PEM
   WHO DEFINITION (1973)
   Arange of pathological conditions arising from
   coincidental lack in varying proportions of
   proteins   and    calories   occurring    most
   commonly in infants & young children and
   commonlyassociatedwith infections
  Assessment and Classification 
       of PEM
   Classification of PEM
   • Spectrum ranges from Growth failure  to overt
     marasmusandkwashiorkar
   • Marasmus is characterized by gross wasting of
     muscle and subcutaneous tissue resulting in
     emaciation, marked stunting and no oedema.
   Principle features of severe PEM
     Features        Marasmus             Kwashiorkar
     Clinical                    Always present
     Muscle wasting  Obvious            Sometimes hidden 
                                        by edema and fat
     Fat wasting     Severe loss of Sub  Fat often retained 
                     cut Fat            but not firm
     Oedema          None               Present in lower 
                                        legs and usually in 
                                        face an dlower arm
     W/H             Very Low           Low but m/b 
                                        masked by edema
     Mental Changes Sometimes quiet     Irritable, moaning 
                     and apathetic      and apathetic