Protein Energy Malnutrition (PEM)

Protein energy malnutrition ids also known as protein-calorie malnutrition. The two common clinical syndromes due to severe protein-calorie malnutrition in young children are kwashiorkor and marasmus. Both the conditions are caused by severe deficiencies of protein and calories in diet. The two characteristic symptoms of kwashiorkor, i.e., oedema and diarrhoea are absent in marasmus

Nutritional Requirements

The diet should be easily digestible and should contain proteins of high nutritive value, eg: milk proteins. The nutritional requirements are briefly discussed below:

Calories: The calorie intake should be about 1 1/2 times the normal requirements, i.e., 140 kcal/kg for rapid recovery.

Protein: The protein intake should be about twice the normal protein requirements i.e 4 to 5 g/kg body weight.

Electrolytes: Potassium chloride (2-4 g) and magnesium chloride (0.5 g) should be added daily to the diet for a period of 2 weeks.

Vitamins: The daily requirements of all vitamins should be added to the diet.

Vitamins-A Deficiency: If vitamin A deficiency is present, oral administration of a single dose of 50,000 I.U of fat soluble vitamin A should be given immediately followed by 5000 units daily. The deficiency symptoms will be cured in about 2 weeks.

Anaemia: For the treatment of anaemia ferrous ammonium citrate (0.8 g) should be given daily in the form of a syrup in 3 divided doses for a period of one month. Folic acid (1 mg) should be given daily for a week followed by 100 μg daily afterwards.


For a child suffering from protein-calorie malnutrition and weighing 12 kg, the daily calorie intake should be about 12×140=1680 kcal and protein intake should be 12×4 or 5=48 to 60 g.

The diet and daily menu are given below:

Diet For A Child Suffering From Kwashiorkor And Marasmus (Body wt. 12 kg, Calories 1700 kcal, Protein 50-60 g)

Milk, skimmed (ml)1000_
Milk, skimmed (ml)10002000
Cane sugar (g)100100
Dextrimaltose (g)50_
Ripe banana (two) (g)150150
Corn or wheat flour (g)2550
Bread and biscuits (g)2510-100
VitaminsDaily requirements added to milkDaily requirements added to milk

Daily Menu For A Child Suffering From Kwashiorkor And Marasmus

1st DAT TO 10th DAYTIMINGS11th DAY TO 30th DAY
Milk (half fat) with sugarMorning 6:00 AMMilk (full fat) with sugar-1 cup

Corn flour milk pudding-1 serving
Banana (one)
Milk with sugar-1 cup
Breakfast 8:00 AMBread (1 slice) with milk
Corn flour milk pudding-1 serving
Milk with sugar-1 cup
Milk with sugar-1 cup10:00 AM Milk with sugar-1 cup
Bread soaked in milk-1 slice
Milk with sugar-1 cup
1:00 PM
Bread- 2 slice (with milk)
Milk pudding-1 serving
Milk with sugar-1 cup
Milk with sugar-1 cup 4:00 PM Milk with sugar-1 cup
Same as lunchDinner
7:00 PM
Same as lunch
Milk with sugar-1 cup 10:00 PM Milk with sugar-1 cup
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