Protein energy malnutrition in India: The plight of our under five children

Abstract

Protein energy malnutrition (PEM) is a major public health problem in India. This affects the child at the most crucial period of time of development, which can lead to permanent impairment in later life. PEM is measured in terms of underweight (low weight for age), stunting (low height for age) and wasting (low weight for height). The prevalence of stunting among under five is 48% and wasting is 19.8% and with an underweight prevalence of 42.5%, it is the highest in the world. Undernutrition predisposes the child to infection and complements its effect in contributing to child mortality. Lalonde model (1974) is used to look into the various determinants of PEM in under five children and its interrelation in causation of PEM. The determinants of PEM are broadly classified under four distinct categories: Environmental factors including the physical and social environment, behavioral factors, health-care service related and biological factors. The socio-cultural factors play an important role wherein, it affects the attitude of the care giver in feeding and care practices. Faulty feeding practice in addition to poor nutritional status of the mother further worsens the situation. The vicious cycle of poor nutritional status of the mother leading to low birth weight child further exposes the child to susceptibility to infections which aggravates the situation. However, it is seen that percapita income of the family did not have much bearing on the poor nutritional status of the child rather lack of proper health-care services adversely contributed to poor nutritional status of the child. PEM is a critical problem with many determinants playing a role in causing this vicious cycle of undernutrition. With almost half of under five children undernourished in India, the Millennium Development Goal (MDG) of halving the prevalence of underweight by 2015 seems a distant dream.

Prevalence, Demographic Characteristics and Associated Risk Factors of Malnutrition among 0-5 Aged Children: A Cross-Sectional Study from Van, Eastern Turkey

“…The term, Protein-energy malnutrition (PEM) has been defined as an imbalance between the supply of protein and energy and the body’s demand for them to ensure optimal growth and function by WHO. 4 On the other hand there was no consensus in defining the terms failure to thrive, failure to gain weight, undernutrition etc. and absence of a definite description of these terms results in underrecognition of prevalance, demograhic features, relationship with other disorders as well as outcomes in children.…”

“…1,3,8 According to previous terminology, we used malnutrition (or PEM) term to describe the conditions that defined as underweight (low weight for age), stunting (low height for age) and wasting (low weight for height). 4 …”

“…1-3 Deficits of protein, energy and micronutrients together with environmental, behavioral, biological and health-care service related factors lead to growth failure, development delay and other worse outcomes. 1,3,4 Malnutrition is a chronic and extensive situation, difficult to cope typical of developing countries. On the other hand, it is usually a result of acute or chronic diseases in developed countries.…”

Challenges in the Diagnosis and Management of Growth Hormone Deficiency in India

“…Weight recording to identify protein-energy malnutrition (PEM) has been ingrained in pediatric practice, as PEM is still a major public health problem in India [41]. Height measurement is also critical to assess wasting (weight for height) and stunting (height for age) [41]. This is justified by the study of growth retardation by Nath et al where PEM and chronic anemia resulted in more than 60% of cases of SS [42].…”

Secondary malnutrition: clinico-etiological spectrum

“…1 Primary malnutrition is due to the combined effect of multiple factors including low birth weight, lack of adequate food, frequent infections and environmental enteropathy. Secondary malnutrition, on the other hand results from an underlying disease that compromises growth directly or through its deleterious effect on appetite or the absorption of nutrients.…”