What combination of clinical features would prompt classification as marasmic kwashiorkor rather than either marasmus or kwashiorkor alone?

• A. Moderate obesity with localized edema but normal growth percentiles, indicating mixed metabolic syndrome rather than marasmic kwashiorkor.
• B. Acute severe diarrhea without weight loss or edema, which signals an infectious etiology rather than combined PEM.
• C. Presence of severe wasting (loss of subcutaneous fat and muscle) together with peripheral edema and some hypoalbuminemia—i.e., concurrent signs of both energy deficiency and protein-deficiency edema.
• D. Isolated stunting with good muscle mass and no edema, a pattern consistent with chronic undernutrition but not the mixed syndrome.

Answer: (C)