Respond to at least two of your colleagues on 2 different days and respectfully

Respond to at least two of your colleagues on 2 different days and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not.
Below is the case scenario and colleague assessment
Case Scenario:
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 a history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.
Colleague assessment post
Protein Malnutrition
Malnutrition, which literally means bad nutrition, is a term used to describe excess and deficiency in essential nutrients needed for good health. Protein energy malnutrition is the most severe form of undernutrition affecting children mostly. Kwashiorkor and marasmus are the two known types.
Protein energy malnutrition can occur as a sudden, total (starvation) or gradual illness. Some clinical manifestations can be muscle wasting, edema, hair loss, and skin atrophy. Impairment of multiple organ systems can occur as well (Morley, 2022).
In those suffering marasmus and kwashiorkor, there is impairment of cell-mediated immunity which causes increased susceptibility to infections which in turn leads to the release of cytokines. Cytokines causes anorexia which leads to increased muscle wasting and a marked reduction in serum albumin levels (Morley, 2022).
In the case study presented, the patient has developed this condition due to a lack of dentures and a preexisting condition which is malabsorption syndrome. Due to this condition, if a patient consume some protein, the small intestines are unable to absorb either the macronutrients, micronutrients, or both. The small intestines are implicated because there is where the microvilli existing on a substantial surface where it can absorb nutrients (Zuvarox & Belletieri, 2022). Protein malnutrition occurrence is affected by different situations, like social economic status, famine, and draught in certain geographical locations like Africa and so on.
Role of Genetics in Protein Malnutrition
Malnutrition is a complex disorder and can occur due to genetic polymorphisms which affects absorption of nutrients and metabolism. In patients with chronic malnutrition, patients might develop gene expression and problems with genome stability which can result in gene sequence mutations at the chromosomal levels (Ahmed, 2009).
Physiologic Response to the Stimulus
This patient had a preexisting history of malabsorption syndrome. In patients with malabsorption syndromes, there is inadequate assimilation of dietary substances due to defects in digestion, absorption, or transport. Malabsorption can affect macronutrients (e.g., proteins, carbohydrates, fats), micronutrients (e.g., vitamins, minerals), or both, causing excessive fecal excretion, nutritional deficiencies, and gastrointestinal (GI) symptoms (Malik, 2023). Malabsorption makes it difficult to absorb necessary nutrients in the small intestine, such as proteins (Crohn’s & Colitis Foundation, 2022). Over time, signs of malnutrition will appear. Macronutrient undernutrition can look like protein malnutrition.
Patient Presentation of Symptoms (Edema)
This patient is presenting with edema because albumin is an essential protein and is the largest component of blood which is needed to maintain adequate osmotic pressure and maintain fluid balance thereby preventing fluid retention (Stuhldreher, 2022). Albumin formed from dietary protein is necessary to maintain intravascular volume and the return of fluid from the interstitial space back into the vascular compartment. In such disease state, there is increase in capillary permeability which allows fluids to leave the intravascular compartment, which then accumulates in the interstitial space and when permeability increases, plasma proteins also shift into interstitial space from the vascular space, thereby reducing the osmotic pressure there and increasing the pressure in the interstitial space. This lowers the rate of fluid return causing edema (Hamdi, Doman & Doman, 2022). The extreme lack of protein means albumin is insufficient which causes osmotic imbalance in the GI system leading to swelling of the intestinal tract which further impairs absorption, a large protuberant belly and edema from passive hepatic congestion.
Cells Involved in the Process
Protein malnutrition can impair hemopoiesis and immune cells production and function. Lympho-hemopoietic tissues have high metabolic demand, thereby requiring a great amount of nutrient supply, hence they are the most affected in protein malnutrition. There is a reduction in T cell counts, CD4 counts being the most affected than CD8. In vitro T cell function in response to mitogens and antigens and in vivo delayed type hypersensitivity are also impaired (Medici, 2003), (De Bandt, 2015), (Iyer, et. al., 2013).
Influence of other Characteristics
Social determinants of health (SDOH) are those conditions socioeconomic status, especially with low-income earners can influence the risk of protein malnutrition. Even if a child survives the ordeal and returns back to that living condition and environment, protein malnutrition will return. Patients who experience repeated episodes of this health condition usually have high mortality rates (Stuhldreher, 2022).

References
Ahmed, T., Haque, R., Shamsir Ahmed, A. M., Petri, W. A., Jr, & Cravioto, A. (2009). Use of metagenomics to understand the genetic basis of malnutrition. Nutrition reviews, 67 Suppl 2, S201–S206. https://doi.org/10.1111/j.1753-4887.2009.00241.x
Crohn’s & Colitis Foundation. (2022). Malnutrition and IBD. https://www.crohnscolitisfoundation.org/diet-and-nutrition/malnutrition-and-ibd
De Bandt, J. P. (2015). Comprendre la physiopathologie de la denutrition pour mieux la traiter [Understanding the pathophysiology of malnutrition for better treatment]. Annales pharmaceutiques francaises, 73(5), 332-335. https://doi.org/10.1016/l.pharma.2015.03.002
Hamdy, R. C., M. D., Doman, M. R., M. D., & Doman, K. H. (2022). Edema. Magill’s Medical Guide (Online Edition).
Iyer, S. S., Chatraw, J. H., Tan, W. G., Wherry, E. J., Becker, T. C., Ahmed, R., Kapasi, Z. F. (2013). Protein Energy Malnutrition Impairs Homeostatic Proliferation of Memory CD8 T Cells. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3244573/
Malik, Z. (2023). Overview of Malabsorption. https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/overview-of-malabsorption
Medici, E. (2003). Liver|Nutritional Management of Liver and Biliary Disorders. Encyclopedia of Food Sciences and Nutrition (2nd Ed.). https://sciencedirect.com/topics/medicine-and-dentistry/protein-calorie-malnutrition
Morley, J. E. (2022). Protein-Energy Undernutrition (PEU). Saint Louis University School of Medicine. https://msdmanuals.com/professional/nutritional-disorders/undernutrition
Stuhldreher, W. L., PhD. (2022). Malnutrition. Magill’s Medical Guide (Online Edition).
Suvero, T., & Belletieri, C. (2022). Malabsorption Syndromes. In StatPearls. StatPearls Publishing.