Thursday, January 28, 2010



Picture 1: A girl, shown suffering the effects of severe hunger and malnutrition.

Starvation is the result of a serious lack or deficiency of nutrients need for maintenance of life, it is the most extreme form of malnutrition.


According to FAO [Food and Agriculture Organization] the starvation currently affects more than one billion people or one in six people of the world population 6.7 billion. Prolonged starvation can cause permanent organ change, and eventually death, that is about 20 000 die each day. The WHO [World Health Organization] also states that malnutrition is by far the biggest contributor to child mortality, present in half of all cases.
Picture 2: Starved Vietnamese man,who was deprived of food in Viet Cong prison camp.


What is the cause of starvation ?
What are the symptoms and signs of starvation?
How to treat starvation ?
How to prevent starvation ?
What is the prognosis of starvation ?


The basic cause of starvation is the imbalance between energy of intake and energy expenditure. In other words: the body expends more energy that it takes is as food.
The starvation is caused by a number of factors. They include: Anorexia nervosa, fasting, coma, stroke, severe gastrointestinal disease, famine and extreme poverty. The poverty where half of the world’s population lives on less than $ 2 a day.
Picture 3: Adult,shown suffering of starvation is dying


1. Chronic diarrhea, decreased ability to digest of food because of lack of digestive acid production in the stomach.
2. Shrinkage of vital organs such as heart, lungs, ovaries or testes and their functions.
3. Reduction in muscle mass and weakness because of it.
4. Low body temperature.
5. Irritability.
6. Immune deficiency, less of resistance to infections.
7. Decrease sex drive.
8. The signs of specific nutrient deficiency may occur such as deficiency of vitamins.


It is necessary to treat the cause of starvation. Nutrients feeding rich in protein, energy and adequate vitamins and minerals. If the degree of malnutrition is severe, the intravenous feeding must begin the treatment and then the treatment with liquid nutrients. Gradually, solid foods are introduced with high protein and energy.


For the individual, prevention obviously consists of ensuring they eat plenty of food, varied enough to provide a nutritionally complete diet. Supporting farmer in areas of food insecurity through such measures as free or subsidized fertilizers and seeds increases food harvest and reduces food prices.


People can recover from severe diagnosis of starvation to a normal stature and function. Children may suffer from permanent mental retardation or growth defects of their deprivation was long and extreme.
Cecil & Loeb A Textbook of Medicine.W.B.Saunders Company,Philadelphia,USA,1959,p 537-540.
Waldo E.Nelson,M.D., D.Sc. Texbook of Pediatrics.W.B.Saunders Company,Philadelphia,USA,1959,p 358-369.

Friday, January 22, 2010



Marasmus is a form of severe malnutrition, dominated by energy deficiency of nutrients or foods intake. Probably combine with protein, vitamins and minerals deficiency. Marasmus occurrence increases prior to age one to under five year age.

The syndrome of marasmus:
1. Clinically, there is failure to gain weight, later followed by weight less and finally emaciation [to cause to lose flesh so as to become very thin] and dry skin.
2. There is loss of adipose tissue from normal areas for deposits like buttocks and tights.
3. There is extensive tissue and muscle wasting and weakness.
4. Other common symptoms include loose skin folds hanging over the axillary skin and gluteal skin.
5. The abdomen may be concave or flat; if there is distention of the abdomen, usually it is due to parasitic diseases such as ascariasis [roundworm], schistosoma, oxyuriasis [enterobius vermicularis or seatworm] combines with mild edema.
6. Vitamins deficiency vitamin B-complex and C are common often leading to anemia, pellagra, dry beriberi and scurvy.
7. The afflicted patients are often fretful and irritable.

Picture: Child suffering with marasmus in India.

It seems, the child is about under five years old.

Marasmus is caused by a severe deficiency of nearly all nutrients or foods intake particularly energy or calories and protein.

It is necessary to treat the cause of marasmus with adequate nutrients feeding rich in energy or calories, protein, vitamins and minerals. Treatment in the uncomplicated case requires temporarily a high energy, high protein diet, with much of the nutrients derived from milk, eggs and meat.
The maintenance diet should be an average one according to age and weight of the patient.

Others treatment for anemia, pellagra, dry beriberi and scurvy can be administered with vitamin B-complex and vitamin C; and the treatment of any coexisting infections with antibiotics.
Parasitic diseases treatment with combantrin [pyrantel pamoate] syrup for children.
Treatment of dry skin and dehydration, administer the Ringer's lactate solution or Dextran 6 % in saline intravenous infusion.

Nutrients should be planned to avoid dietary deficiency by feeding rich in protein, adequate in energy, vitamins and minerals. Nutrients derived from milk, eggs, meat, whole grain, fruit, and vegetables.
Good hygienic habit and immunization to prevent infectious diseases.

Thursday, January 14, 2010




Pluri-deficiency means more than one deficiency or multiple deficiency of nutrient. Syndrome is from the Greek word meaning “run together” diseases and symptoms. Clinical pluri-deficiency syndrome [PDS] which results from more than one deficiency such as deficiency of calories [energy], protein and probably other nutrients such as vitamins and minerals.
PDS is the most extreme form of malnutrition [under nourished].
The basic cause of PDS is an imbalance between energy, protein, and vitamins intake and expenditure. In other words: the body expends more energy, protein and vitamins than it takes in as food. The imbalance can come from one or more medical condition causes and socio-economic condition causes.
Medical causes: Anorexia nervosa, digestive diseases, depression and coma.
Socio-economic causes: famine, poverty, uneducated, deprivation and observed in various countries, especially in war-torn areas where starvation is common.
We can identify 3 types of extreme PDS:
2. Marasmus
3. Starvation.


Kwashiorkor is the term applied to a clinical syndrome which results from an extreme deficiency of protein, and probably deficiency of other nutrients, especially those of vitamins B-complex and vitamin A, , C and K.
The term “kwashiorkor is said to mean “red boy” in the language of Gold Coast Africa. Another interpretation is the “syndrome of the changeling”
The syndrome of kwashiorkor as it has been described signs among the children consist of :

Picture 1: A. Kwashiorkor in a two year-old boy. Note the generalized edema and the skin lesions.B. Close-up of the same child the showing hair changes ; the edema of the face and the skin lesions can be seen more clearly.

Source: Waldon E.Nelson,M.D.,D.Sc.
Textbook of PEDIATRICS. Seven Edition,W.B.SaundersCompany,Philadelphia,USA,1959, p 358.
1. Retarded growth in the weaning and post-weaning under 3 years old children.
2. Edema usually associated with hypo-proteinemia [low protein in the plasma of the blood].

Picture 2: Left, infant with "sugar-baby" kwashiorkor,showing stunting, edema of feet and hands,moon face and depigmentation of the hair.
Right, normal infant of same age and racial group.Source: Ibid, p 360
3. Alteration in skin and hair pigmentation.
4. The frequent association of a variety of dermatoses [skin disorders] such as pellagra.
5. Gastrointestinal disorders, including anorexia, vomiting, and diarrhea.
6. Irritability and apathy.
7. Fatty infiltration, cellular necrosis or fibrosis of the liver.
8. A high mortality rate.

Some combinations of these signs is essential for diagnosis.
Edema usually starts in the feet, but soon involves the face, hands, arms and genitals; ascites [accumulation of fluid in the abdominal cavity] is rare.
The hair loses its luster and in Negro tends to lose its curl and become straight and fine; it becomes pale or almost reddish.
If there is vitamin A deficiency with symptoms of night blindness, xerophthalmia [ocular disease] appear late in the disease.

Picture 3: Recovery from xerophthalmia, showing permanent eye lesion.
Source : Opcit, p 361

Vitamin B-complex deficiency is a common , often leading to anemia, beri-beri and pellagra.

Vitamin C deficiency there may be a "rosary" at the costochondral junctions and a depression of the sternum.Rickets due to vitamin D deficiency. Hemorrhagic jaundice of vitamin K deficiency.
Picture 4: Vitamin C deficiency scorbutic rosary,depression of sternum and the so-called frog position. Source: Opcit, p 369

Kwashiorkor is usually treated with the diet rich in proteins of high biological value, vitamins and minerals, adequate energy ; and the treatment of the coexisting infections.

It can be accomplished by feeding an adequate diet during the post-weaning phase. Nutrient diet rich in source of protein such as dried milk, skim milk, fish meal and legume [soy beans]; adequate energy, vitamins and minerals

Picture 5: Hemorrhagic jaundice due to vitamin K deficiency.Source: Cecil & Loeb. A Textbook of MEDICINES. W.B.Saunders Company, Philadelphia,USA,1959, p 540