Starvation
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Starvation is a severe reduction in vitamin, nutrient, and energy intake, and is the most extreme form of malnutrition.
Pathophysiology
When food intake ceases, the body enters the starvation response. Initially, the body’s glycogen stores are used up in about 24 hours. 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.
Diagnosis
Physical Examination
Cachexia is present as individuals experiencing starvation lose substantial fat and muscle mass as the body breaks down these tissues for energy.
Electrocardiogram
Electrocardiogram of patients with starvation may show QT lengthening.
Treatment
Medical Therapy
Starving patients can be treated, but this must be done cautiously to avoid refeeding syndrome.[1] 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.[2]
Primary Prevention
For the individual, prevention 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, addressing 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.[3]
References
- ↑ Mehanna HM, Moledina J, Travis J (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. Unknown parameter
|month=ignored (help) - ↑ “The Physiology and Treatment of Starvation”. US national library of medicine. Retrieved 17 August 2012.
- ↑ Ending Famine, Simply by Ignoring the Experts
Historical Perspective
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References
Pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
When food intake ceases, the body enters the starvation response. Initially, the body’s glycogen stores are used up in about 24 hours. 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.
References
Causes
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Causes
Common Causes
- Anorexia nervosa
- Bulimia nervosa
- Clinical Depression
- Coma
- Crash dieting
- Diabetes mellitus (untreated)
- Digestive disease
- Famine
- Fasting
- Malnutrition
- Overpopulation
- Poverty
References
Differentiating Starvation from other Diseases
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References
Epidemiology and Demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Epidemiology and Demographics
According to the Food and Agriculture Organization of the United Nations, more than 25,000 people died of starvation every day in 2003,[1] and as of 2001 to 2003, about 800 million people were chronically undernourished.[2][1] According to estimates by the FAO there were 925 million under- or malnourished people in the world in 2010.[3] This was a decrease from an estimate of 1023 million malnourished people in 2009.[4] 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.
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 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.[6] 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 | 2004 | 2007 | 2009 |
|---|---|---|---|---|---|---|
| Share of undernourished people in the developing world[4][7][8] | 37 % | 28 % | 20 % | 16 % | 17 % | 16 % |
References
- ↑ 1.0 1.1 Kirby, Alex (2003-03-05). “UN warns of future water crisis”. BBC. Retrieved 2007-09-01.
- ↑ “The spectrum of malnutrition” (pdf). Food and Agricultural Organization. 2001-10-05. Retrieved 2007-08-03.
- ↑ FAO:Hunger
- ↑ 4.0 4.1 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.”.
Risk Factors
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References
Natural History, Complications and Prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Complications
- Immune deficiency may occur.
- Vitamin deficiency is also a common result of starvation, often resulting in anemia, beriberi, pellagra, and scurvy. These diseases collectively may cause diarrhea, skin rashes, edema, and heart failure. Individuals are often irritable, fatigued, and lethargic as a result.
Prognosis
In humans, prolonged starvation (in excess of 1-2 months) causes permanent organ damage and, eventually, death.
References
Diagnosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Other Imaging Findings | Other Diagnostic Studies
Treatment
Treatment
Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
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