Starvation

From Wikipedia, the free encyclopedia

This article is about extreme malnutrition. For other uses, see Starvation
(disambiguation).
Starvation
Starved girl.jpg
A girl during the Nigerian Civil War of the late 1960s, shown suffering the effects
of severe hunger and malnutrition.
Classification and external resources
Specialty Critical care medicine
ICD-10 T73.0
ICD-9-CM 994.2
DiseasesDB 12415
MeSH D013217
[edit on Wikidata]
Starvation is a severe deficiency in caloric energy intake, below the level needed
to maintain an organism's life. 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.
Starvation may also be used as a means of torture or execution.

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]
Undernutrition is a contributory factor in the death of 3.1 million children under
five every year.[3] Figures on actual starvation are difficult to come by, but
according to the Food and Agriculture Organization, the less severe condition of
undernourishment currently affects about 842 million people, or about one in eight
(12.5%) people in the world population.[4]

The bloated stomach, as seen in the adjacent picture, represents a form of

malnutrition called kwashiorkor which is caused by insufficient protein despite a
sufficient caloric intake.[5] Better medicine will prevent the pictured symptoms in
which included is weight loss and muscle wasting from further taking form.[5]

Contents
1 Common causes
2 Signs and symptoms
3 Biochemistry
4 Prevention
5 Treatment
5.1 Organizations
6 Starvation statistics
7 Capital punishment
8 Concentration camps and ghettos
9 See also
10 References
11 External links
Common causes
Causes of hunger are related to poverty. There are inter-related issues causing
hunger, which are related to economics and other factors that cause poverty. They
include land rights and ownership, diversion of land use to non productive use,
increasing emphasis on export oriented agriculture, inefficient agricultural
practices, war, famine, drought, over fishing, poor crop yield, etc.

Starved Vietnamese man, who was deprived of food in a Viet Cong prison camp. Note
the rib cage showing, a clear sign of starvation.
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. This
imbalance can arise from one or more medical conditions or circumstantial
situations, which can include:

Medical reasons

Anorexia nervosa
Bulimia nervosa
Eating disorder, not otherwise specified
Celiac disease
Coma
Major depressive disorder
Diabetes mellitus
Digestive disease
Constant vomiting
Circumstantial causes

Child/ Elder/ Dependent Abuse

Famine � for any reason, such as political strife and war
Excessive fasting
Poverty
The main causes of starvation are as follows:

Economy; poor people sometimes cannot buy enough foodstuffs and thereby fail to
fulfill the caloric demands of the body.
Food scarcity in the society. This causes a decreased supply of food to the whole
of the population, and thus mass starvation may occur.
Diseases that can cause rapid weight loss either due to the nature of the disease
or the inability of the person to either eat or eat enough due to symptoms
including fatigue, nausea, and vomiting. The person may also be the host to a
parasite such as an intestinal worm which may take a significant amount of the
calories ingested by its host. This effect is exacerbated if the human host is
already ingesting far less food than is required to meet their daily caloric intake
needs.
Clinical conditions, such as recovering from surgery or burns, etc., in which the
person may be too fatigued or incapacitated to eat enough during their period of
convalescence.
Signs and symptoms

Starving Russian girl during the Russian famine of 1921

Early symptoms include impulsivity, irritability, and hyperactivity. 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.
Individuals experiencing starvation lose substantial fat (adipose tissue) and
muscle mass as the body breaks down these tissues for energy.[6] 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.
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. In females,
menstruation ceases when the body fat percentage is too low to support a fetus.

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
painful. Vitamin deficiency is also 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.

There is insufficient scientific data on exactly how long people can live without
food.[7] Although the length of time varies with an individual's percentage of body
fat and general health, one medical study estimates that in adults complete
starvation leads to death within 8 to 12 weeks.[8] There are isolated cases of
individuals living up to 25 weeks without food.[9] Starvation begins when an
individual has lost about 30% of their normal body weight.[10] Once the loss
reaches 40% death is almost inevitable.[10]

Biochemistry
Under normal metabolic conditions, the human body relies on free blood glucose as
its primary energy source. The level of blood sugar is tightly regulated; as blood
glucose is consumed, the pancreas releases glucagon, a hormone that stimulates the
liver to convert stored glycogen into glucose. The glycogen stores are ordinarily
replenished after every meal, but if the store is depleted before it can be
replenished, the body enters hypoglycemia, and begins the starvation response.
[citation needed]

After the exhaustion of the glycogen reserve, and for the next 2�3 days, fatty
acids become the principal metabolic fuel. At first, the brain continues to use
glucose, because, if a non-brain tissue is using fatty acids as its metabolic fuel,
the use of glucose in the same tissue is switched off. Thus, when fatty acids are
being broken down for energy, all of the remaining glucose is made available for
use by the brain. Basically the body will use up stored fat cells first, then move
on to muscles.

After 2 or 3 days of fasting, the liver begins to synthesize ketone bodies from
precursors obtained from fatty acid breakdown. The brain uses these ketone bodies
as fuel, thus cutting its requirement for glucose. After fasting for 3 days, the
brain gets 30% of its energy from ketone bodies. After 4 days, this goes up to 75%.
[11] Thus, the production of ketone bodies cuts the brain's glucose requirement
from 80 g per day to about 30 g per day. Of the remaining 30 g requirement, 20 g
per day can be produced by the liver from glycerol (itself a product of fat
breakdown). But this still leaves a deficit of about 10 g of glucose per day that
must be supplied from some other source. This other source will be the body's own
proteins.

After several days of fasting, all cells in the body begin to break down protein.
This releases alanine and lactate produced from pyruvate into the bloodstream,
which can be converted into glucose by the liver. Since much of human muscle mass
is protein, this phenomenon is responsible for the wasting away of muscle mass seen
in starvation. However, the body is able to selectively decide which cells will
break down protein and which will not. About 2�3 g of protein has to be broken down
to synthesize 1 g of glucose; about 20�30 g of protein is broken down each day to
make 10 g of glucose to keep the brain alive. However, this number may decrease the
longer the fasting period is continued in order to conserve protein.

Starvation ensues when the fat reserves are completely exhausted and protein is the
only fuel source available to the body. Thus, after periods of starvation, the loss
of body protein affects the function of important organs, and death results, even
if there are still fat reserves left unused. (In a leaner person, the fat reserves
are depleted earlier, the protein depletion occurs sooner, and therefore death
occurs sooner.) The ultimate cause of death is, in general, cardiac arrhythmia or
cardiac arrest brought on by tissue degradation and electrolyte imbalances.

Prevention
For the individual, prevention consists of ensuring they eat plenty of food, varied
enough to provide a nutritionally complete diet.

Starvation can be caused by factors, other than illness, outside of the control of
the individual. The Rome Declaration on World Food Security outlines several
policies aimed at increasing food security[12] and, consequently, preventing
starvation. These include:

Poverty reduction
Prevention of wars and political instability
Food aid
Agricultural sustainability
Reduction of economic inequality
Supporting farmers in areas of food insecurity through such measures as free or
subsidized fertilizers and seeds increases food harvest and reduces food prices.
[13]

Treatment
Starving patients can be treated, but this must be done cautiously to avoid
refeeding syndrome.[14] Rest and warmth must be provided and maintained. Small sips
of water mixed with glucose should be given in regular intervals. Fruit juices can
also be given. Later, food can be given gradually in small quantities. The quantity
of food can be increased over time. Proteins may be administered intravenously to
raise the level of serum proteins.[15]

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 Food and Agriculture Organization there were 925
million under- or malnourished people in the world in 2010.[16] This was a decrease
from an estimate of roughly 1 billion malnourished people in 2009.[17] In 2007, 923
million people were reported as being undernourished, an increase of 80 million
since 1990-92.[18] It has also been recorded that the world already produces enough
food to support the world's population.[citation needed]

As the definitions of starving and malnourished people are different, the number of
starving people is different from that of malnourished. Generally, far fewer people
are starving, than are malnourished.

The proportion of malnourished and of starving people in the world has been more or
less continually decreasing for at least several centuries.[19] This is due to an
increasing supply of food and to overall gains in economic efficiency. In 40 years,
the proportion of malnourished people in the developing world has been more than
halved. The proportion of starving people has decreased even faster.

Year 1970 1980 1990 2004 2007 2009

Proportion of undernourished people in the less-developed world[17][20][21] 37 %
28 % 20 % 16 % 17 % 16 %
Capital punishment

This section needs additional citations for verification. Please help improve this
article by adding citations to reliable sources. Unsourced material may be
challenged and removed. (December 2008) (Learn how and when to remove this template
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Main article: Immurement
Wikisource has original text related to this article:
The Women of the Caesars

The starving Livilla refusing food.

From a drawing by Andr� 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 subsequently her death by
starvation was arranged by the empress Messalina.

A Mongolian woman condemned to die of starvation, c. 1922

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 (Nyk�ping Banquet). According to legend they
died of starvation a few weeks later, since their brother had thrown the prison key
in the castle moat.

In Cornwall in the UK 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. The
Makah, a Native American tribe inhabiting the Pacific Northwest near the modern
border of Canada and the United States, practiced death by starvation as a
punishment for slaves.[22]

Concentration camps and ghettos

Buchenwald inmates, 16 April 1945 when camp was liberated

Many of the prisoners died in the Nazi concentration camps through deliberate
maltreatment, disease, starvation, and overwork, or were executed as unfit for
labor. Many occupants of ghettos in eastern Europe also starved to death, most
notoriously in the Warsaw ghetto. Prisoners were transported in inhumane conditions
by rail freight cars, in which many died before reaching their destination. The
prisoners were confined to the cattle cars for days or even weeks, with little or
no food or water. Many died of dehydration in the intense heat of summer or froze
to death in winter. Nazi concentration camps in Europe from 1933 to 1945
deliberately underfed prisoners, who were at the same time forced to perform heavy
labour. The diet was restricted to watery vegetable soup and a little bread, with
little or no dietary fats, proteins or other essential nutrients. Such treatment
led to loss of body tissues, and prisoners became skeletal, the so-called Muselmann
who were murdered by gas or bullet when examined by camp doctors.

Maximilian Kolbe, on a West German postage stamp, marked Auschwitz

Starvation was also used as a punishment where victims were locked into a small
cell until dead, a process which could take many days. Saint Maximilian Kolbe, a
martyred Polish friar, underwent a sentence of starvation in Auschwitz
concentration camp in 1941. Ten prisoners had been condemned to death by starvation
in the wake of a successful escape from the camp. Kolbe volunteered to take the
place of a man with a wife and children. After two weeks of starvation, Kolbe and
three other inmates remained alive; they were then executed with injections of
phenol.

See also
Hunger relief portal
2007-2008 world food price crisis
Anorexia mirabilis
Norman Borlaug
Cachexia
Global Hunger Index
Starvation mode
Famine scales
Hunger strike
List of famines
List of people who died of starvation
Marasmus
Muselmann
Human overpopulation
Santhara
References
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."
Malnutrition The Starvelings
"Hunger Stats". World Food Programme.
FAO: The State of Food Insecurity in the World
"Archived copy". Archived from the original on 2011-10-02. Retrieved 2011-06-26.
"With spirulina, and together, we will end child malnutrition in the world. Now".
Retrieved Dec 16, 2014.
Hoffman, Matthew (2014). "How long can you live without food?". Answers. WebMD,
LLC. Retrieved October 5, 2014.
Bernhard, Virginia (2011). A Tale of Two Colonies: What Really Happened in
Virginia and Bermuda?. University of Missouri Press. p. 112. ISBN 0826272576.
Bydlowska, Jowita (2013). Drunk Mom: A Memoir. Doubleday Canada. p. 91. ISBN
0385677812.
Time magazine, November 11, 1974, cited in Pojman, Paul; Pojman, Louis (2011).
Food Ethics. Cengage Learning. p. 128. ISBN 1111772304.
C. J. Coffee (Dec 1, 2004). Quick Look: Metabolism. Hayes Barton Press. p. 169.
World Food Summit - Rome Declaration on World Food Security
Ending Famine, Simply by Ignoring the Experts
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?Freely accessible. PMID 18583681.
"The Physiology and Treatment of Starvation". US national library of medicine. PMC
2181967?Freely accessible.
 FAO:Hunger
The State of Food Insecurity in the World, 2010: Addressing Food Insecurity in
Protracted Crises
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.�.
Fogel, RW (2004). The escape from hunger and premature death, 1700-2100: Europe,
America, and the Third World. Cambridge: Cambridge University Press.
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.�.
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.�.
Donald, Leland (1997). Aboriginal Slavery on the Northwest Coast of North America,
University of California Press, p. 23
External links
Wikimedia Commons has media related to Starvation.
Wikiquote has quotations related to: Starvation
Online books, and library resources in your library and in other libraries about
Starvation
U.N. Chief: Hunger Kills 17,000 Kids Daily - by CNN
Wilson, DE; Zeikus, R; Chan, IF (Apr 1987). "Relationship of organ lipoprotein
lipase activity and ketonuria to hypertriglyceridemia in starved and streptozocin-
induced diabetic rats". Diabetes. 36 (4): 485�90. doi:10.2337/diabetes.36.4.485.
PMID 3817303.
Swaner, JC; Connor, WE (Aug 1975). "Hypercholesterolemia of total starvation: its
mechanism via tissue mobilization of cholesterol". The American Journal of
Physiology. 229 (2): 365�9. PMID 169705.
[hide] v t e
Consequences of external causes (T66�T78, 990�995)
Temperature
Elevated
Hyperthermia Heat syncope
Reduced
Hypothermia Immersion foot syndromes Trench foot Tropical immersion foot Warm water
immersion foot Chilblains Frostbite Aerosol burn Cold intolerance Acrocyanosis
Erythrocyanosis crurum
Radiation
Radiation poisoning Radiation burn Chronic radiation keratosis Eosinophilic,
polymorphic, and pruritic eruption associated with radiotherapy Radiation acne
Radiation-induced cancer Radiation recall reaction Radiation-induced erythema
multiforme Radiation-induced hypertrophic scar Radiation-induced keloid Radiation-
induced morphea
Air
Hypoxia/Asphyxia Barotrauma Aerosinusitis Decompression sickness High altitude
Altitude sickness Chronic mountain sickness HAPE HACE
Food
Starvation
Maltreatment
Physical abuse Sexual abuse Psychological abuse
Travel
Motion sickness Seasickness Airsickness Space adaptation syndrome
Adverse effect
Hypersensitivity Anaphylaxis Angioedema Allergy Arthus reaction
Adverse drug reaction
Other
Electric shock Drowning Lightning injuries
Ungrouped
skin conditions
resulting from
physical factors
Dermatosis neglecta Pinch mark Pseudoverrucous papules and nodules Sclerosing
lymphangitis Tropical anhidrotic asthenia UV-sensitive syndrome
environmental skin conditions Electrical burn frictional/traumatic/sports Black
heel and palm Equestrian perniosis Jogger's nipple Pulling boat hands Runner's rump
Surfer's knots Tennis toe Vibration white finger Weathering nodule of ear
Wrestler's ear Coral cut Painful fat herniation Uranium dermatosis
iv use Skin pop scar Skin track Slap mark Pseudoacanthosis nigricans Narcotic
dermopathy
Categories: FaminesMalnutritionExecution methodsCauses of deathEffects of external
causesWeight lossHungerPhysical torture techniques
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