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Protein-Energy Malnutrition and Oral Health

Published on Jan 21, 2022 and last reviewed on Oct 06, 2022   -  4 min read


Protein-energy malnutrition is detrimental to the millions of children in developing countries. Learn its features, management, and oral impact on these patients.


What Is Protein-Energy Malnutrition?

One of the fundamental balancing acts in the human body is the protein-energy metabolism that energizes our system and is pivotal for functioning a healthy systemic apparatus. This protein-energy metabolism, in other words, is the cellular balance for nutrient enrichment in our system that in turn ensures or promotes growth maintenance and development. PEM or protein-energy malnutrition occurs when a dietary insufficiency of proteins would be either acute or chronic in origin. Affected children are at increased risk of multisystemic diseases apart from gross oral impact exhibited due to nutritional deficiencies.

Protein-energy malnutrition nearly affects 5-6 million children globally, as per the 2006 UNICEF report given the lack of a proteinaceous diet to compensate for children of low socioeconomic status in developing countries. This breach of immune defenses seen mainly due to imbalanced protein-energy metabolism in this global condition may result in numerous immunodeficiencies, mainly in children below five years of age and young adults. The most common systemic comorbidities resulting from poverty are especially diarrhea and malaria. Though initial symptoms of these conditions can be addressed effectively by the physician, these children are still prone to health risks like the transmission of infectious diseases via community spread or prenatal and genetic components of malnutrition hampering their immunity.

The risk of hospitalization is observed more with the occurrence of the following diseases that may increase the fatality or mortality rate:

These conditions lead to eventual loss of gastrointestinal immunity, and increased metabolic demand of the body causes fat and visceral volume loss (due to electrolyte imbalance and abnormalities). Severe cases of PEM do result in multi-organ failure if not treated in time.

How Does Protein-Energy Malnutrition Impact Oral Health?

Vitamin B Deficiency -

Vitamin C and Calcium Deficiency -

Bacterial Colonization and Hypomineralization of Enamel -

What Is the Treatment for Protein-Energy Malnutrition?

  1. The dental surgeon should primarily address dietary issues and advise suitable vitamin supplementation and prophylactic and restorative treatment for the affected (or impacted) teeth. Timely diagnosis and intervention by the dentist in these children for observing the impact of PEM on permanent erupting dentition would be incredibly beneficial for addressing prosthetic and restorative concerns if needed.

  2. PEM usually requires multidisciplinary management via all aspects of medicine, mainly addressing the patients' environmental needs, dietary changes, and feeding assistance.

  3. Daily nutrient supply in these patients may be increased upto 2 gram of protein per kilogram bodyweight. In those hospitalized due to PEM, fluid and electrolyte abnormalities need to be attended by the physician along with management of hyperglycemia, cardiac arrhythmias, and diarrhea by the diabetologist, cardiologist, and gastroenterologist.

  4. Parenteral supplementation of vitamins and magnesium supplementation (0.4 mEq/kg/day) is necessary for at least a week. Due to low oral absorption of iron, these children need oral or intramuscular iron supplementation.


PEM is not just a multisystemic condition in affected children, but it also impairs oral health and well-being to the maximal extent. Hence treatment should include diverse approaches from physicians and dental surgeons and a nutrient-rich diet, supplementation, and vitamin therapy.


Last reviewed at:
06 Oct 2022  -  4 min read




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