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 history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition. For this Discussion, you will examine the above case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.


In this case study, an 83-year-old resident of a skilled nursing facility presents with generalized edema of extremities and abdomen. The patient has a history of malabsorption syndrome and difficulty eating due to the lack of dentures. The patient has been diagnosed with protein malnutrition. This discussion aims to explore the disease suggested by the symptoms and provide an understanding of the cells involved, as well as potential alterations and impacts.

Protein Malnutrition

Protein malnutrition, also known as protein-energy malnutrition (PEM), is a condition characterized by insufficient intake of protein and energy-rich foods, resulting in an imbalance of nutrients necessary for the body’s proper functioning (Bistrian et al., 2011). It predominantly affects individuals who do not meet their adequate dietary requirements over an extended period.

The symptoms of generalized edema and ascites observed in the patient suggest the occurrence of kwashiorkor, a form of severe protein malnutrition. Kwashiorkor typically arises when there is an inadequate intake of high-quality protein, along with excess carbohydrate consumption (Tham, Barton, & Greenough, 2018). The lack of dentures in this case may have contributed to the patient’s difficulty in consuming foods rich in protein.

Cellular Involvement

Protein malnutrition affects various cells and systems in the body, leading to widespread ramifications. The cells primarily involved are hepatocytes, lymphocytes, and intestinal epithelial cells.

Hepatocytes are crucial for the synthesis and regulation of circulating proteins, including albumin, transferrin, and clotting factors. In protein malnutrition, the liver’s ability to produce these proteins is compromised, resulting in hypoalbuminemia and impairment of the body’s fluid balance (Bistrian et al., 2011).

Lymphocytes play a central role in the immune response. Protein malnutrition weakens the immune system by reducing the number and activity of lymphocytes, impairing the ability to fight off infections (Bistrian et al., 2011). Additionally, low levels of serum proteins can lead to a decrease in antibody synthesis, further compromising the immune response.

Intestinal epithelial cells are responsible for nutrient absorption. In protein malnutrition, these cells undergo structural and functional alterations, leading to reduced absorptive capacity (Bistrian et al., 2011). The decreased absorption of essential nutrients exacerbates the deficiency and perpetuates the cycle of malnutrition.

Potential Alterations and Impacts

Protein malnutrition can lead to various alterations and impacts on the body, affecting multiple systems and contributing to numerous complications. Some potential alterations and impacts include:

1. Edema: A hallmark of kwashiorkor, edema occurs due to the hypoalbuminemia caused by liver dysfunction. Low levels of circulating albumin result in decreased plasma oncotic pressure, leading to fluid accumulation in the interstitial spaces (Bistrian et al., 2011). Edema is often observed in dependent areas such as the extremities and abdomen.

2. Impaired Wound Healing: Protein is essential for tissue repair, and protein malnutrition hinders the wound healing process. The lack of adequate protein impairs collagen synthesis, angiogenesis, and immune function, all of which are crucial for proper wound healing (Bistrian et al., 2011).

3. Weakened Immune Response: Protein malnutrition compromises the immune system, making individuals more susceptible to infections. The decreased number and activity of lymphocytes, along with the reduced synthesis of antibodies, contribute to this weakened immune response (Bistrian et al., 2011).

4. Muscle Wasting: Protein is vital for maintaining muscle mass and function. In the absence of adequate protein intake, the body starts breaking down muscle tissue to meet its energy needs. This leads to muscle wasting, weakness, and decreased functional capacity (Bistrian et al., 2011).

5. Impaired Growth and Development: Protein is crucial for growth and development, especially in children. Protein malnutrition can result in stunted growth, cognitive impairments, and delays in physical and mental development (Bistrian et al., 2011).


Protein malnutrition, exemplified in this case study by kwashiorkor, is a condition characterized by inadequate protein intake, leading to various complications. The hepatocytes, lymphocytes, and intestinal epithelial cells are among the primary cells affected by this condition. The resulting alterations, such as edema, impaired wound healing, weakened immune response, muscle wasting, and impaired growth and development, significantly impact the individual’s health and well-being. Early recognition and appropriate management are essential to mitigate the long-term effects of protein malnutrition.