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From insufficient nutrition to severe malnutrition and ultimately starvation, the process progresses to a stage where the body can no longer maintain life. In Gaza today, thousands of children under five and pregnant or nursing women are experiencing…experiencing acute malnutrition. In Sudan, fighting and limited humanitarian access have forced millionson the verge of starvation, as warnings of hunger become increasingly dire each day.

We requested nutrition experts Ola Anabtawi and Berta Valente to clarify the scientific aspects of starvation and describe the effects on the body when it lacks food.

What is the least amount of nourishment required for the body to remain alive?

For survival, individuals require more than just clean water and security. Availability of food that fulfills daily energy, protein, and vitamin needs is essential.essentialto maintain wellness, aid in healing, and avoid nutritional deficiencies.

As per the World Health Organization (WHO), adults need varying levels of energy based on factors such as age, gender, and degree of physical activity. A kilocalorie (kcal) is a unit used to quantify energy. In the context of nutrition, it indicates the amount of energy a person receives from food or the energy required by the body to operate. In scientific terms, one kilocalorie represents the energy needed to increase the temperature of one kilogram of water by one degree Celsius. The body utilizes this energy for essential functions like breathing, digesting food, regulating body temperature, and—particularly in children—for growth.

Energy requirements are derived from three different sources:

• basal metabolic rate: the energy required by the body while at rest to support essential processes like respiration and blood flow

• physical exertion: can differ during crises based on elements such as movement, providing care, or tasks related to survival

• thermogenesis: the energy required for breaking down and processing nutrients from food.

The majority of a person’s energy requirements typically comes from resting energy expenditure, particularly when physical activity is minimal. Additional elements such as age, gender, body dimensions, overall health, pregnancy, or exposure to cold climates can also affect the amount of energy needed.

Energy requirements change across different stages of life. InfantsrequireAround 95kcal to 108kcal per kilogram of body weight daily in the initial six months, and between 84kcal and 98kcal per kilogram from six to twelve months. For children under ten years old, energy requirements are determined by typical growth rates, with no difference between males and females.

For instance, a child who is two years old usually needs approximately 1,000 to 1,200 kilocalories each day. A five-year-old typically requires around 1,300 to 1,500, while a ten-year-old generally needs between 1,800 and 2,000 kilocalories per day. Starting at the age of ten, the energy needs start to vary between boys and girls because of differences in growth patterns and activity levels, and these recommendations are modified according to body weight, level of physical activity, and growth rate.

For adults engaging in light to moderate physical activity, the typical daily energy requirement for men between the ages of 19 and 50 is approximately 2,900kcal, whereas women in the same age bracket need around 2,200kcal each day. These figures allow for a variation of plus or minus 20% to accommodate differences in metabolism and activity levels. For adults above the age of 50, energy requirementsdecrease slightly, with men needing approximately 2,300 calories and women around 1,900 calories per day.

In humanitarian emergencies, food aid provision must ensure the universally recognized minimum energy requirement to sustain essential health and functionality, which has been established at 2,100kcal per individual per day. This standard is designed to fulfill core physiological requirements and avoid malnutrition during periods of food scarcity.

This power has to originate froma balance of macronutrients, with carbohydrates contributing 50%-60% (such as rice or bread), proteins making up 10%-35% (like beans or lean meat), and fats accounting for 20%-35% (for instance, cooking oil or nuts).

Fat requirements are higherfor children aged 30%-40%, and also for expectant and nursing mothers (minimum 20%).

Besides energy, the body needs vitamins and minerals, including iron, vitamin A, iodine, and zinc, which are essential for immune system support, growth, and brain development. Iron can be found in foods such as red meat, beans, and fortified cereals. Vitamin A is obtained from carrots, sweet potatoes, and dark green vegetables. Iodine is typically acquired through iodized salt and seafood. Zinc is available in meat, nuts, and whole grains.

If food systems fail, this equilibrium is disrupted.

What occurs in the body when it is deprived of food?

From a physiological perspective, the impact of starvation on the human body occurs in three stages that overlap. Each stage represents the body’s attempt to endure without food. However, these adjustments impose significant physical strain.

In the first stage, which can last up to 48 hours after eating stops, the body uses glycogen stored in the liver to maintain stable blood sugar levels.

This mechanism, known as glycogenolysis, serves as a temporary remedy. Once glycogen is depleted, the next phase commences.

The body turns to gluconeogenesis, generating glucose from non-carbohydrate materials such as amino acids (from muscle), glycerol (from fat), and lactate. This mechanism provides energy for essential organs but leads to muscle degradation and higher nitrogen loss, particularly from skeletal muscle.

By the third day, ketogenesis takes over as the main process. The liver begins transforming fatty acids into ketone bodies—molecules originating from fat that act as an alternative energy source when glucose is in short supply. These ketones are utilized by the brain and other organs for energy. This transition helps preserve muscle tissue but also indicates a more severe metabolic issue.

Fluctuations in hormones, such as lower levels of insulin, thyroid hormone (T3), and nervous system function, decrease the metabolic rate.to conserve energy. As time passes, fat serves as the primary source of energy. However, when fat reserves are depleted, the body must start breaking down its own proteins for fuel. This speeds up muscle loss, weakens the immune system, and raises the likelihood of severe infections.

Death, usually due to pneumonia or other issues, typicallyoccursbetween 60 and 70 days without food in a healthy adult.

As the body faces extended periods without adequate nutrition, the visible and hidden indicators of starvation become more pronounced. Physically, people lose significant weight and suffer from muscle atrophy, exhaustion, a reduced heart rate, dry skin, hair loss, and impaired ability to heal wounds. The immune system becomes weaker, making them more susceptible to infections, especially pneumonia — a common cause of mortality during starvation.

From a psychological perspective, starvation leads to intense emotional suffering. Individuals often experience a lack of interest, moodiness, worry, and an ongoing focus on eating. Mental facultiesabilities declineand emotional control worsens, occasionally resulting in depression or isolation.

In children, long-term effectsinclude delayed growth and hindered brain development. Both may turn permanent.

When the body is deprived of food, it goes through various phases to stay alive. At first, it relies on stored glycogen for fuel. As the period of starvation extends, it starts to metabolize fat, and later, muscle mass. This progressive change accounts for the physical exhaustion and mental alterations such as mood swings or sadness.

But hunger does not affect just one person. It breaks apart families and communities. As energy levels drop, individuals find it hard to take care of themselves or others. In humanitarian emergencies such as Gaza and Sudan, starvation…compoundsthe experience of violence and being forced to leave one’s home, leading to a complete breakdown of social and physical endurance.

What actions can be taken to stop the pattern?

Following a time of hunger, the body exists in a delicate metabolic condition. The abrupt return of food, particularly carbs, results in an increase in insulin and a quick movement of electrolytes such as phosphate, potassium, and magnesium into cells. This can strain the body, causing a condition referred to asrefeeding syndrome, which could lead to severe issues like heart failure, breathing difficulties, or even death if not properly controlled.

Standard protocols begin withTherapeutic milks known as F-75, specifically created to stabilize patients in the early stage of treatment for severe acute malnutrition, are followed by ready-to-use therapeutic food, a specially made peanut-butter paste or biscuit that can restore a malnourished child from near death to full health within four to eight weeks, along with oral rehydration salts and micronutrient powders.

They need to be transported securely. Continuous humanitarian access is crucial.

Airdrops are not considered part of food security. Ensuring survival demands continuous, collaborative actions that rebuild food systems, safeguard people, and maintain humanitarian law. Failing to do so increases the likelihood of recurring cycles of starvation and suffering.

If food aid is insufficient in quality or amount, or if access to clean water is lacking, malnutrition quickly becomes more severe.