Nutrition, disease and death in times of famine.

In this article we review the relationship between malnutrition and mortality, and the interaction of morbidity, with the aim of clarifying the health risks of malnutrition in situations of famine and food insecurity. Apart from reviewing what is known about this relationship, we highlight areas where further research is needed. Among refugee and famine affected populations living in camps, there appears to be a close association between high rates of malnutrition and excess mortality. Results from community-based prospective studies of malnutrition and mortality among individuals conclude that as nutritional status declines the risk of death increases, although the discriminating power of different nutritional indices and the strength of the association varies considerably in different locations and at different times. These differences are attributed mainly to the different prevailing patterns of morbidity and growth failure, which are influenced by both environmental and social factors. In situations of famine and population displacement, the deterioration in the health environment increases exposure to infection and is likely to raise the threshold of nutritional status which corresponds to an increased risk of mortality. This has important implications for nutritional assessments and interventions.