A 2-year-old boy from rural India presents with severe malnutrition. On examination, he has prominent ribs, sunken cheeks, loss of subcutaneous fat, and an "old man face" appearance. Notably, the feature marked **C** in the diagram—absence of pitting edema—is documented. His weight is 55% of expected for age. Which of the following best describes the PRIMARY pathophysiologic distinction this clinical finding represents?
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