**Question:** A child is suffering from severe PEM. Calories to be given per kg of body weight to regain weight -

A. 70-100 kcal/kg
B. 50 kcal/kg
C. 100 kcal/kg
D. 60 kcal/kg

**Core Concept:** Protein-Energy Malnutrition (PEM) is a deficiency of essential nutrients, particularly proteins and energy, leading to impaired growth and development in children. In severe cases, PEM can lead to impaired immune function, organ dysfunction, and increased morbidity and mortality. To address PEM, nutritional rehabilitation is essential, which involves addressing both calorie and protein deficiencies.

**Why the Correct Answer is Right:** The correct answer (D) recommends providing 60 kcal/kg of body weight for the child to regain weight. The appropriate caloric intake ensures adequate energy supply for growth, development, and restoration of physiological functions. In severe PEM, the child may have a low body weight, so a higher caloric intake is required to stimulate weight gain.

**Why Each Wrong Option is Incorrect:**

A) Providing excessively high calories (70-100 kcal/kg) could lead to lipodystrophy (fat accumulation) and impair further growth.

B) A low calorie intake (50 kcal/kg) may not adequately support the child's needs for growth and development, potentially leading to delayed recovery.

C) Providing excessive calories (100 kcal/kg) could lead to lipodystrophy as mentioned above, and may also increase the risk of obesity and other nutritional disorders.

**Why the Correct Answer is Right:**

Calories are necessary for growth, development, and restoration of physiological functions in children with severe Protein-Energy Malnutrition (PEM). Adequate caloric intake helps in stimulating weight gain and ensures the child's needs are met for growth and development. Adequate calorie intake can be calculated using the formula:

**Correct Answer: Calories per kg = (Body Weight x 100) / 2.2

Applying this formula to the correct answer (60 kcal/kg):

Calories per kg = (Body Weight x 100) / 2.2
Calories per kg = (x x 100) / 2.2
Calories per kg = (x x 100) / 2.2
Calories per kg = (x x 100) / 2.2

Where 'x' represents the body weight of the child in kg.

**Why the Correct Answer is Right:**

Calories are essential for growth and development in children. In severe Protein-Energy Malnutrition (PEM), providing adequate calories helps to stimulate weight gain and ensures the child's needs are met for growth and development. The body weight in kg is used to calculate the required caloric intake.

**Why Each Wrong Option is Incorrect:**

A) Providing excess calories (70 kcal/kg) could