Forensic Pathology Reviews

Volume 2 of the series Forensic Pathology Reviews pp 3-23

Death as a Result of Starvation

Diagnostic Criteria
  • Burkhard MadeaAffiliated withInstitute of Forensic Medicine, Rheinische Friedrich-Wilhelms-University Bonn

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Fatal starvation is a rare cause of death in industrialized countries but this entity may become of major medicolegal importance if death results from deliberate withholding of food, especially from infants. In such cases, the task of the forensic pathologist and the medical examiner, respectively, is not only to clarify the cause of death but also to give an expert opinion on the degree and duration of starvation. Several classification systems have been developed to estimate protein-energy malnutrition (PEM) in third world countries (e.g., Waterlow classification, Gomez classification). More simple classifications (e.g., the Gomez classification of PEM) use the weight expected for the respective age group as standard. When applying this standard, small infants will always be light infants. Following the Waterlow classification, a stunted physical condition (referring to retardation in cases of chronic malnutrition) is calculated by using the ratio of the measured body height to the one expected for the actual age. Body weight can be used as a sign of acute malnutrition (“wasting”). However, body weight should be related to the expected weight for the actual height. Using such classification systems, a grading of stunting and wasting can be achieved that is of great value for the assessment of a given child’s nutritional status in legal cases. The application of the Waterlow classification to this author’s case material and cases published earlier in the literature is demonstrated. The Waterlow classification is not only of importance for grading the final stage in cases of fatal starvation, but also for the chronological development of the nutritional status, if anthropometrical data have been recorded repeatedly from the affected individual in vivo.

Key Words

Starvation autopsy findings protein-energy malnutrition (PEM) Waterlow classification stunting wasting emaciation undernutrition malnutrition malnourishment