Understanding Severe Malnutrition: What is severe starvation called?

October 14, 2025 •

5 min read

Worldwide, an estimated 50 million children under five suffer from protein-energy malnutrition. When this condition becomes extreme, the question of what is severe starvation called is answered by specific medical diagnoses, most notably marasmus and kwashiorkor.

Quick Summary

The medical terms for severe starvation are typically marasmus and kwashiorkor, representing different forms of protein-energy malnutrition. It triggers a metabolic shift where the body consumes its own tissues. Consequences include severe wasting, fluid retention, organ damage, and susceptibility to infection. Treatment requires careful reintroduction of nutrients to prevent life-threatening complications like refeeding syndrome.

Key Points

Marasmus: A severe form of protein-energy malnutrition, marasmus is characterized by visible wasting of fat and muscle due to an overall lack of calories.
Kwashiorkor: This type of severe malnutrition is distinguished by a severe protein deficiency that causes edema, or fluid retention, resulting in a bloated appearance.
Metabolic Phases of Starvation: The body adapts to starvation by first using glycogen, then fat, and finally breaking down its own muscle and organ tissue for energy.
Refeeding Syndrome: This life-threatening complication can occur when a severely malnourished person is fed too quickly, causing dangerous electrolyte shifts.
Cachexia: Associated with chronic diseases rather than simple starvation, cachexia is a severe wasting syndrome driven by inflammation and altered metabolism.
Visible Signs: Physical symptoms of severe malnutrition include weight loss, muscle wasting, dry skin and hair, and, in the case of kwashiorkor, edema.
Treatment Approach: Treatment for severe starvation involves a carefully managed reintroduction of nutrients under medical supervision to avoid potentially fatal complications.

The Medical Terminology for Severe Starvation

Severe starvation is a life-threatening condition that refers to an extreme deficiency in energy intake required to maintain human life. Medically, this condition is most often categorized under protein-energy malnutrition (PEM) and manifests in two distinct clinical syndromes: marasmus and kwashiorkor. These terms describe different physiological responses to a severe lack of nutrients.

Marasmus: The Wasting Disease

Marasmus represents a state of severe undernutrition resulting from a significant deficit of all macronutrients—carbohydrates, proteins, and fats. The body's initial response to this prolonged deprivation is to deplete its stored energy reserves. When these stores are exhausted, it begins to break down its own fat and muscle tissue for energy, leading to a visibly emaciated or "wasted" appearance. The word "marasmus" comes from the Greek word marasmós, meaning "withering". This condition most commonly affects infants and young children in areas of poverty and food scarcity but can occur in anyone with a sustained caloric deficit.

Key features of marasmus include:

Severe weight loss and loss of muscle mass
Near-complete depletion of subcutaneous fat
A gaunt, wizened, or "old man" facial appearance, especially in children
A noticeable low body weight for height
Dry, loose, and thin skin
Chronic lethargy and irritability
Stunted growth and developmental delays in children
Compromised immune function

Kwashiorkor: The Edematous Malnutrition

Kwashiorkor is another form of severe protein-energy malnutrition, though it is more specifically a severe deficiency of protein, with a relatively higher intake of carbohydrates. This imbalance in nutrients causes the hallmark symptom of kwashiorkor: bilateral pitting edema, or swelling due to fluid retention, particularly in the ankles, feet, hands, and face. This can be misleading, as the swelling can mask the true state of malnutrition. The name comes from a Ga language term meaning "the sickness the baby gets when the new baby comes," referring to the time when an older child is weaned from protein-rich breast milk and given a carbohydrate-heavy diet.

Key features of kwashiorkor include:

Presence of bilateral pitting edema
A distended, bloated belly due to fluid accumulation (ascites) and an enlarged liver
Hair changes, such as brittle texture, loss of pigment, and easy hair loss
Dermatitis, or skin lesions, that can peel or crack
Anorexia and apathy
Immunodeficiency

Cachexia: A Related Medical Wasting Syndrome

While not directly a term for starvation, cachexia is a severe wasting syndrome often associated with chronic illnesses like cancer, HIV, and advanced heart failure. It is characterized by significant, involuntary weight loss, including the loss of both muscle and fat mass. Unlike simple starvation, cachexia is driven by complex metabolic and inflammatory processes related to the underlying disease, which can cause the body to enter a hypermetabolic, catabolic state. Cachexia is often more resistant to standard nutritional support than malnutrition caused by simple food deprivation and carries a poor prognosis.

Comparison of Severe Malnutrition Manifestations


Feature	Marasmus	Kwashiorkor	Cachexia
Primary Cause	Severe deficiency of all macronutrients (protein, carbs, fat).	Severe protein deficiency with relative carbohydrate abundance.	Systemic inflammation and metabolic dysfunction from chronic disease.
Appearance	Wasted, emaciated, shriveled skin, visible skeleton.	Edema (swelling) in extremities and abdomen, appearing puffy or bloated.	Unintentional and progressive weight loss, including muscle and fat.
Body Composition	Near-complete loss of fat and muscle tissue.	Retained subcutaneous fat, but depleted muscle mass.	Loss of both muscle and fat mass.
Edema	Not typically present.	Prominent and defining feature (bilateral pitting edema).	Not a defining feature, though fluid retention can occur with underlying disease.
Typical Patient	Infants and very young children.	Children, particularly after weaning, in developing regions.	Patients with advanced chronic diseases like cancer or AIDS.

The Metabolic Journey of Starvation

When the body is deprived of food, it progresses through several metabolic stages to survive.

Initial Stage (Glycogenolysis): The body first uses up its readily available glucose from the bloodstream. When this is gone, it begins to break down stored glycogen from the liver and muscles to produce more glucose. This can last up to 24 hours.
Intermediate Stage (Ketosis): After glycogen is depleted, the body shifts to breaking down fat stores for energy. The liver converts fatty acids into ketone bodies, which are then used as a fuel source by the brain and other tissues. This process helps conserve muscle protein. This phase can last for weeks or even months, depending on the individual's fat reserves.
Terminal Stage (Protein Breakdown): When fat reserves are exhausted, the body resorts to breaking down muscle tissue to supply amino acids for energy. This phase leads to rapid muscle wasting and is extremely dangerous, often resulting in organ failure. Once protein loss exceeds 50%, death is imminent.

The Dangers of Refeeding Syndrome

After a period of severe starvation, the reintroduction of food must be done carefully to prevent a potentially fatal condition known as refeeding syndrome. This occurs when a severely malnourished person begins eating again, triggering a massive shift of fluids and electrolytes back into the body's cells. This sudden metabolic shift can cause rapid and dangerous drops in critical minerals like phosphate, potassium, and magnesium in the blood.

Symptoms and complications of refeeding syndrome include:

Cardiac arrhythmias and heart failure
Respiratory failure
Neurological symptoms, such as delirium, seizures, and tremors
Fluid retention and swelling
Muscle weakness

Treatment of severe starvation, especially for patients at high risk for refeeding syndrome, must be conducted under close medical supervision. The process involves slow, cautious reintroduction of calories and careful monitoring and supplementation of electrolytes.

Conclusion: The Critical Role of Proper Nutrition

The medical terms for severe starvation, such as marasmus and kwashiorkor, highlight the specific and devastating impacts of nutrient deprivation on the body. These conditions are not merely states of hunger but complex metabolic syndromes that dismantle the body's tissues and systems. Recognizing the signs and understanding the underlying physiology is crucial for providing effective treatment and preventing long-term damage. From managing the metabolic shifts that occur during starvation to carefully navigating the risks of refeeding syndrome, proper medical and nutritional intervention is essential for recovery. In the broader context of nutrition and diet, these conditions serve as a stark reminder of the fundamental importance of balanced and consistent nutritional intake for human health and survival.

Learn more about malnutrition from authoritative sources like the World Health Organization.

Frequently Asked Questions

Marasmus results from an overall deficiency of calories, protein, and fat, leading to a visibly emaciated appearance with severe wasting of muscle and fat. Kwashiorkor is primarily a severe protein deficiency with relatively normal caloric intake, causing edema (swelling) that can mask the severe malnutrition.

Survival time varies based on factors like initial body fat, hydration, and overall health. With water, individuals have survived for several weeks to months, while without both food and water, survival is typically limited to about one week.

The body first burns through its glycogen stores for energy. Once these are depleted, it shifts to burning fat (ketosis). In the final stage, when fat reserves are gone, the body begins breaking down muscle tissue, which leads to organ failure and can be fatal.

Refeeding syndrome is a dangerous metabolic complication that can occur when a severely malnourished person is fed too rapidly. It involves severe shifts in fluids and electrolytes, particularly low levels of phosphate, potassium, and magnesium, which can lead to cardiac arrest, respiratory failure, and other neurological complications.

No. While both involve severe weight loss, starvation is caused by a lack of nutrient intake. Cachexia is a wasting syndrome caused by an underlying chronic disease, like cancer or AIDS, and is driven by metabolic and inflammatory changes that are often resistant to standard nutritional support.

Populations at high risk include children in developing countries with food scarcity, the elderly in institutional care, people with eating disorders like anorexia nervosa, and those suffering from chronic illnesses or malabsorption disorders.

With proper medical intervention and careful nutritional rehabilitation, many people can recover from severe malnutrition. However, long-term effects such as stunted growth in children or damage to organs can persist, especially if treatment is delayed.