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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
MeSH	D013217

World map showing percentage of population suffering from malnutrition, World Food Programme, 2006

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

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

According to the World Health Organization, hunger is the gravest single threat to the world's public health.^[1] The WHO also states that malnutrition is by far the biggest contributor to child mortality, present in half of all cases.^[1] According to the FAO, starvation currently affects more than one billion people, or 1 in 6 people on the planet.^[2]

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
• Coma
• Major depressive disorder
• Diabetes mellitus
• Digestive disease

Circumstantial causes

• Famine for any reason, including overpopulation and war.
• Fasting, when done without proper medical supervision and lasting more than a month.
• 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.

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, his or her 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'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. 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 makes more glucose available to the brain.

Efforts

Treatment

Starving patients can be treated, but this must be done cautiously to avoid refeeding syndrome.^[3]

Prevention

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.^[4]

Example of successful response in Malawi

In Malawi, almost 5 million of its 13 million people needed emergency food aid. Then, however, deep fertilizer subsidies and lesser ones for seed, abetted by good rains, helped farmers produce record-breaking corn harvests in 2006 and 2007, according to government crop estimates. The government reported that corn production rose from 1.2 million metric tons (mmt) in 2005, to 2.7 mmt in 2006 and 3.4 mmt in 2007. The harvest also helped the poor by lowering food prices and increasing wages for farm workers. Malawi became a major food exporter, selling more corn to the World Food Program and the United Nations than any other country in Southern Africa.

Over the 20 years prior to this change in policy (enacted by the World Bank), some rich nations that Malawi depended on for aid had periodically pressed it to cut back or eliminate fertilizer subsidies, in the name of free market policies. This is despite the fact that the United States and Europe extensively subsidized their own farmers. However, many, if not most, of its farmers are too poor to afford fertilizer at market prices. Proponents for helping the farmers includes the economist Jeffrey Sachs, who has championed the idea that wealthy countries should invest in fertilizer and seed for Africa’s farmers. He also conceived the Millennium Villages Project (MVP), which provides seeds and fertilizers, as well as training, to qualifying farmers. In one Kenyan village, application of this policy resulted in a tripling of its corn harvest, even though the village had previously experienced a cycle of hunger.

Organizations

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.

Hunger statistics

In 2007, 923 million people were reported as being undernourished, an increase of 80 million since 1990-92.^[5] It has also been recorded that the world already produces enough food to support the world's population — 6 billion people — and could support double — 12 billion people.^[6]

Hunger mortality statistics

• On the average, 1 person dies every second as a result, either directly or indirectly, of hunger - 4000 every hour - 100 000 each day - 36 million each year - 58 % of all deaths (2001-2004 estimates).^[9][10][11]
• On the average, 1 child dies every 5 seconds as a result, either directly or indirectly, of hunger - 700 every hour - 16 000 each day - 6 million each year - 60% of all child deaths (2002-2008 estimates).^{[12][13][14][15][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 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.

Maximilian Kolbe, a Polish friar, offered his life to save another inmate sentenced to death in the Auschwitz concentration camp. He was starved, along with another nine inmates. After two weeks of starvation, only Kolbe and three other inmates were still alive, and were executed with phenol injection.

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.

See also

References

External links

• FAO - Understanding food insecurity
• FAO - What the new figures on hunger mean
• Click to Give @ The Hunger Site
• U.N. Chief: Hunger Kills 17,000 Kids Daily - by CNN

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