The case study I was presented was "An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition". 

When looking into protein malnutrition, protein energy-malnutrition is the most commonly seen terminology, or PEM, that is the result of starvation (with or without catabolic stress). PEM is considered a disease and is the result of chronic inadequate protein or energy intake not meeting the body's needed intake of nutrients. In some cases, the loss of fat is reduced due to a slowed energy use accomplished by decreasing the metabolism and instead using the body's storage of lean protein. Typically, the majority of the protein is released from muscle tissues and the kidneys, blood, immune cells, GI tract and liver are spared for the most part. In cases where the ration of energy and protein are not obsolete, the body can adapt to the environment by decreasing the energy and protein needed to sustain homeostasis. PEM results in "a lowered metabolic rate and reduced muscle mass (including reduced cardiac and respiratory muscle mass); its clinical consequences include muscle weakness and functional disability, reduced cardiac and respiratory capacity, mild hypothermia and a reduced body protein reserve" (Hoffer, 2001). In PEM, the extracellular fluid also shifts and can cause generalized edema. 

In consideration of protein malnutrition, there are two conditions that come up in various articles, Kwashiorkor and marasmus. "Kwashiorkor is predominantly a protein deficiency, while marasmus is a deficiency of all macronutrients — protein, carbohydrates and fats. People with marasmus are deprived of calories in general, either because they’re eating too little or expending too many, or both. People with kwashiorkor may not be deprived of calories in general but are deprived of protein-rich foods" (C.C. Medical, n.d.). In this case study, though the primary diagnoses is protein malnutrition, marasmus may be more fitting and in align with the physiologic problems this patient is facing. "For older adults, adverse health outcomes associated with malnutrition can often be more complex and disproportionally worse than outcomes associated with overweight or obesity. Malnutrition in older adults can lead to weight loss. Functional recovery from this weight loss is unlikely to occur due to the loss of skeletal muscle mass, even with full nutritional support" (Dent et. al, 2023).  "Marasmus is equally distributed between the genders, however, as a result of cultural differences in some parts of the world women may be at an increased risk of marasmus" (NCBI, 2023).

• Respectfully agree or disagree with your colleague’s assessment and
• Explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not. Support each of your replies with at least 0ne citation and reference.