PEM covers two related conditions, marasmus (from a lack of both calories and protein) and kwashiorkor (from a lack of protein even when calories are close to normal). A diet correcting PEM has to address both problems together.
- Protein, carbohydrates and vitamins: Protein rebuilds wasted muscle and organ tissue, carbohydrates restore the energy the child's body has been missing, and vitamins support the many recovery processes happening at once. This covers both the marasmus and kwashiorkor sides of PEM.
- Fats and vitamins: This raises energy intake through fats but does not supply the protein a kwashiorkor type child badly needs for tissue repair.
- Water soluble vitamins: These are useful but minor compared to the bulk of protein and energy the child's body is missing, so they cannot be the main answer.
- Micro nutrient: Micronutrients matter, but PEM is fundamentally a macronutrient (protein and energy) deficiency, so a diet described only by micronutrients misses the point.
Since PEM stems from a shortage of both protein and energy, the diet must supply protein, carbohydrates, and vitamins together to support full recovery.
Therefore, the correct answer is Protein, carbohydrates and vitamins.