Starvation

This article is about extreme malnutrition. For other uses, see Starvation (disambiguation).

Starvation
Classification and external resources
A girl during the Nigerian-Biafran war of the late 1960s, shown suffering the effects of severe hunger and malnutrition.
ICD-10	T73.0
ICD-9	994.2
DiseasesDB	12415

Starved Vietnamese man, who was deprived of food in a Viet Cong prison camp.

Starvation is a severe deficiency in caloric energy, nutrient and vitamin intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage^[1] and eventually, death. The term inanition refers to the symptoms and effects of starvation.

According to the World Health Organization, hunger is the single gravest threat to the world's public health.^[2] The WHO also states that malnutrition is by far the biggest contributor to child mortality, present in half of all cases.^[2] Six million children die of hunger every year.^[3]Figures on actual starvation are difficult to come by, but according to the FAO, the less severe condition of undernourishment currently affects about 925 million people, or about 14 % of the world population.^[4]

The bloated stomach, as seen in the picture to the right, represents a form of malnutrition called kwashiorkor which is caused by protein deficiency combined with inadequate caloric consumption.^[5] Children are more vulnerable to kwashiorkor whose advanced symptoms include weight loss and muscle wasting.^[5] It is quite common to depict a thin child with a bloated stomach as starving, but in reality, such child is malnourished.

Common causes

The basic cause of starvation is an imbalance between energy intake and energy expenditure. In other words, the body expends more energy than it takes in as food. This imbalance can arise from one or more medical conditions and/or circumstantial situations, which can include:

Medical reasons

• Anorexia nervosa
• Bulimia nervosa
• Coeliac Disease
• Coma
• Major depressive disorder
• Diabetes mellitus
• Digestive disease
• Constant vomiting

Circumstantial causes

• Famine – for any reason, including overpopulation and war.
• Fasting – done without proper medical supervision and lasting more than a month^{[citation needed]}. Although, there are cultures where fasting is done without any problems for longer periods and usually no medical supervision. People from Eastern Orthodox Church fast every year for 7 weeks in a row before Easter and 40 days before Nativity without any noticeable problems; however their fasting isn't absolute.
• Poverty

Signs and symptoms

Individuals experiencing starvation lose substantial fat (adipose) and muscle mass as the body breaks down these tissues for energy. Catabolysis is the process of a body breaking down its own muscles and other tissues in order to keep vital systems such as the nervous system and heart muscle (myocardium) functioning. Vitamin deficiency is a common result of starvation, often leading to anemia, beriberi, pellagra, and scurvy. These diseases collectively can also cause diarrhea, skin rashes, edema, and heart failure. Individuals are often irritable and lethargic as a result.

Early symptoms include impulsivity, irritability, hyperactivity and possibly submissiveness.^[6] Atrophy (wasting away) of the stomach weakens the perception of hunger, since the perception is controlled by the percentage of the stomach that is empty. Victims of starvation are often too weak to sense thirst, and therefore become dehydrated.

All movements become painful due to muscle atrophy and dry, cracked skin that is caused by severe dehydration. With a weakened body, diseases are commonplace. Fungi, for example, often grow under the esophagus, making swallowing unbearably painful.

The energy deficiency inherent in starvation causes fatigue and renders the victim more apathetic over time. As the starving person becomes too weak to move or even eat, their interaction with the surrounding world diminishes.

There is also an inability to fight diseases, and in females, irregular menstruation can occur.

Biochemistry

When food intake ceases, the body enters the starvation response^{[citation needed]}. Initially, the body's glycogen stores are used up in about 24 hours.^{[citation needed]} The level of insulin in circulation is low and the level of glucagon is very high. The main means of energy production is lipolysis. Gluconeogenesis converts glycerol into glucose and the Cori cycle converts lactate into usable glucose. Two systems of energy enter the gluconeogenesis: proteolysis provides alanine and lactate produced from pyruvate, while acetyl CoA produces dissolved nutrients (Ketone bodies), which can be detected in urine and are used by the brain as a source of energy.

In terms of insulin resistance, starvation conditions make more glucose available to the brain.

Efforts

Treatment

Starving patients can be treated, but this must be done cautiously to avoid refeeding syndrome.^[7]

Prevention

See also: Food security

For the individual, prevention obviously consists of ensuring they eat plenty of food, varied enough to provide a nutritionally complete diet. Short of sitting in front of a potentially starving person and offering him or her food, to address societal mechanisms by which people are denied access to food is a more complicated matter.

Supporting farmers in areas of food insecurity through such measures as free or subsidized fertilizers and seeds increases food harvest and reduces food prices.^[8]

Organizations

Main article: Famine relief

Many organizations have been highly effective at reducing starvation in different regions. Aid agencies give direct assistance to individuals, while political organizations pressure political leaders to enact more macro-scale policies that will reduce famine and provide aid.

Starvation statistics

Main articles: Malnutrition and Hunger

According to estimates by the FAO there were 925 million under- or malnourished people in the world in 2010.^[9] This was a decrease from an estimate of 1023 million malnourished people in 2009.^[10] In 2007, 923 million people were reported as being undernourished, an increase of 80 million since 1990-92.^[11] It has also been recorded that the world already produces enough food to support the world's population.

As the definitions of starving and malnourished people are different, the number of starving people is different from that of malnourished. Generally, much fewer people are starving, than are malnourished. The numbers here may provide some indication, but should not be quoted as a number of starving people.

The share of malnourished and of starving people in the world has been more or less continually decreasing for at least several centuries.^[12] This is due to an increasing supply of food and to overall gains in economic efficiency. In 40 years, the share of malnourished people in the developing world has been more than halved. The share of starving people has decreased even faster. This improvement is expected to continue in the future.

Year	1970	1980	1990	2005	2007	2009
Share of undernourished people in the developing world[10][13][14]	37 %	28 %	20 %	16 %	17 %	16 %

As capital punishment

The starving Livilla refusing food.
From a drawing by André Castagne

Historically, starvation has been used as a death sentence. From the beginning of civilization to the Middle Ages, people were immured, or walled in, and would die for want of food.

In ancient Greco-Roman societies, starvation was sometimes used to dispose of guilty upper class citizens, especially erring female members of patrician families. For instance, in the year 31, Livilla, the niece and daughter-in-law of Tiberius, was discreetly starved to death by her mother for her adulterous relationship with Sejanus and for her complicity in the murder of her own husband, Drusus the Younger.

Another daughter-in-law of Tiberius, named Agrippina the Elder (a granddaughter of Augustus and the mother of Caligula), also died of starvation, in 33 AD. (However, it is not clear whether or not her starvation was self inflicted.)

A son and daughter of Agrippina were also executed by starvation for political reasons; Drusus Caesar, her second son, was put in prison in 33 AD, and starved to death by orders of Tiberius (he managed to stay alive for nine days by chewing the stuffing of his bed); Agrippina's youngest daughter, Julia Livilla, was exiled on an island in 41 by her uncle, Emperor Claudius, and not much later, her death by starvation was arranged by the empress Messalina.

It is also possible that Vestal Virgins were starved when found guilty of breaking their vows of celibacy.

Ugolino della Gherardesca, his sons and other members of his family were immured in the Muda, a tower of Pisa, and starved to death in the thirteenth century. Dante, his contemporary, wrote about Gherardesca in his masterpiece The Divine Comedy.

In Sweden in 1317, King Birger of Sweden imprisoned his two brothers for a coup they had staged several years earlier (Nyköping Banquet). A few weeks later, they died of starvation.

In Cornwall in 1671, John Trehenban from St Columb Major was condemned to be starved to death in a cage at Castle An Dinas for the murder of two girls.

Saint Maximilian Kolbe, a martyred Polish friar, offered his life to save another inmate who had a family that had been sentenced to death in the Auschwitz concentration camp along with nine other prisoners because a prisoner had escaped. He was starved, along with another nine inmates. After two weeks of starvation, only Kolbe and three other inmates were still alive, and they were then executed with injections of phenol.

Nikolai Vavilov was starved to death in the Soviet Union for supporting the concept of genes in the face of the official position of effectively limitless environmental plasticity.

See also

2007-2008 world food price crisis Anorexia mirabilis Anorexia nervosa Norman Borlaug Celiac Disease Cachexia Dehydration Global Hunger Index Famine

Famine response Famine scales Fasting Food security Hunger Hunger strike Kwashiorkor List of famines

List of people who died of starvation Malnutrition Marasmus Muselmann Overpopulation Poverty Refeeding syndrome Santhara

1. ^ Disease-Related Malnutrition: An Evidence-Based Approach to Treatment "When [food] intake is poor or absent for a long time (weeks), weight loss is associated with organ failure and death."
2. ^ ^{a b} Malnutrition The Starvelings
3. ^ http://edition.cnn.com/2009/WORLD/europe/11/17/italy.food.summit/
4. ^ FAO: The State of Food Insecurity in the World
5. ^ ^{a b} http://www.bettermedicine.com/article/kwashiorkor
6. ^ http://randyschellenberg.tripod.com/anorexiatruthinfo/id45.html
7. ^ Mehanna HM, Moledina J, Travis J (June 2008). "Refeeding syndrome: what it is, and how to prevent and treat it". BMJ 336 (7659): 1495–8. doi:10.1136/bmj.a301. PMC 2440847. PMID 18583681. http://bmj.com/cgi/pmidlookup?view=long&pmid=18583681. 
8. ^ Ending Famine, Simply by Ignoring the Experts
9. ^ FAO:Hunger
10. ^ ^{a b} The State of Food Insecurity in the World, 2010: Addressing Food Insecurity in Protracted Crises
11. ^ Food and Agriculture Organization Economic and Social Development Department. “The State of Food Insecurity in the World, 2008 : High food prices and food security - threats and opportunities”. Food and Agriculture Organization of the United Nations, 2008, p. 2. “FAO’s most recent estimates put the number of hungry people at 923 million in 2007, an increase of more than 80 million since the 1990–92 base period.”.
12. ^ Fogel, RW (2004). The escape from hunger and premature death, 1700-2100: Europe, America, and the Third World. Cambrige: Cambrige University Press.
13. ^ Food and Agriculture Organization Agricultural and Development Economics Division. “The State of Food Insecurity in the World, 2006 : Eradicating world hunger – taking stock ten years after the World Food Summit”. Food and Agriculture Organization of the United Nations, 2006, p. 8. “Because of population growth, the very small decrease in the number of hungry people has nevertheless resulted in a reduction in the proportion of undernourished people in the developing countries by 3 percentage points – from 20 percent in 1990–92 to 17 percent in 2001–03. (…) the prevalence of undernourishment declined by 9 percent (from 37 percent to 28 percent) between 1969–71 and 1979–81 and by a further 8 percentage points (to 20 percent) between 1979–81 and 1990–92.”.
14. ^ Food and Agriculture Organization Economic and Social Development Department. “The State of Food Insecurity in the World, 2008 : High food prices and food security - threats and opportunities”. Food and Agriculture Organization of the United Nations, 2008, p. 6. “Good progress in reducing the share of hungry people in the developing world had been achieved – down from almost 20 percent in 1990–92 to less than 18 percent in 1995–97 and just above 16 percent in 2003–05. The estimates show that rising food prices have thrown that progress into reverse, with the proportion of undernourished people worldwide moving back towards 17 percent.”.

External links

• U.N. Chief: Hunger Kills 17,000 Kids Daily - by CNN