What are the causes of PEM, as highlighted on SlideShare and other medical sources?

October 29, 2025 •

3 min read

According to the World Health Organization (WHO), acute Protein-Energy Malnutrition (PEM) affects more than 18 million children annually, primarily due to insufficient caloric and protein intake. This complex and global health issue, often summarized in educational materials like those on SlideShare, has a range of underlying causes that extend beyond simple food shortages.

Quick Summary

PEM, or Protein-Energy Malnutrition, is a condition resulting from inadequate energy and protein consumption. Its causes are diverse and include poverty, limited food access, infections, poor feeding practices, and various chronic diseases that affect nutrient metabolism and absorption.

Key Points

Socioeconomic Roots: Poverty, war, and limited food access are primary environmental drivers leading to inadequate nutritional intake.
Infection Cycle: Chronic or repeated infections, especially gastrointestinal, impair nutrient absorption, while PEM weakens the immune system, creating a detrimental cycle.
Feeding Practices: Poor maternal health, inadequate breastfeeding, and improper weaning onto nutrient-poor diets are major contributors to PEM in infants and young children.
Underlying Medical Conditions: Diseases affecting metabolism, absorption (like celiac disease), or increasing energy demand (like burns) can trigger secondary PEM.
Kwashiorkor vs. Marasmus: PEM manifests in different forms; Kwashiorkor is defined by protein deficiency leading to edema, while Marasmus is a severe calorie and protein deficit causing extreme wasting.
Elderly at Risk: In developed countries, PEM is often seen in the elderly due to depression, social isolation, and chronic diseases.

Dissecting the Primary Causes of Protein-Energy Malnutrition

Protein-Energy Malnutrition (PEM), a critical global health concern, is not caused by a single factor but is instead a multifactorial issue with deep roots in social, economic, and biological systems. Educational platforms like SlideShare often present this information in a concise format, but a full understanding requires examining the specific root causes in detail. While the core issue is insufficient intake of protein and energy, the reasons for this inadequate consumption are complex and varied.

Socioeconomic Factors and Food Insecurity

Poverty and food scarcity are arguably the most significant drivers of PEM, particularly in developing countries. Where resources are limited, families may rely on staple foods that are high in carbohydrates but critically low in protein, leading to specific forms of malnutrition. Disasters, war, and political instability further exacerbate this problem by disrupting food distribution and displacing populations. Even in developed nations, poverty, social isolation, and substance misuse can contribute to malnutrition, especially in vulnerable populations like the elderly.

The Impact of Illness and Infection

Repeated or chronic infections can precipitate and worsen PEM. Gastrointestinal infections, in particular, lead to issues like chronic diarrhea and malabsorption, which prevent the body from properly absorbing the limited nutrients that are consumed. Diseases like HIV/AIDS, tuberculosis, and cancer increase the body's metabolic demands, leading to muscle wasting and PEM. The weakened immune system that results from malnutrition, in turn, makes individuals more susceptible to further infections, creating a dangerous and self-perpetuating cycle. In infants, infections are particularly serious during the post-weaning stage, where the risk is already high.

Poor Feeding and Weaning Practices

Inadequate breastfeeding and improper weaning are significant causes of PEM in infants and young children, a point frequently emphasized in pediatric nutrition resources. The introduction of nutrient-poor foods after breastfeeding, especially in regions where protein-rich options are scarce, can lead to severe malnutrition like kwashiorkor. A lack of parental education about nutritional needs and poor hygiene can also contribute to the problem. In a 2022 study on PEM etiology, dietary behavior problems and food allergies were identified as major factors among pediatric patients, suggesting that cultural or informational gaps can also play a role in inadequate nutrient intake.

Medical and Biological Conditions

Beyond environmental and social factors, numerous medical conditions can lead to secondary PEM. These include disorders that affect nutrient absorption, increase metabolic demand, or cause excessive nutrient loss.

Common medical causes include:

Gastrointestinal Disorders: Conditions like celiac disease, inflammatory bowel disease, and pancreatic insufficiency impair nutrient absorption.
Chronic Kidney or Liver Disease: These conditions disrupt metabolic processes and can lead to PEM.
Eating Disorders: Conditions like anorexia nervosa and bulimia are associated with severe reduction of nutritional intake.
High Metabolic Demand: Severe trauma, burns, and hyperthyroidism significantly increase the body's energy and protein requirements.
Psychological Factors: Depression, particularly in the elderly, can lead to decreased appetite and inadequate food intake.

Kwashiorkor vs. Marasmus: A Comparison of PEM Manifestations


Feature	Kwashiorkor	Marasmus
Primary Deficiency	Severe protein deficiency, often with relatively adequate calorie intake.	Severe deficiency of both calories and protein.
Key Symptom	Edema (fluid retention) leading to a characteristic swollen appearance, especially in the extremities and abdomen.	Emaciation (extreme thinness) and severe muscle wasting, with no edema.
Appearance	"Moon face," distended abdomen, and enlarged fatty liver.	"Old man face" or sunken cheeks, with visible ribs and prominent bones.
Typical Age	Usually affects older infants and children after weaning (1-4 years).	Most common in younger infants (under 18 months).
Immune Response	Significantly impaired cellular immunity due to protein deficiency.	Impaired cellular immunity, but often with lower infection risk than kwashiorkor.

Conclusion

While inadequate dietary intake is the direct cause, what lies beneath this nutritional deficit is a complex web of social, economic, environmental, and medical factors. The resources available on platforms like SlideShare provide valuable summaries, but they underscore the need for a comprehensive, multi-pronged approach to address and prevent PEM. This includes improving food security, combating infectious diseases, enhancing nutritional education, and providing targeted care for individuals with predisposing medical conditions. Only by tackling these diverse root causes can the global burden of protein-energy malnutrition be effectively reduced. The ongoing battle against PEM requires a collaborative effort, combining medical intervention with robust public health policies and economic development.

Frequently Asked Questions

The two main clinical types of PEM are Kwashiorkor, caused by severe protein deficiency and characterized by edema, and Marasmus, which is caused by a severe deficiency of both calories and protein and is characterized by extreme wasting.

Poverty contributes to PEM by limiting access to nutritious food, forcing families to rely on cheap, carbohydrate-heavy diets with insufficient protein. It also results in poor sanitation, which increases the risk of infections that worsen malnutrition.

Yes, infections can cause or exacerbate PEM. Chronic or severe infections, such as HIV/AIDS, tuberculosis, and chronic diarrhea, increase the body's metabolic needs and impair nutrient absorption, leading to a state of malnutrition.

Kwashiorkor is primarily a protein deficiency leading to edema and a swollen appearance, typically affecting children after weaning. Marasmus is a deficiency of both protein and calories, resulting in extreme emaciation and muscle wasting, most common in younger infants.

While PEM is most commonly associated with children in developing countries, it can affect people of all ages. In developed countries, PEM is often linked to underlying chronic diseases in adults and the elderly, or eating disorders.

SlideShare presentations can be useful educational tools and summaries, but they should not be considered authoritative medical sources on their own. For accurate and complete medical information, it is best to consult authoritative sources like Medscape or NIH resources.

Prevention of PEM involves a multi-pronged approach, including addressing socioeconomic factors like poverty and food security, improving nutritional education, promoting proper breastfeeding and weaning practices, and ensuring access to healthcare to prevent and treat infections.