Which statement is true of protein-energy malnutrition (PEM)?

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Question and options restated: Which statement is true of protein-energy malnutrition (PEM)?

Option a: 'PEM results when people are deprived of protein and carbohydrate.' This is partially off the mark. PEM results from inadequate total energy intake and/or insufficient high-quality protein, not merely a deprivation of carbohydrates; malnutrition is more about overall energy and protein deficit rather than specifically lacking carbohydrates. So this statement is misleading because it oversimplifies and emphasizes only protein and carbohydrate deprivation without mentioning energy balance and quality.

Option b: 'The two forms of PEM are 'Marasmus' and 'kwashiorkor'. This is the classic and widely taught dichotomy in PEM. Marasmus reflects severe energy deficiency with wasting, while kwashiorkor reflects protein deficiency with edema despite some caloric intake. This statement accurately identifies the two principal clinical forms recognized in many nutrition texts, though in practice PEM can present with a spectrum beyond these two. Overall, this option is correct as a true statement about PEM.

Option c: 'rehabilitating children with PEM involves giving then a diet plentiful in protein and energy'. At first glance this seems reasonable, but the phrasing is a bit off and incomplete. Rehabilitation requires a carefully monitored refeeding plan that starts with gentle energy and protein increases to prevent refeeding syndrome; simply giving a diet plentiful in protein and energy without medical supervision can be dangerous, especially in severely malnourished children. Therefore, as stated, it’s not an adequate or safe general guideline, making this statement not entirely correct as a standalone principle.

Option d: 'PEM mostly affects adults'. This is incorrect, as PEM more commonly affects children, especially in resource-limited settings, due to higher metabolic demands, growth needs, and higher susceptibility to inadequate intake. Thus this option mischaracterizes the typical affected population.

Summary of reasoning:
- Option a misstates the mechanism by focusing only on protein and carbohydrate deprivation and ignores energy balance aspects.
- Option b accurately identifies the two well-known forms of PEM (marasmus and kwashiorkor), making it true in the common medical understanding.
- Option c outlines a rehabilitative approach but lacks the nuance of staged, medically supervised refeeding, so it is not an entirely accurate statement.
- Option d wrongly asserts adults are the primary group affected, which contradicts epidemiological patterns showing PEM predominantly affects children in many contexts.

Which statement is true of protein-energy malnutrition (PEM)?

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