HOW HUNGER KILLS

Nobody can say flatly how many calories a human needs to survive. Too many factors depend upon the individual, his environment, his activity and his general condition. In a northern industrial country, a 30-year-old, 150-lb. man needs a bare 3,000 calories a day; a 125-lb. woman and a six-year-old boy each require about 2,000. In the tropics, where people do not need many calories just to maintain body heat, the figures fall. But there is no disagreement on what happens to the child or adult whose caloric intake drops below his daily expenditure of energy. Unless he can reduce his work or play, he must draw upon his own tissues for energy. When he does this for too long, he starves.

The victim of starvation burns up his own body fats, muscles and tissues for fuel. His body quite literally consumes itself and deteriorates rapidly. The kidneys, liver and endocrine system often cease to function properly. A shortage of carbohydrates, which play a vital role in brain chemistry, affects the mind. Lassitude and confusion set in, so that starvation victims often seem unaware of their plight. The body's defenses drop; disease kills most famine victims before they have time to starve to death. An individual begins to starve when he has lost about a third of his normal body weight. Once this loss exceeds 40%, death is almost inevitable.

Starvation is only one of the ways in which hunger kills. People whose bellies are full can still die of malnutrition if their diets lack certain essential elements. Lack of the proteins containing essential amino acids--found in milk, meat, fish, beans and nuts--can bring on kwashiorkor, a wasting disease that kills tens of thousands of children each year in Africa, India, Southeast Asia and parts of South America. Kwashiorkor victims, whose tissues are usually swollen with fluid, develop a scaly rash and liver troubles. They are most easily recognized by the characteristic that gave the disease its Ghanaian name of "Red Johnny"; for reasons unknown, their hair turns a coppery color.

Other deficiency diseases can be equally deadly. Rickets, which results from a lack of vitamin D, can produce soft, deformed bones in children. Beriberi--caused by too little of the thiamin normally found in vegetables, liver, pork, eggs and whole grains--affects the heart, the circulatory system and the brain. Its victims are unable to remember and prone to confabulation, the concocting of stories to fill memory gaps. A lack of niacin (commonly found in brown rice, fish and meat) can produce pellagra, a deficiency disease characterized by the "four Ds": dermatitis, diarrhea, dementia and death.

Most adults can come close to starvation and survive. Hunger strikers and concentration-camp inmates have been pulled back from the brink of death with carefully measured supplements of essential nutrients. Though survivors of concentration camps tend to die sooner than their contemporaries, their deaths--or health problems--are rarely a direct result of near starvation, but are caused by old injuries or tuberculosis and other infections.

Children who survive starvation remain scarred for life. No amount of vitamin D will straighten legs bowed by rickets; proper portions of essential proteins cannot undo the damage done to a growing child's brain by their absence. Brain cells require protein, and they need it from the very moment that life begins. At least 80% of all human brain growth occurs between conception and the age of two. This growth cannot take place in the fetus if the mother is malnourished, and it cannot be accomplished in the infant if he is starving. Nor will it happen later. In many cases, brain development that does not occur when it is supposed to does not take place at all. Thus hunger is condemning countless thousands of infants--from Harlem to the Sahel--to the twilight zone of mental retardation, and leaving them no hope of deliverance.

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