Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The limit of human adaptation to starvation

Abstract

During the height of the 1992–93 famine in Somalia, data were collected from 573 inpatients at the Concern Worldwide Adult Therapeutic Centre in Baidoa, the town at the epicentre of the disaster. These data indicate that a body mass index (BMI, body weight in kilograms divided by height in metres squared) of less than 10 kg m−2 can be compatible with life, so long as specialized care is provided. Such low levels of BMI may be explained, in part, by the high ambient temperature, the tall phenotype of the Somalis, the gradual reduction in food intake and previous exposure to chronic energy deficiency. Famine oedema occurred with the same prevalence in male and female patients, but male patients had more severe oedema and a poorer prognosis at any given degree of severity. Survival from these extremes of emaciation has never before been recorded, and many of the BMI values documented here are below the level of 12, previously thought to mark the limit of human adaptation to starvation.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Collins, S.R. The need for adult therapeutic care in emergency feeding programmes. JAMA 270, 637–638 (1993).

    CAS  Article  Google Scholar 

  2. 2

    Winick, M. Hunger Disease. (Wiley-Intersfcience, New York, New York, 1979).

    Google Scholar 

  3. 3

    Moore, P.S. et al. Mortality rastes in displaced and resident populations of central Somalia during 1992 famine. Lancet 341, 935–938 (1993).

    CAS  Article  Google Scholar 

  4. 4

    Centers for Disease Control. Population based mortality assessment: Baidoa and Afgoi, Somalia 1992. Morbid. Mortal. Weekly Rep. 41, 913–917 (1992).

  5. 5

    Somali Red Cross & Red Crescent: Figures for the number of unclaimed bodies buried in Baidoa 1992–1993 (1993).

  6. 6

    Henry, C.J.K. Body mass index and the limits of human survival. Eur. J. Clin. Nutr. 44, 329–335 (1990).

    CAS  PubMed  Google Scholar 

  7. 7

    Keys, A. The Biology of Human Starvation (Univ. Minnesota Press, Minneapolis, Minnesota, 1950).

    Book  Google Scholar 

  8. 8

    McCance, R.A. & Widdowson, E.M. Studies in undernutrition, Wuppertal 1946–9. (Medical Research Council, London, 1951).

  9. 9

    Ville de Goyet, C., Seaman, J. & Geijer, U. The management of nutritional emergencies in large populations. (World Health Organization, Geneva, 1978).

  10. 10

    World Health Organization. Use and interpretation of anthropometric indicators of nutritional status. WHO Bull. 64 (6) 929–941 (1986).

  11. 11

    Ferro-Luzzi, A., Setti, S., Franklin, M. & James, W.P.T. A simplified approach to assessing adult chronic energy deficiency. Eur. J. Clin. Nutr. 46, 173–186 (1992).

    CAS  PubMed  Google Scholar 

  12. 12

    James, W.P.T., Ferro-Luzzi, A. & Waterlow, J.C. Definition of chronic energy malnutrition in adults. Eur. J. Clin. Nutr. 42, 969–981 (1988).

    CAS  PubMed  Google Scholar 

  13. 13

    James, W.P.T. & Shetty, P.S. Body mass index: An objective measure for the estimation of chronic energy deficiency in adults. (World Health Organization, Geneva, 1992).

  14. 14

    Ross, A.R., Taylor, N., Hayes, R. & Mclean, M. Measuring malnutrition in famines: are weight for height and arm circumference interchangeable? Int. J. Epidemiol. 19 (3) 636–645 (1990).

    CAS  Article  Google Scholar 

  15. 15

    Friedman, P. Severe arm-muscle wasting: Sign of lethal malnutrition in sick elderly men. Nutrition 7 (3) 223–226 (1991).

    CAS  PubMed  Google Scholar 

  16. 16

    James, W.P.T. & Norgan, N.G. The value of arm circumference in assessing chronic energy deficiency in Third World adults. Eur. J. Clin. Nutr. 49, 883–894 (1994).

    Google Scholar 

  17. 17

    Mollinson, P.L. Observation on cases of starvation in Belsen. Br. Med. J. 5 (Jan) 4–8 (1946).

    Article  Google Scholar 

  18. 18

    Lipscomb, F.M. Medical aspects of Belsen concentration camp. Lancet 1, 313–315 (1945).

    Article  Google Scholar 

  19. 19

    Eveleth, P.B. & Tanner, J.M. Worldwide Variation in Human Growth (Cambridge Univ. Press, Cambridge, 1976).

    Google Scholar 

  20. 20

    Branca, F. & Abdulle, A. Famine in Somalia. Lancet 341, 1478 (1993).

    CAS  Article  Google Scholar 

  21. 21

    Henry, C.J.K. Variability in adult body size: Uses in defining the limits of human survival. in Anthropometry: The Individual and Population. (Cambridge Univ. Press, Cambridge, 1993).

    Google Scholar 

  22. 22

    Burger, G.C.E., Sandstead, H.R. & Drummond, J. Starvation in western Holland: 1945. Lancet 282–283 (1945).

    Article  Google Scholar 

  23. 23

    Leyton, G.B. The effects of slow starvation. Lancet 1, 73–79 (1946).

    Article  Google Scholar 

  24. 24

    Shetty, P.S. Adaptive changes in basal metabolic rate and lean body mass in chronic undernutrition. Hum. Nutr. Clin. Nutr. 41C, 287–290 (1984).

    Google Scholar 

  25. 25

    Keys, A. Human starvation and its consequences. J. Am. diet. Assoc. 22, 582–587 (1946).

    CAS  PubMed  Google Scholar 

  26. 26

    Gopalan, C. & Krishnaswamy, K. Famine oedema. Progr. Food Nutr. Sci. 1(3), 207–224 (1975).

    CAS  Google Scholar 

  27. 27

    Aykroid, W.R. The Conquest of Famine. (Chatto & Windus, London, 1974).

    Google Scholar 

  28. 28

    Beattie, J., Herbert, P.H. & Bell, D.J. Famine oedema. Br. J. Nutr. 2, 47–65 (1948).

    CAS  Article  Google Scholar 

  29. 29

    Dean, A.G., Dean, J.A., Burton, A.H. & Dicker, R.C., Info version 6: A word processing, database and statistics programme for epidemiology on microcomputers. (USD Inc., Stone Mountain, Georgia, 1990).

  30. 30

    Dallal, G.E. Logistic: A logistic regression programme for the IBM PC. Am. Statistic. 42, 272 (1988).

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Collins, S. The limit of human adaptation to starvation. Nat Med 1, 810–814 (1995). https://doi.org/10.1038/nm0895-810

Download citation

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing