Int. J. Pharm. Sci. Rev. Res., 80(1), May – June 2023; Article No.

04, Pages: 17-22 ISSN 0976 – 044X

Review Article

Protein Energy Malnutrition: An Overview for Child Health

Dimple S. Sahare*, T. M. Rasala, Kajal P. Kesare, Shubham S. Gupta, Dr. Abhay M. Ittadwar
Department of Pharmaceutics, Gurunanak College of Pharmacy, Nagpur, India.
*Corresponding author’s E-mail: [email protected]

Received: 06-02-2023; Revised: 25-04-2023; Accepted: 03-05-2023; Published on: 15-05-2023.

ABSTRACT
In this current scenario, modernization of world in all aspects is one of the tremendous pressure for influencing lifestyle of people
which has led to an explosive increase on working for whole body protein. Various new diseases, disorders and syndromes are under
research for the measures to overcome such medical conditions. Protein Energy Malnutrition is one of the medical condition affecting
the growth and development of people’s health at the most crucial period of life. WHO reports that every age group of human beings
suffers from this health condition and even death ratios are also reported from the same. PEM is most commonly seen in infants,
paediatrics and children under the age of 5 approximate 24.8% of population suffer from stunting, 2.21% by overweight and 6.41%
by wasting and severe wasting by the survey reports of UNICEF, WHO, and World Bank. From the study it is reported that, besides of
developing medical facilities there is still a need to promote the child health programs for the recovery from malnutrition in children.
Keywords: Protein Energy Malnutrition, WHO (World Health Organization), paediatric, health programs, under nutrition, stunted,
wasted, obesity, UNICEF.

among children under 5 years old, and Body Mass Index

QUICK RESPONSE CODE →
(BMI) for age among 5 to 19 year olds. Stunting (linear
growth impairment) is measured in terms of (HAZ) height
DOI: (or length) for age.3
10.47583/ijpsrr.2023.v80i01.004
Need to study protein energy malnutrition:

DOI link: http://dx.doi.org/10.47583/ijpsrr.2023.v80i01.004

Despite the fact that this population has not significantly
improved, a sizable portion of children still suffer from
nutritional inadequacies. Yet, due to worries about other
INTRODUCTION infectious diseases, simple issues like PEM have gone

I n recent years, Public health issues and improvements unnoticed.4 Undernutrition is linked to decreased
in people's health have received more attention. immunological responses, which increases susceptibility to
Children are an important segment of the present and infections, which worsen undernutrition. If this vicious
future of the country. Therefore, one of the biggest deals cycle persists, the child may die. Complex relationships
in the global aspect is reducing child disease and death. It exist in pre-schoolers between dietary intake, nutritional
is a significant public health issue in India that primarily status, and morbidity.5
affects infants and young children (under the age of 6), Poor nutrition (poor diet quantity and/or quality resulting
with devastating effects on everything from physical in over- or undernutrition) and lack of early learning
development to cognitive growth to infection opportunities contribute to the loss of growth and
susceptibility. 1 academic potential and result in lifelong health and
What is protein energy malnutrition? economic disparities for learning. Learning has been linked
to positive early child development (ECD) outcomes when
Protein-Energy Malnutrition, indicates a mismatch it is supported by responsive caregiving behaviours that
between the amount of protein and energy available and are prompt, contingent on children's actions, and
what the body needs to grow and function at its best. This developmentally appropriate and stimulating.2
imbalance encompasses both insufficient and excessive
energy intake, the latter of which causes overweight and One important measure of a community's nutritional
obesity while the former causes malnutrition in the form quality and health is considered to be a child's growth. The
of wasting, stunting, and underweight.2 World Health Organization estimates that approximately
half of all child fatalities under the age of five are caused
Intake, requirements, and expenditure of energy and/or by undernutrition. According to the Joint Child
specific nutrients are very rarely directly assessed. Instead, Malnutrition Estimates, stunting and wasting affected 151
practise and research rely on anthropometric and 51 million under-5 children worldwide, respectively.
measurements compared to a control population. Wasting One of the rare nations with a high frequency of both
(thinness) is defined by (WHZ) weight for height/length
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Int. J. Pharm. Sci. Rev. Res., 80(1), May – June 2023; Article No. 04, Pages: 17-22 ISSN 0976 – 044X

stunting and wasting is India.6 Children's physical, mental, as malnutrition that develops as a result of chronic
and social development is impacted by malnutrition. Early conditions like chronic kidney, liver, or cardiac disease. 10
malnutrition detection is crucial to allow for the prompt
Malnutrition can appear in many different ways, but the
implementation of necessary corrective measures.7
preventive process is essentially the same: proper
Nutrition is once again a topic of concern for the nutrition of the mother before, during and after
development and growth of children. The current study pregnancy; optimal care during the first two years of life;
aims to draw attention to one of the issue of silent killer healthy, varied and safe foods for young children; and a
i.e. protein energy malnutrition and to develop new healthy environment, including access to essential
strategies to overcome this problem in upcoming years.8 medical, water, sanitation and hygiene services, and
opportunities for safe physical activity.11
1. CAUSES:
Malnutrition in children is the consequence of a variety of
Primary malnutrition, which accounts for the majority of
causes, typically including combinations of the following:
malnutrition in underdeveloped countries, is caused by a
poor food quality, inadequate food intake, severe and
lack of food and the interaction of diseases. Politics and
recurrent infectious infections. The general level of living
social and gender inequality, particularly in regards to
and the ability of a population to meet fundamental
income and education, are the primary causes of
requirements like access to food, housing, and healthcare
malnutrition.9 Social injustice and civil unrest are
are directly correlated with these circumstances.2
significant antecedents. Secondary malnutrition is defined

Figure 1. Causes of Malnutrition15

2. CLINICAL FEATURES: Undernutrition: when children don’t eat or absorb enough

nutrients to grow.
Malnutrition refers to deficiencies, excesses, or imbalances
in a person’s intake of energy and/or nutrients. The term Hidden hunger: when children don’t get enough essential
malnutrition addresses 3 broad groups of conditions: vitamins and minerals
• undernutrition, which includes wasting (low Overweight: when a child’s weight is too high for his or her
weight-for-height), stunting (low height-for-age) height.
and underweight (low weight-for-age);
Obesity: the most severe form of overweight.
• micronutrient-related malnutrition, which Food systems: all the elements and activities involved in the
includes micronutrient deficiencies (a lack of production, processing, distribution, preparation and
important vitamins and minerals) or micronutrient consumption of food.
excess; and
Stunting: a form of undernutrion when population of
• overweight, obesity and diet-related non- children are too short for their age.
communicable diseases (such as heart disease,
stroke, diabetes and some cancers).12 Wasting: an extreme form of undernutrition when a child is
too thin for his or her height.13

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Int. J. Pharm. Sci. Rev. Res., 80(1), May – June 2023; Article No. 04, Pages: 17-22 ISSN 0976 – 044X

3. PANDEMIC REPORT: children from unhealthy processed and ultra-processed

food and beverages and harmful marketing practices aimed
Method:
at children and families. Use multiple communication
The study outlined below expands on past research reports channels, including digital media, to reach caregivers with
analyses and results published by (World Health factual information and advice about infant nutrition and
Organization) (World Bank Group)) (UNICEF) and literature increase appetite for nutritious and safe foods.14
reviews that confirmed that malnutrition has a
Health System: By investing in the hiring, training,
multiplicative effect on child growth and development and
oversight, and encouragement of community-based
can lead to other diseases and population-level death.
counsellors and workers, we can increase carer access to
4. PREVENTIVE MEASURE: high-quality counselling and support on feeding young
children. To young children at risk of micronutrient
Food System: Increase the availability and affordability of
deficiencies, anaemia, and poor growth and development,
nutrient-dense foods (including fruits, vegetables, eggs,
administer nutritional supplements, homemade fortifiers,
fish, meat and fortified foods) by promoting their
and fortified supplementary meals.14
production, distribution and retail sales. National standards
and legislation must be implemented to protect young

40
35.4
35 32.6 32.8
29.7 30.4
30 27.3 27.7
26.1
% Of Population

23.7
25 22
19.920.3 20.220.5
20 16.1
14.1 13 14
15 12.7
10.4
10
4.6 4.2 5.2 4.1
5
0
East Asia & Pacific India Least Developed South Asia Sri Lanka Low Income
(Excluding High Countries: UN
Income) Classification
Countries

2002 2005 2015 2018

Figure 2. Prevalence of undernourishment (World Bank Data)13

Stunting Wasting and Severe Wasting Overweight

60
48.4
50
43.6
40
Numbers In %

33.9

30
22.2
20 14.5
13.9
11
7 7.2 7.4 8.1
10 5.5 5.8 5.5
3.2 2.1
0.7 0
0
African region Region of America South-East Asia Eastern Europe Region Western Pacific
Region Mediterranean Region
Region

WHO Regions

Figure 3. Prevalence estimate of year 200011

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Int. J. Pharm. Sci. Rev. Res., 80(1), May – June 2023; Article No. 04, Pages: 17-22 ISSN 0976 – 044X

Stunting Wasting and Severe Wasting Overweight

35 31.7
30.1
30 26.2
25
Numbers In %

20
15
8.9 8 9.3
10 7.7 7.9 7.5
5.7
5
4.2 3.3 4.5 3
1.4 0.1 0.5
0
0
African region Region of America South-East Asia Eastern Europe Region Western Pacific
Region Mediterranean Region
Region
WHO Regions

Figure 4. Prevalence estimate of year 202011

AFFECTED POPULATION YEAR 2000

Stunting Wasting and Severe Wasting Overweight
85.5
90
80
Numbers In Millions

70
60 48.6
50
40 27.5
30 24.6 22.3
20 10.8
6.2 9.9 5.4 5.8 4.8 6.3 5 4.2 6.8 2.4
10 0.5
0
African region Region of America South-East Asia Eastern Europe Region Western Pacific
Region Mediterranean Region
Region
WHO Regions

Figure 5. Affected population year 200011

AFFECTED POPULATION YEAR 2020

Stunting Wasting and Severe Wasting Overweight

60 54.9
51.1
Numbers In Millions

50
40
30 22.4
20 11 8.8
10
7.3 6.5 5.8 5.6 7.7 6.6
3.2 4.4
2.3 0.1 2.6 0.6
0
African region Region of South-East Asia Eastern Europe Region Western Pacific
America Region Mediterranean Region
Region
WHO Regions

Figure 6. Affected population of year 202011

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Int. J. Pharm. Sci. Rev. Res., 80(1), May – June 2023; Article No. 04, Pages: 17-22 ISSN 0976 – 044X

Social Protection System: Provide social transfers (cash, CONCLUSION

food, and/or vouchers) that promote wholesome eating
Very poor children are more likely to be underfed and
habits in young children, even in vulnerable environments
malnourished, especially in rural parts of low-income
and in response to humanitarian disasters, rather than
nations. They are least likely to have access to clean water,
undermining them. Use social protection programmes to
proper hygienic practises, and medical treatment. Due to
educate carers about how to feed young children, offer
their hardship, they are less likely to complete their
counselling and education, and promote the use of health
education, are more likely to fall ill, and are ultimately more
and nutrition services.14
likely to stay in poverty.
Multi-system governance: Establish the right of early
Malnutrition still hinders children's growth and
children to healthy diets as a top priority in the national
development, and it can also result in other infectious
development agenda and make sure that laws and policies
disorders. Thus, it is necessary to implement fresh
are consistent across all systems and sectors. Set goals and
approaches and methods to address these societal issues
monitor progress using sector-specific monitoring systems
that have gone unresolved. In order to combat this issue of
and household surveys to increase public accountability for
protein energy deficiency, medical facilities must also be
young children's diets. Study the availability, cost, and
built.
acceptability of context-specific barriers, enablers, and
paths to enhancing the quality of young children's nutrition, ❑ Empower families, children and young people to
as well as other factors.14 demand nutritious food.
DISCUSSION ❑ Drive food suppliers to do the right thing for
children.
Prevalence estimates for stunting and overweight
throughout the course of a year, are comparatively stable. ❑ Build healthy food environments for all children.
So, it is possible to monitor the evolution of these two
❑ Mobilize supportive systems to scale up nutrition
criteria on a global and regional scale. In the course of a
results for every child.
year, acute illnesses like wasting and severe wasting can
change frequently and quickly. As a result, it is challenging ❑ Collect, analyse and use good-quality data and
to produce trustworthy long-term trends using the current evidence regularly to guide action and track
input data, and as such, this report provides only most progress.
recent global and regional estimates.
ACKNOWLEDGEMENT: The author is thankful to all the
Data collected from world bank group shows prevalence of contributors in compiling and preparing manuscript for this
undernourishment of year 2002, 2005, 2015 and 2018 in article.
some of countries selected where East Asia and Pacific
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Conflict of Interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

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