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

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PEM has adverse effects on respiratory musculature and the immune response. PEM may be either 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 increased nutrient demands (e.g., injury or infection). As many as 50% of hospital patients may have secondary PEM.

Which of the Following Is Associated with Primary Protein-Energy Malnutrition