Which finding indicates protein malnutrition on physical examination?

• A. Jaundice and elevated LFTs
• B. Muscle wasting and subcutaneous fat loss
• C. Edema and ascites
• D. Weight gain and normotension

Answer: (B)

Protein malnutrition directly reduces the body's ability to maintain lean tissue, so the body starts breaking down muscle and fat stores to supply essential proteins and energy. On exam, this presents as clear muscle wasting and loss of subcutaneous fat, giving a cachectic appearance. Jaundice and elevated liver enzymes point to liver disease rather than malnutrition. Edema can occur with severe protein deficiency due to low albumin, but it isn’t as specific or direct a marker of overall protein malnutrition as muscle and fat loss. Weight gain and normal blood pressure do not indicate malnutrition. Thus, muscle wasting with subcutaneous fat loss is the most representative finding of protein malnutrition.