Protein Energy Malnutrition – How Serious Can it Be?

Protein is a major component of every cell, organ and function in the body. It is vitally important and is found in a number of sources in the typical diet- including in foods that are not so good for the human body, like processed or fast foods. Even though protein is found in so many different food sources there are still many people that do not get enough calories in their diet including protein.

Protein energy malnutrition (PEM) is a potentially fatal body deprivation disorder that is the leading cause of death in developing countries. PEM happens when there are not enough calories or proteins to meet the body’s nutritional needs. However, it does not always happen simply in the absence of protein in the diet, it can also occur when the body is either unable to absorb the protein or is not able to convert it for its own use.

PEM is not a common problem in the United States; statistically however it does affect two different demographic groups: the elderly who are living in nursing homes or other long term care facilities and children from poor families. It occurs in one in every two surgical patients and strikes 48% of all other, admitted, hospital patients (Source:

There are two varieties of PEM, Primary and Secondary. Primary PEM occurs when there is a lack of overall protein sources in the diet and too few calories. Secondary PEM is more common in the United States and is typically a complication that has developed from another disease including: AIDS, cancer, chronic kidney failure, inflammation bowel disease. PEM can develop slowly during a chronic illness or when the body is in a state of semi-starvation, but may develop quickly if there is an acute illness.

Protein energy malnutrition occurs in both hospital patients and long term care facility residents for a number of reasons. Many of them cannot chew or swallow correctly, preventing them from getting enough food into their system. Others may have slowed or faulty digestive systems, keeping them from processing the foods that they are taking in and leaving them feeling uncomfortable and unwilling to eat the next meal. Many of them are also not active and may have slowed or completely absent metabolisms, preventing them from feeling hunger at all. The elderly also tend to have a reduced sense of appetite to begin with, even when healthy.

In addition to the inability to eat and get enough calories in the diet, these patients may have additional nutrition losses because of bleeding, diarrhea, high sugar levels, kidney disease, malabsorption disorders. There are also other conditions that greatly increase the nutritional needs in the body, especially the need for protein. These conditions include: fever, infection, surgery, trauma, tumors, burns and some the use of some medications.

Continued inability to get enough calories or enough protein in the diet can lead to severe problems and can alter the form or function of every organ in the body. How fast or severe the condition actually is will depend on prior nutritional and health status, the nature of the disorder and the speed of its progression.

Protein energy malnutrition ranges from mild to severe; however there are no set criteria for setting the levels. Most doctors agree that a loss of ten to twenty percent of the body weight constitutes moderate PEM. At this level, there is a weakened grip and the inability to perform any high energy tasks.

Severe PEM involves a weight loss of more than twenty percent and is potentially fatal. At this stage of the condition, the patient will be unable to eat any normal sized meals even if they have an appetite, the heart rate will be abnormally slow and the blood pressure will be dangerously low. The body’s core temperature will also drop below normal. The skin will appear baggy and wrinkled and the hair will be dry, thin and brittle. Constipation is very likely at this point as is lethargy. The patient will also be more prone to pressure ulcers (commonly referred to as bed sores) and other skin lesions as the body is unable to fight off damage to the skin’s surface or underlying infectious agents.

It is very important that those people who are most at risk for protein energy malnutrition (children, the sick and the elderly) be given enough calories, including all three macronutrients to ensure their good health or to help them recover from illness or trauma. Using a protein supplement may be beneficial because is it more easily assimilated into the body. Once the condition has reached the moderate to severe stage, the likelihood of fatality becomes even more eminent without medical and nutritional intervention.

There are several different types of protein supplements that can be considered at this point, however they must meet the same criteria to be useful:

– They must contain high quality protein that can be assimilated by the body without extra effort. (Protein requires the most energy by the body to digest)

– They must not contain additional ingredients that can cause allergic reactions or be hard to digest or finally, could displace the protein.

– They must be palatable. A protein supplement that is very high in amino acids is typically very bitter and will not be easily eaten by the average person. The protein in the supplement should be broken down into smaller peptides so that it is easier to use and does not have the bitter taste.

– They should be adaptable meaning that the patient should be able to transition with the same protein supplement from feeding tube to consumption without the need to introduce a new supplement source to the system which could increase the risk of allergic reaction in some people.

– They should not cause a rise in blood sugar which can happen in the presence of added sugars.

– They should address the actual problem of protein digestion or absorption if at all possible.

– Finally, the protein supplement should give as many additional benefits as possible without comprising current health status or impeding healing.

There are a number of protein supplement types including the protein powders that can be added to other feeding sources and protein supplement shots. Protein powders have a number of advantages and disadvantages for each of the four types.

Whey Protein Powder: Advantages

– Enhances the production of glutathione, an immunity booster

– Highest level of natural food sourced branch chain amino acids which can be metabolized straight to muscle tissue

– Excellent source of the amino acid leucine which is vital for muscle growth

– Helps with the optimal intake of protein, fats, carbohydrates and the micronutrients

– Helps preserve muscle tissue

– Maintains a healthy blood sugar level

– High calorie protein source

Whey Protein: Disadvantages

– Potential allergic reaction in those who are lactose intolerant

– Too much whey can damage the liver

Soy Protein: Advantages

– Highly digestible form of protein

– Improves the nutritional value of other foods

– May decrease cholesterol

– Is suitable for vegans

– Source of phytoestrogens which are beneficial in a number of conditions and diseases including osteoporosis and breast health

Soy Protein: Disadvantages

– Potential allergen

– May not be indicated in some forms of breast cancer

Rice Protein: Advantages

– Hypoallergenic

– Easy to digest

– Suitable for vegans

Rice Protein: Disadvantages

– May be difficult to find in some areas

– May be more expensive to buy

Egg protein Advantages

– Made from the white of the egg, considered to be the perfect protein source

– Fat free

– High quality protein

– Highest food source in the amino acids, alanine, argine, glycine and methione.

Egg protein disadvantages

– Allergen potential

– May react with some medications

Michael Ortiz

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