Protein-energy Malnutrition (PEM) arises due to deficiency of both dietary energy and proteins. Since energy is mainly supplied by carbohydrates and fats. We can say that protein energy malnutrition is due to deficiency of proteins, carbohydrates and fats in the diet. It is the most important nutritional disorder affecting the children in our country in the age period of 1-5 years.

PEM is largely responsible for the fact that in poor families many children born, do not survive to the age of 5 years. PEM results in retarded body growth of the child in both height and weight.

Two common diseases caused by protein-energy malnutrition are Kwashiorkor and Marasmus.

1. Kwashiorkor

Kwashiorkor is a deficiency disease, which occurs due to deficiency of proteins in the diet. This disease occurs in children in the age group of 1-5 years. Kwashiorkor arises when after a prolonged period on the protein in rich breast-feeds, the child is weaned on to the traditional family diet that may be low in protein and energy. ‘Kwashiorkor’ is an African word from Ghana, which literally means ‘rejected child’.


Children suffering from Kwashiorkor show the following symptoms:

1. They have low body weight and look small for their age.

2. Such children have a look of unhappiness and apathy.

3. Their skin becomes broken, scaly and pale in colour. Their hair becomes reddish.


4. Their muscles become limp and wasted.

5. Their abdomen, feet and legs swell due to accumulation of excess fluid. This swelling of the body due to retention of fluids is called oedema.

6. Digestive upsets such as diarrhoea are very common in children suffering from Kwashiorkor.

Treatment of Kwashiorkor:


This disease can be cured in most of the cases by supplying high protein diet such as combination of wheat, gram, peanuts, soyabean and jaggery. In case of non-vegetarians a diet containing animal protein may be given to treat Kwashiorkor.

2. Marasmus

Marasmus is a malnutrition disease, which arises due to deficiency of carbohydrates, fats and proteins in the diet. Marasmus is the childhood equivalent of starvation in adults. This disease develops due to early and abrupt weaning followed by artificial feeding which is inadequate in protein and energy nutrients. Sometimes this disease occurs due to the reason that the child suffers from some disease such as diarrhoea, which prevents the utilization of food. The victims of Marasums are generally infants under one year of age.

Children suffering from Maramus show the following symptoms:

1. They have low body weight and less length.


2. A Marasmic child has thin, wrinkled and inelastic skin. However, the skin does not break down.

3. A Marasmic child shows wasting of muscles. The swelling of limbs as in case of Kwashiorkor is not seen in Marasmus.

4. Digestive upsets such as diarrhoea are common in children suffering from Marasmus.

Treatment of Marasmus:


This disease can be cured by providing the child with diet containing sufficient protein in energy supplying nutrients, and by controlling infection. Milk as a diet is excellent for this purpose. In case the child is seriously ill and cannot tolerate whole milk, skimmed milk may be given.