Proteinenergy malnutrition

The terms protein—energy malnutrition and protein—energy deficiency are widely used to mean a general lack of food, as opposed to specific deficiencies of vitamins or minerals

(discussed in Chapter 11). However, the problem is one not of protein deficiency, but rather a deficiency of metabolic fuels. Indeed, there may be a relative excess of protein, in that protein which might be used for tissue protein replacement, or for growth in children, is being used as a fuel because of the deficiency of total food intake.

This was demonstrated in a series of studies in India in the early 1980s. Children whose intake of protein was just adequate were given additional carbohydrate (as sugary drinks). They showed an increase in growth and the deposition of new body protein. This was because their previous energy intake was inadequate, despite an adequate intake of protein. Increasing their intake of metabolic fuel both spared dietary protein for the synthesis of tissue proteins and also provided an adequate energy source to meet the high energy cost of protein synthesis (section The body's first requirement, at all times, is for an adequate source of metabolic fuels. Only when

Table 8.1 Classification of protein-energy malnutrition by body mass index



Acceptable/desirable range


Moderate protein-energy malnutrition


Moderately severe protein-energy malnutrition

< 16

Severe protein-energy malnutrition

energy requirements have been met can dietary protein be used for tissue protein synthesis.

The severity of protein—energy malnutrition in adults can be assessed from the body mass index (the ratio of weight (in kg)/height2 (in m); section 6.1.1), as shown in Table 8.1.

There are two extreme forms of protein—energy malnutrition:

  • Marasmus can occur in both adults and children and occurs in vulnerable groups of the population in developed countries as well as in developing countries.
  • Kwashiorkor affects only children and has been reported only in developing countries. The distinguishing feature of kwashiorkor is that there is fluid retention, leading to oedema.

Protein—energy malnutrition in children can therefore be classified by both the deficit in weight compared with what would be expected for age and also the presence or absence of oedema, as shown in Table 8.2. The most severely affected group, and therefore the priority group for intervention, are those suffering from marasmic kwashiorkor — they are both severely undernourished and also oedematous.

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