It’s one of the most painful aspects of starvation to witness: the stomachs of children who are dying appear ridiculously swollen. It’s as if the body plays an unbelievably cruel joke on itself, causing the starved to resemble people whose bellies are large from over-eating. Is there a connection? In fact the two instances — starvation and overeating — only resemble each other in a superficial way. The belly of an over-eater looks the way it does due to a build-up of fat cells, also present on other areas of the body. The starvation belly stands out in painful relief against emaciated arms, legs, and face, and will appear more taut and inflexible.
That’s because the belly on a starving person has nothing to do with fat. Rather, it is often the result of Protein Calorie Malnutrition, or PCM. PCM means a healthy number of calories are being eaten — say in the form of rice — but with a severe deficiency in protein. This is often the case in third-world countries where meat and fish are rare or too expensive for many. Even in a healthy state, the blood vessels and organs leak fluids a little. This is generally no problem, as the lymphatic system removes the excess, and a little fluid cushioning the organs is a good thing. In PCM, however, the lymphatic system can’t keep up with the leakage, and the stomach area begins to bloat with its own waste fluids. Add to this the likelihood of a swollen liver, which is another result of PCM, and you wind up with the terrible irony of a person on the verge of starvation looking weirdly similar to an overeater.