses. Secondary PEM decreases the appetite and impairs nutrient metabolism.

What causes protein-energy malnutrition?

Protein-energy malnutrition (PEM) is a common childhood disorder. It is primarily caused by a deficiency of energy, protein, and some micronutrients.

What are the symptoms of protein-energy malnutrition?

Protein is the building block of your body it is required by muscles, skin, bones, enzymes, and hormones, which play an essential role in all body tissues. Its deficiency may cause serious health issues with edema, fatty liver, skin, hair, and nails problems, loss of muscle mass, greater risk of bone fractures, stunted growth in children, increased severity of infections, greater appetite

What are 2 protein-energy malnutrition disorders?

Marasmus and Kwashiorkor are the two protein-energy malnutrition disorders.

What are PEM and its types?

According to the definition of the World Health Organization (WHO), protein-energy malnutrition (PEM) refers to “an imbalance between the supply of protein and energy and the body’s demand for them to ensure optimal growth and function”.
PEM is classified into two types: (1) Primary PEM (2) Secondary PEM

What disease is caused by a lack of protein-energy?

Lack of protein-energy malnutrition can cause mild to serious health-related issues in both children and adults but it’s more common in children below 5 years of age. Marasmus and Kwashiorkor are two disorders related to protein-energy malnutrition (PEM).

Leave a Comment