Question

Which parameter most conclusively rules out malnutrition?

• A. Edema
• B. Lean body mass
• C. Skinfold thickness
• D. Normal ECF volume

Hint:

When fat runs out, PEM eats into which tissue, so its preservation reassures you most?

Answer 1

The Correct Option is B

Step 1: Nutritional status is judged by anthropometry, but each measure has limitations. The question asks which one most reliably reflects the true state and so can rule out malnutrition.
Step 2: In protein-energy malnutrition (PEM), once fat reserves are used up the body breaks down lean body mass (muscle and even organ tissue). Preserved lean body mass therefore indicates intact nutritional reserves and reliably argues against PEM.
Step 3: So a normal lean body mass conclusively rules out significant malnutrition.
Why the others mislead: Edema and ECF volume are confounded by fluid shifts (kwashiorkor causes oedema despite severe malnutrition, so absence of oedema does not exclude malnutrition). Skinfold thickness measures only subcutaneous fat and can be normal early or altered by oedema, making it less reliable than lean body mass.
Ref: Park's Textbook of Preventive and Social Medicine, 24th edition, Pg 677.