The limit of human adaptation to starvation

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.