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Protein-Energy Malnutrition (PEM) is a major public health problem, particularly in developing countries. It refers to a spectrum of clinical conditions resulting from deficiencies of protein and energy in the diet over a period of time. It affects mainly children under five years of age but can occur at any age. PEM exists in two main clinical forms—Marasmus and Kwashiorkor, along with mixed forms. These conditions are often associated with poor socioeconomic status, infectious diseases, inadequate dietary intake, and lack of awareness about nutrition. Marasmus is a form of severe protein-energy malnutrition that results primarily from a deficiency in both protein and calories. It usually affects infants under one year of age and is associated with early weaning, diluted feeding, recurrent infections, and poor maternal nutrition. Marasmus is characterized by severe wasting of fat and muscle, resulting in an emaciated appearance. Children with marasmus appear extremely thin, with prominent ribs, sunken eyes, and wrinkled skin. Their growth is severely retarded, and there is often a general absence of subcutaneous fat. However, edema is not present, and appetite may be relatively preserved. The immune system is often compromised, leading to increased susceptibility to infections such as diarrhea, respiratory infections, and skin diseases. Marasmic children are usually irritable and may exhibit persistent crying due to hunger or discomfort. Kwashiorkor is _______ _____ _______ ___ ________ _________ ________ ________.
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