Starvation is a state of severe deficiency in caloric energy intake, resulting in the body breaking down its own tissues for fuel. It is the most extreme form of undernutrition, a type of malnutrition that occurs when the body does not get enough food and necessary nutrients. While a lack of food is the most common cause, malnutrition can also be due to conditions that prevent the body from absorbing nutrients, such as inflammatory bowel disease or anorexia nervosa. The body's response to starvation is a series of metabolic adaptations to conserve energy, starting with stored glycogen and then moving to fat reserves and muscle tissue as fuel. When these reserves are exhausted, critical organ function begins to fail, and specific diseases and complications arise.
The Two Main Diseases of Severe Starvation
Severe protein-energy undernutrition (PEU) is broadly categorized into two main diseases: marasmus and kwashiorkor. While they both result from starvation and nutritional deficiency, their specific causes and clinical presentations differ notably.
Kwashiorkor
Kwashiorkor is primarily a disease of severe protein deficiency, though it is often accompanied by other nutritional deficits. The name comes from a Ga language term meaning “the sickness the baby gets when the new baby comes,” referring to a child being abruptly weaned from breastfeeding to a low-protein, carbohydrate-rich diet.
- Characteristic Sign: The most distinguishing symptom of kwashiorkor is edema—swelling, particularly in the ankles, feet, and face. The belly may also become bloated and distended due to fluid buildup.
- Other Symptoms: Patients with kwashiorkor may also experience dry, brittle hair that changes color, skin lesions, apathy, fatigue, and a weakened immune system.
Marasmus
Marasmus results from a general, severe deficiency of all macronutrients, including protein, carbohydrates, and fats. It is often caused by an overall lack of calories and is the type of severe malnutrition that most people associate with starvation.
- Characteristic Sign: The primary clinical sign is pronounced wasting of fat and muscle tissue, giving the individual an emaciated, shrunken, and wizened appearance.
- Other Symptoms: A person with marasmus will be severely underweight, with visible ribs and loose skin folds due to the loss of subcutaneous fat. They also exhibit extreme weakness, stunted growth in children, and low body temperature and heart rate.
Kwashiorkor vs. Marasmus: A Comparison
| Feature | Kwashiorkor | Marasmus |
|---|---|---|
| Primary Cause | Severe protein deficiency with potentially sufficient calories. | Severe deficiency of all macronutrients (protein, carbs, fats). |
| Appearance | Swollen extremities, face, and abdomen due to edema. | Wasted, emaciated, shrunken, and severely underweight. |
| Muscle Wasting | Can be masked by edema; muscle mass is depleted but some subcutaneous fat may be retained initially. | Overt and severe muscle and fat wasting; skin hangs in loose folds. |
| Associated Signs | Brittle, discolored hair; dermatitis; fatty liver. | Low body temperature; slow heart rate; stunted growth. |
| Age Group | Often affects children after being weaned from breastmilk. | Can affect infants and children, as well as adults. |
Broader Health Complications of Starvation
Beyond the specific diseases of kwashiorkor and marasmus, prolonged starvation causes a cascade of health problems affecting nearly every organ and tissue in the body. These effects, which can be permanent, highlight the critical role of nutrition for overall health.
- Cardiovascular Issues: Starvation leads to a weakened heart muscle and a reduced heart rate and blood pressure. In severe cases, this can lead to heart failure or cardiac arrest.
- Compromised Immunity: The immune system is one of the first systems to shut down to conserve energy during starvation. This leaves the body vulnerable to severe infections, which are a major cause of death in malnourished individuals.
- Organ Failure: As the body runs out of fat stores, it begins to break down muscle tissue, including that of vital organs. This can cause severe kidney damage, liver damage, or liver failure.
- Neurological and Psychological Effects: Cognitive changes, such as difficulty concentrating, irritability, and apathy, are common. Severe malnutrition can cause permanent brain damage, and mental health conditions like depression, anxiety, and anorexia nervosa are both causes and consequences of starvation.
- Bone Health: Starvation and nutrient deficiencies lead to bone loss (osteoporosis), which increases the risk of fractures.
- Gastrointestinal Problems: The digestive system can atrophy from lack of use, leading to problems like constipation, malabsorption, and bacterial overgrowth.
The Dangers of Refeeding Syndrome
Refeeding syndrome is a potentially fatal complication that can occur when a severely malnourished person is fed too quickly. After a period of starvation, the body’s metabolism shifts dramatically to rely on fats and proteins for energy instead of carbohydrates. When carbohydrates are reintroduced, the metabolism shifts back, which can cause severe and dangerous fluctuations in electrolytes and fluids.
- Fluid and Electrolyte Shifts: The most common and dangerous shifts are in phosphorus (hypophosphatemia), potassium (hypokalemia), and magnesium (hypomagnesemia). These can cause sudden, life-threatening heart arrhythmias.
- Neurological and Respiratory Issues: Thiamine deficiency, a common issue in refeeding syndrome, can cause neurological symptoms like delirium and balance problems. Severe hypophosphatemia can impair respiratory muscle function, leading to respiratory failure.
- Careful Management: Due to these risks, refeeding must be done slowly and under close medical supervision. Electrolytes are carefully monitored and replenished as needed, and feeding begins with cautious amounts of specialized formulas.
Treatment and Recovery
Treating starvation-related diseases is a complex, multi-stage process requiring hospitalization for severe cases. The first stage focuses on stabilizing the patient by treating immediate, life-threatening conditions like dehydration, electrolyte imbalances, and infections. This initial phase uses therapeutic formulas like RESOMAL (REhydration SOlution for MALnutrition) to correct fluid and electrolyte issues.
The second stage is nutritional rehabilitation, where calories are gradually increased using special liquid formulas and, eventually, ready-to-use therapeutic foods (RUTF). This slow approach is crucial to prevent refeeding syndrome. Once stable, catch-up growth is encouraged, especially in children. Follow-up care is essential to prevent relapse, with education provided on nutrition, sanitation, and continued support for caregivers.
Conclusion
Starvation is a severe and life-threatening condition that leads to extreme forms of malnutrition, such as kwashiorkor and marasmus. While these diseases are distinct, they both cause widespread damage to the body, including vital organ failure, a compromised immune system, and developmental delays, particularly in children. The process of recovery is complex and fraught with risks like refeeding syndrome, emphasizing the need for carefully managed, medically supervised treatment. Early intervention is critical to minimizing long-term or irreversible effects. Understanding the science behind starvation and its specific disease manifestations is crucial for effectively combating this global health crisis.
For more insight into the physiological impact, you can read about the science of starvation at The Conversation.
