Malnutrition, Effects of

Protein-Energy Malnutrition

Malnutrition, more appropriately referred to as protein-energy malnutrition (PEM) or protein-calorie malnutrition, continues to be associated with conditions of extreme poverty in the developing world, but it may also affect low-income children in developed nations. Low birth weight, anemia, growth failure, weakened resistance to infection, increased susceptibility to lead poisoning, dental disease, and so forth are all associated with undernutrition. Children who manage to survive PEM and live into adulthood have lessened intellectual ability, lower levels of productivity, and higher incidences of chronic illness and disability, serving to further continue the cycle of poverty.

Besides PEM, nutrient deficiencies such as iron, iodine, and vitamin A may appear in combination and contribute to each other's debilitating effects. However, PEM is the most common form of malnutrition in the world, affecting an estimated 500 million children. Severe PEM in childhood has traditionally been classified as either marasmus or kwashiorkor(Weigley, Mueller, & Robinson, 1997). Marasmus results from insufficient energy intake, that is, an extremely low intake of both protein and calories, and is most often observed in infants 6–18 months old at the time of weaning. In attempting to stretch their limited resources, impoverished mothers will often dilute commercial formula, further contaminating it with dirty water, which leads to bacterial infection. In attempting to cure the baby, the mother may even withhold food. Recurrent infections, coupled with little or no food, subsequently lead to marasmus. In terms of resulting behavior, the marasmic infant is typically irritable, but may also appear weak and apathetic.

In contrast, kwashiorkor results from the insufficient intake of protein, with caloric needs usually satisfied. It typically develops when the toddler is 18–24 months of age, and comes about when a newborn sibling arrives and the toddler is weaned from the breast and fed the high carbohydrate–low protein diet on [Page 674]which the family subsists. While such a diet may be adequate for the adult, it is insufficient for the rapidly growing toddler. Since the child of this age is beginning to explore the environment, the opportunity for exposure to bacteria and viruses can further exacerbate the consequences of the poor diet. However, one of the behavioral characteristics of kwashiorkor is a lessened interest in the environment, along with irritability, apathy, and frequently anorexia. But most notably, the toddler with kwashiorkor cries easily and often displays an expression of sadness and misery.

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