Since starvation can be caused by many things, it can be difficult to accurately assess. Sometimes it is an effect of inadequate resources or chronic disease, such as AIDS, or cancer. It can be caused by acute injury like large burns. It can also be self-induced in conditions such as anorexia nervosa. There are many physical and laboratory findings that reflect what is happening in the body on a nutritional level, and by monitoring these, you can recognize the indicators of starvation.
Protein
Protein helps build muscle, supports hair and nail growth, and aids in wound healing. The body's major protein and nutritional indicator is albumin. When albumin drops below 2.8g/dL, you can begin to see signs of starvation. Such characteristics include thin, dry, easily removable hair, skin breakdown and significant swelling, known as edema. You can assess the amount of protein loss by measuring the amount of urea nitrogen, a muscle breakdown product, in the urine.
Fat
About 50 percent of our body's fat is stored in the tissue just beneath the skin. So, it becomes rapidly obvious when you reach starvation levels of fat loss. The triceps skin fold is typically used to assess body fat. Once its thickness has dropped below 3 mm, fat stores are essentially gone. With fat depletion comes the exhaustion of fat-soluble vitamins A, D, E and K. These deficiencies can be identified by night blindness, decreased bone mineral density, anemia and poor wound healing, respectively. This is not a complete list of manifestations however, so if a deficiency is suspected, check with your doctor.
Micronutrients
With the loss of major nutrients like fat and protein, comes the loss of micronutrients. Vitamin and mineral deficiencies are often detectable with a physical exam. For example, small bleeds around hair follicles can indicate vitamin C deficiency. Muscular twitching can be caused by calcium deficiency. The problem is that many vitamin and mineral deficiencies share the same physical findings. So, it is best to have a health care provider run a simple lab test to see what a patient is lacking.
Metabolic Rate
If the cause of starvation is unknown, investigating the metabolic rate offers some clues. A person who has been slowly starving will present with complete body wasting, a condition called marasmus. This person has a slower metabolic rate, as he has adjusted to starvation over time. A person acutely starving because of rapid protein loss but not necessarily total calorie malnutrition, for example, a burn victim, will present with edema and will have a high metabolic rate, a condition called kwashiorkor. Metabolic rate is measured in a number of ways including levels of stress hormones such as cortisol, insulin and glucagon, as well as oxygen consumption and urea excretion.
References
- Harrison's Principles of Intenral Medicine; Malnutrition and Nutritional Assessment. Douglas C. Heimburger; 2008. Pages 450-453.
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