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N Engl J Med. 1993 Apr 8;328(14):1058-61.

Starvation in the modern world.



Nutritionists, including those involved in famine relief, have learned in the last 25 years that certain deficiency diseases arise from the high protein foods used to rehabilitate starving populations. Other, sometimes inappropriate relief foods starving populations. Other, sometimes inappropriate relief foods include unprocessed or inappropriate grains and unfortified dry skimmed milk. Yet, relief workers do not always receive the most appropriate food for distribution to certain populations. Millions of dollars are appropriated to protect relief supplies for starving people in Somalia, but money is not spent to develop and evaluate simple foods that might save the lives of starving people. There are several items relief agencies and governments should consider when deciding on the most appropriate foods to prevent starvation in famine situations. During kwashiorkor, intestinal mucous produce grossly defective cells, resulting in considerable lactose malabsorption. Thus, using milk to rehabilitate people, especially children, poses a considerable hazard. High carbohydrate diets to rehabilitate starving people can cause gross edema and fatal congestive heart failure. Generally, clinically apparent vitamin or mineral deficiencies do not occur during famines, because the amount of vitamins or minerals needed to small to maintain a very shrunken body. Yet, when the body demand increases as a result of a rehabilitation diet poor in vitamins and minerals but high in protein or calories, clinical deficiency symptoms emerge, e.g., pellagra in Mozambique. Common food combinations used in relief situations consists of corn, soy, and milk fortified with vitamins and minerals (Bal'ahar mixture, India). Both mixtures require the addition of vegetable oils to make it easier for infants and small children to digest the mixtures.

[Indexed for MEDLINE]

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