Starvation may result from complete or partial deprivation of regular and constant supply of food. It is regarded as acute when the necessary food and water are suddenly and completely withheld as, for example, in mines or landslides, in entombment in pits, willful withholding of food and also willful refusal to take food. Chronic starvation occurs when there is gradual deficient supply of food, as in famines and camp conditions.¹ Starvation includes both subnutrition (insufficient food quantity) and malnutrition (insufficient food quality). The symptoms and effects of starvation are called as inaniation, while cachexia denotes acute loss of body weight.² The minimum food requirement for an adult depends upon his ideal weight (not current weight) and his normal work and daily activities. For an ideal weight of 60 kg, the usual requirement would be 1800 calories per day. Life is threatened when more than 40% of the original body weight has been lost, though the speed of loss also matters.

Death usually occurs in 10–12 days if both water and food are totally withdrawn. If food alone is withdrawn, death may occur in 6–8 weeks or even more. The period, however, is influenced by a number of factors like age, sex, condition and environment of the body.¹

With nearly a fourth of its 1.1 billion population hungry, India indeed is the world's hunger capital. According to the UN Food and Agriculture Organisation, there are 100 million more hungry people this year. India is ranked 66^th on the 2008 global hunger index of 88 countries. The report of the UN world food programme is quite unflattering. More than 27% of the world's undernourished people live in India. The figure is higher than the global average of 25%.³

A case is reported wherein dead body of an elderly male was recovered near a temple under suspicious circumstances. Postmortem examination was done after receiving police inquest.

Dead body is of an elderly male aged around 65 years measuring 162 cm in length and weighing 36 kg and dressed with blue full shirt, green underwear and black pant. Rigor mortis present all over the body. Postmortem stain present over the back. Body was thin and emaciated. Eyes were sunken, lips dried and cracked, scalp hairs were lusterless and brittle with wrinkled, dry and inelastic skin. Ribs were prominent with depressed intercostals spaces (Figure 1). Abdomen was scaphoid shaped and shrunken (Figure 2). Clavicle, maxilla, mandible, ribs and iliac crests were prominent with skin stretched around them. There was deepening of supraclavicular fossae. External injuries were not present on the body. All natural body orifices were intact. Tongue was dry and coated. Pleurae thickened and adherent to the chest wall along with the lungs. Epicardial fat was depleted over heart with patent coronary arteries. Stomach was empty. Gall bladder was enlarged and distended with bile (Figure 4 and 5). Abdominal subcutaneous fat, mesenteric and omental fat were depleted (Figure 3). Atrophy of gastrointestinal tract with thin walls was noted. Brain was oedematous (Figure 6). The urinary bladder and rectum were empty.

The basic cause of starvation is an imbalance between energy intake and energy expenditure. In other words, the body expends more energy than it takes in as something. Individuals experiencing starvation lose substantial fat and muscle mass as the body breaks down these tissues for energy (catabolysis), in order to keep vital systems such as the nervous system and myocardium functioning. Vitamin deficiency is a common result of starvation, often leading to anaemia, beriberi, pellagra and scurvy. These diseases collectively can also cause diarrhoea, skin rashes, oedema and heart failure. Individuals are often irritable and lethargic as a result. Atrophy of the stomach weakens the perception of hunger, since the perception is controlled by the percentage of the stomach that is empty. Victims of starvation are often too weak to sense thirst, and therefore become dehydrated. All movements become painful due to muscle atrophy and dry, cracked skin is caused by severe dehydration. The energy deficiency inherent in starvation causes fatigue and renders the victim more pathetic over time. When food intake ceases, the body enters the starvation response. Initially, the body's glycogen stores are used up in about 24 h. The level of insulin in circulation is low and the level of glucagon is very high. The main means of energy production is lipolysis. Gluconeogenesis converts glycerol into glucose and the cori cycle converts lactate into usable glucose. Two systems of energy enter the gluconeogenesis: proteolysis provides alanine and lactate produced from pyruvate, while acetyl-Co A produces dissolved nutrients (ketone bodies), which are used by the brain as a source of energy.⁴

In this case, the victim was a destitute living alone and his body was found under suspicious circumstances. There were no external and internal injuries in the body and there was no evidence of poisoning in the internal examination and chemical analysis report. Hence, suspicion of foul play was ruled out. Probably he was too weak to take care of himself. After perusal of external and internal postmortem findings, history given by the police and chemical analysis report, cause of death was opined as starvation.

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