Diet Plan For Protein Energy Malnutrition


Diet plan for protein energy malnutrition is designed to be implemented under supervision of a healthcare professional. However, the diet plan amounts and food choices can be modified as needed to adjust to individual needs and tastes.

Protein energy malnutrition refers to lack of protein and sufficient energy intake in diet. Protein energy malnutrition is also described as “marasmus”. This disease affects children and adults. During childhood, protein energy malnutrition commonly causes stunted physical growth.

Protein-energy malnutrition: Treatment, Recipes

Baby suffering by Protein energy malnutrition

Protein-energy malnutrition is defined as a range of pathological conditions arising from lack of varying proportions of protein and calories, occurring most frequently in infants and young children and often associated with infection (WHO 1973). The peak prevalence of kwashiorkor was frequently seen in the age group of 2-3 years and marasmus in 1-2 years.

PEM occurs when inadequate protein or calories are inadequate to meet nutritional requirements. Protein-energy malnutrition occurs as a result of inadequate food intake or secondary as a result of illness.

The term Protein-energy malnutrition certainly covers a wide spectrum of clinical stages ranging from severe form like kwashiorkor and marasmus to the milder form in which the main detectable manifestation is growth retardation. PEM is due to food gap between intake and requirement. The average energy deficit in Indian children is 300kcal/day.

The prevalence rate of Protein-energy malnutrition is 3-5%. For every 3-5 cases of severe PEM, we can also detect 80-90 cases of mild to moderate PEM and about 10% of well-nourished children.

Cicely Williams introduces the term kwashiorkor first in 1935. However, Severe Acute Malnutrition (SAM) or severe wasting is low weight for height. SAM remains one of the major killers of children under five.

The Indian Academy of Pediatrics recommended diagnostic criteria (2007) adapted from earlier WHO guidelines are weight for height/ length below 70% or visible severe wasting or bipedal edema, criteria may also be used for identifying severe wasting.

Malnutrition can be in the form of underweight(weight/age), stunting or (height/age)wasting(weight/height).

Causes for underweight for age

  • Due to poverty, the mother is not able to provide sufficient food to children resulting in undernutrition.
  • The starchy gruels made up of local staple food like rice, wheat, ragi, bajra, would result in dietary bulk with a low-calorie density hence may not meetup requirement.
  • Abrupt weaning, late weaning the importance of weaning can result in undernutrition.
  • Malnutrition can result in less enzyme synthesis and less appetite leading to less consumption of food.
  • Chronic infections like primarily complex may result in Anorexia.
  • Infestation like Ascariasis particularly giardiasis may lead to Anorexia.

Etiology of Protein-energy malnutrition (PEM)

  • Inadequate medical facilities.
  • poverty and, ignorance illiteracy.
  • Maternal malnutrition.
  • Poor hygiene, sanitation water supply.
  • Occult infectious diseases.
  • Early weaning from breast.
  • Late weaning.
  • High birth rate.
  • Low birth weight.

Types of Protein-energy malnutrition (PEM).

Kwashiorkor: Oedema of face and lower limbs, failure to thrive, anorexia, diarrhea, apathy, dermatosis (hypo and hyperpigmentation) flaky paint appearance, sparse, soft and thin hair, angular stomatitis, cheilosis, and anemia.

Marasmic Kwashiorkor: These children exhibit a mixture of some of the features of both marasmus and kwashiorkor.

Marasmus: Failure to thrive-means children whose weight or rate, irritability, fretfulness, and apathy are common. As a result, their weight is persistently below the third percentile of age or less than 80% of the ideal weight of age. So, diarrhea is frequent.

Many are hungry but some may be anorexic. The child is shrunk and there is also little or no subcutaneous fat. In addition, There is often dehydration. The temperature is subnormal. However, Watery diarrhea and acidic stool mat be present. The muscles are week and atopic, as a result, make the limbs appear as skin and bones.

Nutrition dwarfing: Moreover, Children adapt to prolong insufficiency of food-energy and protein due to marked retardation of growth.

The underweight child: Subsequently, The children are growing up smaller than their generic potential and of greater importance as they are at risk of gastroenteritis, respiratory and other infections.

Nutritional requirement in Protein-energy malnutrition (PEM)

The diet should be rich in protein of good quality and high in calories.
Foods of animal origin are not essential. Also, Foods of vegetable origin are
almost as good. Most importantly the response of children with kwashiorkor is more dramatic and more rapid than the children with marasmus who take a much longer time to respond as weight gains are concerned.

Energy: The child should be given 150-200Kcal/Kg of existing body weight /day. The children less than 2 years 200Kcal/Kg body weight and for older children’s 150-175 Kcal/Kg body weight should be given. It is very important to provide enough calories or protein will be utilized for energy purposes not for building tissues. 

Protein: For the existing weight five grams of protein/Kg body weight /day should be given. The calories derived from protein should be 10% of the total calculated calories per day if the main source is animal protein.

Protein: For the existing weight five grams of protein/Kg body weight /day should be given. The calories derived from protein should be 10% of the total calculated calories per day if the main source is animal protein.

Fats:  Forty percent of total calories are from fats which is permitted by children, unsaturated fats worsen diarrhea. 

Electrolytes: Potassium chloride (2.4g) and magnesium chloride(0.5g) should be added daily to the diet for a period of 2 weeks.

Vitamins: If vitamin A deficiency is present, oral administration of a single dose of 50,000 IU of fat-soluble vitamin A should be given immediately, followed by 500 units daily. So, The deficiency symptoms disappear in about 2 weeks.


Treatment strategy can be divided into the following 3 stages 

  • Solving the life-threatening condition.
  • Replace nutritional status without disrupting homeostasis.
  • Ensuring nutritional rehabilitation.

Low-cost recipes for children recovering from PEM

  • Ragi, green gram, jaggery: Puttu
  • Ragi, Bengal gram, wheat: Puttu
  • Bengal gram, milk, jaggery: payasam.
  • Rice, Bengal gram: porridge
  • Red gram, spinach: dal
  • Wheat Rava, green gram dhal: vegetable Upma.
  • Malted wheat, green gram, and groundnut powder (chapati, gruel, or laddu with jaggery).
  • Rice, green gram dhal: Pongal/kichadi.
  • Idly with sugar.

Suggested diet during convalescence:

  • Increasing the quantity of existing foods(like idlis, rice, chapatis)
  • Increasing the number of meals to satisfy calorie and protein requirements.
  • In Addition to oil and ghee 1-2tsp to increase calories without increasing bulk.
  • Consumption of sugar can be increased to increase the calories in the diet.
  • The child can also be given cereal and pulse mixture.
  • If the patient can afford milk, egg and skim milk can be included in the diet.

Protein energy malnutrition


When diet is not proper or not balanced, it causes undernutrition or malnutrition. The absence of certain nutrients in the daily diet over a period of time causes deficiency diseases. The condition is termed as malnutrition. 

Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and nutrients.

Malnutrition occurs when the nutrients in the body are not obtained in proper proportions in the diet. Malnutrition refers to when a person’s diet does not provide enough nutrients or the right balance of nutrients for optimal health. The word malnutrition refers to the condition that results when a person does not take a balanced diet.

The diseases which are caused due to a lack of nutrients in the diet are called Deficiency Diseases.

Causes of malnutrition:

  • Inappropriate choice of diet
  • Low income or poverty
  • Difficulty in obtaining food
  • Various physical and mental health conditions
  • Lack of awareness and illiteracy
  • Food insecurity.

The deficiency of proteins and energy deficiency leads to severe conditions called:

1. Kwashiorkar

2. Marasmus


Kwashiorkar is a severe protein deficiency that affects children between 1−5 years of age. It is also called as edematous malnutrition as it is associated with edema or fluid retention, or swelling.

Kwashiorkar is caused mainly when the diet lacks proteins but consists only of carbohydrates. It is associated with a poor-quality diet. It is caused due to lack of protein in the diet and in areas where there is famine. The symptoms of Kwashiorkar include:

1. Stunted growth

2. Swelling observed in face and limbs

3. Diarrhoea

4. Stomach bulging

5. Enlarged fatty liver


Kwashiorkor & Marasmus


Marasmus affects infants who are below the age of 1year. It is caused when the diet is poor in proteinscarbohydrates and fats. It is severe malnutrition that is caused due to energy or calorie insufficiency.

It causes loss of adipose tissuemuscles and fat, which is why the children look skinny and famished. The symptoms of Marasmus include:

1. Slow growth of body

2. Skinny appearance

3. Weight loss

Food Diet for Those Who Have Kwashiorkor

A severe deficiency of dietary protein causes kwashiorkor. Many children in developing countries, who are given a high-carbohydrate and low-protein diet after they are weaned from breast milk, develop kwashiorkor. While it is more common in children, kwashiorkor can occur on anyone who is on a predominantly carbohydrate-rich diet. Treatment of kwashiorkor involves the intake of foods that contain adequate amounts of proteins, carbohydrates and other essential nutrients. To avoid the onset of any complications, it is important to make gradual changes to the diet under medical supervision.

Incidence of Kwashiorkor

Kwashiorkor, also referred to as “protein-calorie malnutrition,” occurs most commonly in areas of the world that have a limited supply of food due to political unrest, drought or other natural disasters. Famine and illiteracy in nutrition are also other factors that contribute to the prevalence of kwashiorkor. While kwashiorkor is extremely rare in the United States, the July 2010 issue of the “International Journal of Dermatology” reported a case of kwashiorkor in a Michigan 8-month-old baby who was primarily fed a diet of rice milk, sweet potatoes and bananas.

Causes of Kwashiorkor in the United States

Although most people in the United States consume ample amounts of proteins, PubMed Health reports that about one-half of the elderly people in nursing homes have diets that are low in protein. The Nutrition MD states that other causes of kwashiorkor in developed countries include medical conditions such as cancer, anorexia nervosa, patients with obesity treated with “stomach stapling” and infants on restricted diets. A conscious effort to consume foods that are rich in proteins, with sufficient amount of calories and other nutrients to maintain health, will help to prevent the onset of kwashiorkor.

Symptoms of Kwashiorkor

Kwashiorkor starts with symptoms of irritability, fatigue, lethargy, decreased muscle mass and growth retardation. Over time, the physical appearance changes to include a protruded stomach, edema, discolored hair, pigmented skin, rash and a round face. Children with kwashiorkor are also prone to infections due to an impaired immune system, that further increases the severity of malnutrition. Prolonged protein deficiency also affects the intellectual development in young children. While many of the symptoms of kwashiorkor disappear after treatment with a calorie- and protein-rich diet, these children may never attain their full physical and mental potential.

Diet for Treating Kwashiorkor

Because people with kwashiorkor have been deprived of a nutritionally adequate diet for a long time, a medical professional should monitor and plan their food regimen. Treatment should start with a gradual introduction of carbohydrate foods such as fruits, starchy vegetables, breads and cereals to provide calories. Then the persons should consume foods containing proteins such as meat, fish, poultry, eggs, soybeans and legumes. Milk and milk products are also rich in protein. However, children who have kwashiorkor may be lactose-intolerant and may need lactase enzyme supplements to digest milk, yogurt and cheese.

11 Ways to Get Enough Protein in Your Diet

It is extremely essential to include an adequate amount of protein throughout the day to boost immunity, manage weight loss, control blood pressure

11 Ways to Get Enough Protein in Your Diet


  • Proteins provide immunity and strength and help in weight loss
  • Eggs are abundant in leucine, one of the most essential amino acids
  • Milk contains around 8 grams of protein in a cup

The many benefits of protein have been well-researched and proven in medical studies. In fact, it is extremely essential to include adequate amount of protein throughout the day for your physical wellbeing, to repair muscles, manage blood sugar levels, to provide immunity and strength and help in weight loss. If you don’t consume enough protein on a day to day basis, it can lead to several health problems. Look for these symptoms as they are indicators of insufficient dietary protein:

1. Poor mental focus
2. Lethargy and Fatigue
3. Slow recovery from cold and sore throat
4. Food cravings
5. Muscle weakness
6. Weight gain

It is extremely important to know the quality and quantity of protein needed on daily basis. The highest quality of protein is that, which includes all the essential amino acids and is bio-available to the human body. Of all the essential amino acids, the following four are critical for strength and recovery – Valine, Leucine, Isoleucine and Glutamine. A decline in any of these can lead to fatigue and muscle wastage. Here are some natural sources of protein for balanced nutrition.

1. Eggs

Research suggests that egg protein is highly bio-available and both the egg white and the yolk help support muscle building and strength. Eggs are abundant in leucine, one of the most essential amino acids. Try including Omega-3 enriched eggs which contain 6 grams of protein in 1 egg. Also, recent human studies have confirmed that eggs do not increase your risk of cardiovascular diseases.


2. Paneer or Cottage Cheese

Around 15 grams in half a cup of paneer is a great way to up your protein and most Indian families would love to include it in their diets. It is especially beneficial as a late-night snack.


3. Dahi or Yogurt:

Yogurt provides around 23 grams of protein per bowl plus the added benefits of gut friendly bacteria and bone-strengthening calcium.


4. Milk

With around 8 grams of protein in a cup, enjoy your glass of smoothie or milkshake for breakfast. Try to get milk from cows raised by natural and organic farming methods.

milk new 620

5. Fish and seafood

They are the most healthful foods you can consume. They are great for athletes and people who are recovering from an ailment as they are enriched with Omega-3 fatty acids known as EPA and DHA. The Indian Tilapia fish is a wonderful brain and muscle food. You can also include sardines, salmon, mussels, shrimps, red-snapper, and oysters for their high protein and mineral content.

fish in butter sauce

6. Chicken

Go for the organic chicken that is raised naturally. A broth made with chicken bones is a powerhouse of good quality proteins and collagen to build and repair your muscles.

grilled chicken

7. Lentils

Lentils need to be combined with rice, wheat, or corn to make it a complete protein with an abundant dose of all essential amino acids. So, thumbs-up to dal and rice as an excellent source of protein for vegetarians. Also, sprouts are a great way to get easily absorbable protein with fibre and B and C Vitamins to build immunity.


8. Red meat

Lean goat or lamb meat that is commonly eaten in our country is a major source of protein plus an excellent source of Iron and Zinc. Women of childbearing age must include this superfood in their diet if they are non-vegetarian.

red meat 620

9. Nuts and seeds

These great snacks to add protein to your daily diet include peanuts, cashews, almonds, walnuts and seeds like pumpkin, chia, flax, and sunflower. Remember not to heat or roast the seeds as this kills the healthy fatty acids they contain. Also, do not buy processed and packaged nuts as they are full of sodium.


10. Green peas

One cup of green peas contains 7.9 grams of protein which is almost the same as a cup of milk. So, vegetarians can enjoy a sabzi like matar-paneer and load up on their daily protein requirement.

rice peas

11. Amaranth

Native to India, amaranthladoos and other such treats have been a part of our diet for a long time. This Indian grain is abundant in magnesium, manganese, phosphorus and iron and provides 9 grams of protein in a cup of cooked grains.


These are few useful protein choices you could add to your daily diet whether you want to build muscle, prevent disease, boost immunity or simply lose weight. You must get your daily protein requirement that is around 46 grams for an average woman and 56 grams for men. Your daily requirements change if you are super active or an athlete.

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