Starvation overview

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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. 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.

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.

References

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