What is Protein Energy Malnutrition (PEM)

Protein Energy Malnutrition is when a person does not eat enough protein, fat, and calories.

When this happens over time, it can lead to severe loss of muscle tissue (muscle wasting). This condition also affects the body’s defense system (immune system) and can lead to other health problems.

What are the causes?

This condition may be caused by:

• Not eating enough protein, fat, or calories.
• Having certain chronic medical conditions.
• Eating too little.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Living in poverty.
• Long-term hospitalization.
• Alcohol or drug dependency. Addiction often leads to a lifestyle in which proper diet is ignored. Dependency can also hurt the metabolism and the body’s ability to absorb nutrients.
• Eating disorders, such as anorexia nervosa or bulimia.
• Chewing or swallowing problems. People with these disorders may not eat enough.
• Having certain conditions, such as:
  • Inflammatory bowel disease. Inflammation of the intestines makes it difficult for the body to absorb nutrients.
  • Cancer or AIDS. These diseases can cause a loss of appetite.
  • Chronic heart failure. This interferes with how the body uses nutrients.
  • Cystic fibrosis. This disease can make it difficult for the body to absorb nutrients.
• Eating a diet that extremely restricts protein, fat, or calorie intake.

What are the signs or symptoms?

Symptoms of this condition include:

• Fatigue.
• Weakness.
• Dizziness.
• Fainting.
• Weight loss.
• Loss of muscle tone and muscle mass.
• Poor immune response.
• Lack of menstruation.
• Poor memory.
• Hair loss.
• Skin changes.

How is this diagnosed?

This condition may be diagnosed based on:

• Your medical and dietary history.
• A physical exam. This may include a measurement of your body mass index (BMI).
• Blood tests.

How is this treated?

This condition may be managed with:

• Nutrition therapy. This may include working with a diet and nutrition specialist (dietitian).
• Treatment for underlying conditions.

People with severe protein-energy malnutrition may need to be treated in a hospital. This may involve receiving nutrition and fluids through an IV.

Follow these instructions at home:

• Eat a balanced diet. In each meal, include at least one food that is high in protein. Foods that are high in protein include:
  • Meat.
  • Poultry.
  • Fish.
  • Eggs.
  • Cheese.
  • Milk.
  • Beans.
  • Nuts.
• Eat nutrient-rich foods that are easy to swallow and digest, such as:
  • Fruit and yogurt smoothies.
  • Oatmeal with nut butter.
• Try to eat six small meals each day instead of three large meals.
• Take vitamin and protein supplements as told by your health care provider or dietitian.
• Follow your health care provider’s recommendations about exercise and activity.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have increased weakness or fatigue.
• Faint.
• Are a woman and you stop having your period (menstruating).
• Have rapid hair loss.
• Have unexpected weight loss.
• Have diarrhea.
• Have nausea and vomiting.

Get help right away if you have:

• Difficulty breathing.
• Chest pain.

Summary

• Protein-energy malnutrition is when a person does not eat enough protein, fat, and calories.
• Protein-energy malnutrition can lead to severe loss of muscle tissue (muscle wasting). This condition also affects the body’s defense system (immune system) and can lead to other health problems.
• Talk with your health care provider about treatment for this condition. Effective treatment depends on the underlying cause of the malnutrition.