Which of the following is associated with primary protein-energy malnutrition (PEM)?

a. Poor diet due to living in a developing country
b. Anorexia
c. Malabsorption
d. Severe infection

ANS: A
PEM has adverse effects on respiratory musculature and the immune response. PEM may be ei-ther primary or secondary. Primary PEM results from inadequate intake of calories and/or protein and is typically seen only in developing countries. Secondary PEM is due to underlying illness. Illness may cause (1) decreased caloric or protein intake (e.g., anorexia, dysphagia); (2) increased nutrient losses (e.g., malabsorption or diarrhea); and/or (3) increased nutrient demands (e.g., in-jury or infection). As many as 50% of hospital patients may have secondary PEM.