PROTEIN ENERGY 
    MALNUTRITION (PEM)
     Protein Energy Malnutrition (PEM) 
   or Protein Caloric Malnutrition (PCM) has 
   been identified as not only an important 
   cause of children morbidity and 
   mortality but also leads to permanent 
   impairment of physical and mental 
   growth.
       CLINICAL FORMS OF PEM
       Kwashiorkor is caused by the deficiency of 
        proteins in diet. The main features are 
        growth failure, edema, diarrhoea, anaemia, 
        and changes in skin and hair. 
           Marasmus is caused by severe deficiency 
        of both proteins and calories in the diet. This 
        is characterized by growth failure, loss of fat, 
        signs of dehydration, and mental changes. 
                        CAUSES OF PEM
        An inadequate intake of food in quantity and 
         quality.
        Infections like diarrhoea, measles, respiratory 
         infections and intestinal worms. 
        Poor environmental sanitation. 
        Large family size. 
        Poor maternal health. 
        Failure of lactation. 
        Premature termination of breast feeding. 
        Adverse cultural practices related to breast 
         feeding and weaning. 
     CLINICAL FEATURES OF PEM
  Signs and      Marasmus  Kwashiorkor 
  symptoms 
                                  Sometimes 
 Muscle wasting     Obvious       hidden by 
                                edema and fat
                 Severe loss of 
     Fat loss    subcutaneous    No loss of fat
                      fat
                                Usually present 
     Edema        Not present   on lower limbs, 
                                lower arms and 
                                     face.
    Weight for      Very low       Very low
     height
  Signs and    Marasmus  Kwashiorko
  symptoms                      r 
   Face look   Like monkey   Moon face
                  face
                Sometimes 
 Mental changes quiet and    Very rare
                apathetic
    appetite   Usually good    Poor 
   Diarrhoea      Often        Often