"This patient is suffering from protein–energy malnutrition (PEM), a pathologic
depletion of the body’s lean tissues caused by starvation, or a combination
of starvation and catabolic stress. In this case, the diagnosis is evident
from the physical examination, which reveals a combination of generalized fat
and muscle loss typical of the disease, and from the history of prolonged grossly inadequate
food intake. PEM is easiest to diagnose when fat stores are depleted, but it
can occur without apparent fat loss in previously obese patients, in chronic protein
deficiency without energy deficiency, and in highly protein-catabolic states. The
lean tissues are the fat-free, metabolically active tissues of the body, namely, the
skeletal muscles, viscera, and the cells of the blood and immune system."
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