New and Emerging Prospects for the Paleopathological Study of Starvation


Harris lines
linear enamel hypoplasia
stable isotopes

How to Cite

Simpson , . R. (2020). New and Emerging Prospects for the Paleopathological Study of Starvation: A Critical Review . Pathways, 1(1), 66–83.


Starvation represents a significant contributor to morbidity and mortality, past and present, and is therefore of critical importance to the field of paleopathology. Scholars have previously argued that while critical to understanding past human health, starvation is often not directly observable in skeletal remains. But is this assessment still valid today? In re-evaluating this assessment, this paper discusses new developments in the analysis of (1) the “hunger osteopathies” (osteoporosis with some overlay of osteomalacia), (2) skeletal signs of arrested growth such as Harris lines and Linear Enamel Hypoplasia (LEH), and (3) carbon and nitrogen stable isotope analysis of skeletal remains. Periods of starvation are known to cause these visible and chemical alterations within skeletal remains, but these phenomena are complex, multi-etiological, and approaches to evaluate them are often fraught with a lack of standardization and specificity. An interdisciplinary approach synthesizing multiple lines of osteological and dental evidence, borrowing anatomical and medical research, and implementing new advancements in computer modeling, imaging modalities, and chemical micro-sampling may theoretically aid in inferring starvation bioarchaeologically.


Agarwal, Amit, Sushil K. Gupta, and Ranjith Sukumar. 2009. “Hyperparathyroidism and Malnutrition with Severe Vitamin D Deficiency.” World Journal of Surgery 33: 2303–2313. 68-009-0044-0

Ambrose, Stanley H., and Michael J. DeNiro. 1987. “Bone Nitrogen Isotope Composi-tion and Climate.” Nature 325: 201.

Aufderheide, Arthur C. 2000. “Progress in Soft Tissue Paleopathology.” JAMA 284: 2571–2573. 284.20.2571

Baker, J. R. 1978. “The Differential Diagnosis of Bone Disease.” In Research Problems in Zooarchaeology, edited by D. R. Broth-well, Kenneth D. Thomas, and Juliet Clut-ton-Brock, 107–112. 1st ed. New York: Routledge.

Baković, Marija, Polona Vreča, and Davor Mayer. 2017. “Case of Fatal Starvation: Can Stable Isotope Analysis Serve to Support Morphological Diagnosis and Approximate the Length of Starvation?” Journal of Forensic Sciences 62: 258–264.

Bartosiewicz, László. 2008. “Taphonomy and Paleopathology in Archaeozoology.” Geobios 41: 69–77. 16/j.geobios.2006.02.004

Beaumont, Julia, Andrew Gledhill, Julia Lee-Thorp, and Janet Montgomery. 2013. “Childhood Diet: A Closer Examination of the Evidence from Dental Tissues Using Stable Isotope Analysis of Incremental Human Dentine.” Archaeometry 55, no. 2: 277–295.

Beaumont, Julia, and Janet Montgomery. 2016. “The Great Irish Famine: Identifying Star-vation in the Tissues of Victims using Stable Isotope Analysis of Bone and Incre¬mental Dentine Collagen.” PLOS 11, no. 8: 1–21. pone.0160065

Berbesque, J. Colette, Frank W. Marlowe, Peter Shaw, and Peter Thompson. 2014. “Hunter-Gatherers Have Less Famine Than Agriculturalists.” Biology Letters 10: 20130853.

Bodecker, Charles F. 1925. “A Consideration of Some of the Changes in the Teeth from Young to Old Age.” Dental Cosmos 67: 543–549.

Brickley, Megan, & Rachel Ives. 2008. The Bioarchaeology of Metabolic Bone Disease. Oxford: Academic Press.

Burt, Nicole M. 2013. “Stable Isotope Ratio Analysis of Breastfeeding and Weaning Practices of Children from Medieval Fish-ergate House York, UK.” American Jour-nal of Physical Anthropology, 152, no. 3: 407–416. 22370

Calkins, Kara, and Sherin U. Devaskar. 2011. “Fetal Origins of Adult Disease.” Current Problems in Pediatric and Adolescent Health Care 41(6): 158–176. https://doi. org/10.1016/j.cppeds.2011.01.001

Cares Henriquez, Alejandra, and Marc F. Oxenham. 2017. “An Alternative Objec-tive Microscopic Method for the Identifi-cation of Linear Enamel Hypoplasia (LEH) in the Absence of Visible Perikymata.” Journal of Archaeological Science: Reports 14: 76–84. 1016/j.jasrep.2017.05.040

Cooper, David M. L., C. David L. Thomas, John G. Clement, and Benedikt Hallgríms-son. 2006. “Three-Dimensional Micro-computed Tomography Imaging of Basic Multicellular Unit-Related Resorption Spaces in Human Cortical Bone.” The Anatomical Record Part A 288A: 806–816.

Dalydell, Elsie J., and Harriette Chick. 1921. “Hunger Osteomalacia in Vienna, 1920, I: Its Relation to Diet.” Lancet 198, no. 5121: 842–849.

D’Amelio, Patrizia, Anastasia Grimaldi, Stefania Di Bella, Stefrano Z. M. Brianza, Maria Angela Cristofaro, Cristina Tamone, Giuliana Giribaldi, et al. 2008. “Estrogen Deficiency Increases Osteoclastogenesis Up-Regulating T-cell Activity: A Key Mechanism in Osteoporosis.” Bone 43: 92–100. 2008.02.017

Dempster, David W. 2011. “Osteoporosis and the Burden of Osteoporosis-Related Fractures.” AJMC 17, no. 6: S164–S169.

DeNiro, Michael J., and Samuel Epstein S. 1981. “Influence of Diet on the Distribu-tion of Nitrogen Isotopes in Animals.” Geochimica Cosmochimica Acta 45: 341–351.

Donovan, Marcella A., David Dempster, Hua Zhou, Donald J. McMahon, Jessica Fleischer, and Elizabeth Shane. 2005. “Low Bone Formation in Premenopausal Women with Idiopathic Osteoporosis.” Journal of Clinical Endocrinology & Metabolism 90: 3331–3336. https://doi. org/10.1210/jc.2004-2042

D’Ortenzio, Lori, Megan Brickley, Henry Schwarcz, and Tracy Prowse T. 2015. “You Are Not What You Eat During Phys¬iological Stress: Isotopic Evaluation of Human Hair.” American Journal of Phys¬ical Anthropology 157, no. 3: 374–388.

Dupras, Tosha L., and Henry P. Schwarcz. 2001. “Strangers in a Strange Land: Stable Isotope Evidence for Human Migration in the Dakleh Oasis, Egypt.” Journal of Archaeological Science 28: 1199–1208.

Eerkens, Jelmer W., Ada G. Berget, and Eric J. Bartelink EJ. 2011. “Estimating Weaning and Early Childhood Diet from Serial Micro-Samples of Dentine Collagen.” Journal of Archaeological Science 38: 3101–3111. 2011.07.010

Fitzgerald, Colleen M., and Jerome C. Rose. 2008. “Reading between the Lines: Dental Development and Subadult Age Assess-ment Using the Microstructural Growth Markers of Teeth.” In Biological Anthro-pology of the Human Skeleton, edited by M. Anne Katzenberg, and Shelley R. Saunders, 237–263. 2nd ed. Hoboken, NJ: John Wiley & Sons.

Fuller, Benjamin T., James L. Fuller, David A. Harris, and Robert E. M. Hedges. 2006. “Detection of Breastfeeding and Weaning in Modern Human Infants with Carbon and Nitrogen Stable Isotope Ratios.” American Journal of Physical Anthropol-ogy 129, no. 2: 279–293. 10.1002/ajpa.20249

Geber, Jonny. 2014. “Skeletal Manifestations of Stress in Child Victims of the Great Irish Famine (1845–1852): Prevalence of Enamel Hypoplasia, Harris Lines, and Growth Retardation.” American Journal of Physical Anthropology 155: 149–161.

Goodman, Alan H., and Jerome C. Rose. 1991. “Dental Enamel Hypoplasias as Indicators of Nutritional Status. In Advances in Dental Anthropology, edited by M. Kelley and C. Larson, 279–293. New York: Wiley-Liss.

Gowland, Rebecca L. 2015. “Entangled Lives: Implications of the Developmental Origins of Health and Disease

Hypothesis for Bioarchaeology and the Life Course.” American Journal of Physi-cal Anthropology 159: 530–540.

Gregg, Edward W., Andrea M. Kriska, Loran M. Salamone, Matthew M. Roberts, Stew-art J. Anderson, Robert E. Ferrell, Lewis H. Kuller, and Jane A. Cauley. 1997. “The Epidemiology of Quantitative Ultrasound: A Review of the Relationships with Bone Mass, Osteoporosis and Fracture Risk.” Osteoporosis International 7: 89–99.

Grinspoon, Steven, Karen Miller, Caryn Coyle, Judy Krempin, Catharina Armstrong, Sarah Pitts, David Herzog, and Anne Klibanski. 1999. “Severity of Osteopenia in Estrogen-Deficient Women with Anorexia Nervosa and Hypothalamic Amenorrhea.” The Journal of Clinical Endocrinology & Metabolism 84: 2049–2055. 5792

Grolleau-Raoux, Jean-Louis, Eric Crubézy, Daniel Rouge, Jean-Franćois Brugne, and Shelley R. Saunders SR. 1997. “Harris Lines: A Study of Age-Associated Bias in Counting and Interpretation.” American Journal of Physical Anthropology 103: 209–217. 1096-8644(199706)103:2<209::AID-AJPA6>3.0.CO;2-O

Grue, Helen, and Birger Jensen. 1979. “Review of the Formation of Incremental Lines in Tooth Cementum of Terrestrial Mammals [Age Determination, Game Animal, Variation, Sex, Reproductive Cycle, Climate, Region, Condition of the Animal].” Danish Review of Game Biol-ogy 11.

Hadjidakis, Dimitrios J., and Ioannis I. Androulakis. 2006. “Bone Remodeling.” Annals of the New York Academy of Sciences 1092: 385–396. 10.1196/annals.1365.035

Harrison, Roman G., and M. Anne Katzenberg. 2003. “Paleodiet Studies Using Stable Carbon Isotopes from Bone Apatite and Collagen: Examples from Southern Ontario and San Nicolas Island, Califor-nia.” Journal of Anthropological Archae-ology 22: 227–244. 1016/S0278-4165(03)00037-0

Herzog, Wolfgang, Helmut Minne, Christian Deter, Gudrun Leidig, Dieter Schellberg, Christian Wüster, Rainer Gronwald, et al. 1993. “Outcome of Bone Mineral Density in Anorexia Nervosa Patients 11.7 Years after First Admission.” Journal of Bone and Mineral Research 8, no. 5: 597–605.

Hobson, Keith A., Ray T. Alisauskas, and Robert G. Clark. 1993. “Stable-Nitrogen Isotope Enrichment in Avian Tissues Due to Fasting and Nutritional Stress: Implica-tions for Isotopic Analyses of Diet.” The Condor 95, no. 2: 388–394.

Horocholyn, Kalyna, and Megan B. Brickley. 2017. Pursuit of Famine: Investigating Famine in Bioarchaeological Literature. Bioarchaeology International 1, no. 3–4: 101–115. 2017.1008

Hudec, Susan, and Pauline Camacho. 2013. “Secondary Causes of Osteoporosis.” Endocrine Practice 19: 120–128.

Huumonen, Sisko, Terttu Särkioja, Sinikka Salo, Markku Niskanen, Heli Maijanen, and Jorma Hirvonen. 2016. “Twelve Unidentified Skeletons as Remains of an Epidemic or Famine in Northern Finland.” Scandinavian Journal of Forensic Science 22 no. 2: 33–40. sjfs-2016-0006

Kastin, Darren A., and Alan L. Buchman. 2002. “Malnutrition and Gastrointestinal Disease.” Current Opinion in Gastroen-terology 18, no. 2: 221–228.

Katona, Peter, and Judit Katona-Apte. 2008. “The Interaction between Nutrition and Infection.” Clinical Infectious Diseases 46: 1582–1588. 58

Katzenberg, M. Anne. 2008. “Stable Isotope Analysis: A Tool for Studying Past Diet, Demography, and Life History.” In Biological Anthropology of the Human Skeleton, edited by M. Anne Katzenberg, and Shelley R. Saunders, 413–441. 2nd ed. Hoboken, NJ: John Wiley & Sons.

Katzenberg, M. Anne, D. Ann Herring, and Shelley R. Saunders. 1996. “Weaning and Infant Mortality: Evaluating the Skeletal Evidence.” American Journal of Physical Anthropology 101(S23): 177–199. (1996)23+<177::AID-AJPA7>3.0.CO;2-2

Katzenberg, M. Anne, and Nancy C. Lovell. 1999. “Stable Isotope Variation in Patho-logical Bone.” International Journal of Osteoarchaeology 9: 316–324. https://doi. org/10.1002/(SICI)1099-1212(199909/10) 9:5<316::AID-OA500>3.0.CO;2-D

Kufour, Kofi O. 1994. “Starvation as a Means of Warfare in the Liberian Conflict.” Netherlands International Law Review 41, no. 3: 313–331. S0165070X00008561

Lacruz, Rodrigo S., Stefan Habelitz, J. Timo-thy Wright, and Michael L. Paine. 2017. “Dental Enamel Formation and Implica-tions for Oral Health and Disease.” Physi-ological Reviews 97: 939–993. https://doi. org/10.1152/physrev.00030.2016

Le Cabec, Adeline, Nancy Tang, and Paul Tafforeau. 2015. “Accessing Develop-mental Information of Fossil Hominin Teeth Using New Synchrotron Microto-mography-Based Visualization Tech¬niques of Dental Surfaces and Interfaces.” PLOS 10, no. 4. journal.pone.0123019.

Lewis, Mary, and Charlotte Roberts. 1997. “Growing Pains: The Interpretation of Stress Indicators.” International Journal of Osteoarchaeology 7: 581–586.<581::AID-OA325>3.0.CO;2-C

Lindsay, Robert, and Jack F. Tohme. 1990. “Estrogen Treatment of Patients with Established Postmenopausal Osteoporo¬sis.” Obstetrics and Gynecology 76, no. 2: 290–295.

Lips, Paul. 2001. “Vitamin D Deficiency and Secondary Hyperparathyroidism in the Elderly: Consequences for Bone Loss and Fractures and Therapeutic Implications. Endocrine Reviews 22, no. 4: 477–501.

Lobdell, John E. 1984 “Harris Lines: Markers of Nutrition and Disease at Prehistoric Utquagvik Village.” Arctic Anthropology 21, no. 1: 109–116.

Maratka, Z. 1946. “Contribution a L’Étude Clinique et Histopathologique des Osteo-pathies de Carence. Archives Maladies Appareil Digestive 35: 318–335.

Mattar, Lama, Caroline Huas, Jeanne Duclos, Alexandre Apfel, and Nathalie Godart. 2011. “Relationship between Malnutrition and Depression or Anxiety in Anorexia Nervosa: A Critical Review of the Litera-ture.” Journal of Affective Disorders 132: 311–318. 2010.09.014

Mays, Simon A. 1985. “The Relationship between Harris Line Formation and Bone Growth and Development.” Journal of Archaeological Science 12: 207–220.

Mays, Simon A. 1995. “The Relationship between Harris Lines and Other Aspects of Skeletal Development in Adults and Juveniles.” Journal of Archaeological Science, 22 no. 4: 511–520.

Mekota, Anna-Maria, Gisela Grupe, Sandra Ufer, and Ulrich Cuntz. 2006. “Serial Analysis of Stable Nitrogen and Carbon Isotopes in Hair: Monitoring Starvation and Recovery Phases of Patients Suffering from Anorexia Nervosa.” Rapid Commu-nications in Mass Spectrometry 20, no. 10: 1604–1610. 2477

Méndez Collí, C., Thelma N. Sierra Sosa, Vera Tiesler, and Andrea Cucina. 2009. “Linear Enamel Hypoplasia at Xcambó, Yucatánm during the Maya Classic Period: An Eval-uation of Coastal Marshland Impact on Ancient Human Populations.” HOMO 60, no. 4: 343–358. j.jchb.2009.04.001

Morgan, Johanna. 2013. “The Invisible Hunger: Is Famine Identifiable from the Archaeological Record?” Antrocom Online Journal of Anthropology 9: 115–129.

Oliveri, Beatriz, Claudia Gomez Acotto, and Carlos Mautalen. 1999. “Osteomalacia in a Patient with Severe Anorexia Nervosa.” Revue du Rhumatisme (English Edition) 66(10): 505–508.

Ortner, Donald J. 2003. Identification of Pathological Conditions in Human Skele-tal Remains. 2nd ed. San Diego, CA: Academic Press.

Ortner, Donald J. 2009. “Issues in Paleopathol¬ogy and Possible Strategies for Dealing with Them.” Anthropologisch Anzeiger 67, no. 4: 323–340. https://doi/10.1127/0003-5548/2009/0026

Papageorgopoulou, Christina, Susanne K. Suter, Frank J. Rühli, and Frank Siegmund. 2011. “Harris Lines Revisited: Prevalence, Comorbidities, and Possible Etiologies.” American Journal of Human Biology 23, no. 3: 381–391. /ajhb.21155

Park, Edwards A. 1964. “The Imprinting of Nutritional Disturbances on the Growing Bone.” Paediatrics 33: 815–861.

Park, Edwards A., and Curt P. Richter. 1953. “Transverse Lines in Bone: The Mecha-nism of Their Development.” Bulletin of the Johns Hopkins Hospital 41: 364–388.

Piercecchi-Marti, Marie-Dominique, Claude Louise-Borrione, Christophe Bartoli, Alain Sanvoisin, Michel Panuel, Anne-Laure Pelissier-Alicot, and Georges Leo¬netti. 2006. “Malnutrition, A Rare Form of Child Abuse: Diagnostic Criteria.” Jour¬nal of Forensic Sciences 51: 670–673.

Prowse, Tracy, Henry P. Schwarcz, Shelley Saunders, Roberto Macchiarelli, and Luca Bondioli. 2004. “Isotopic Paleodiet Studies of Skeletons from the Imperial Roman-Age Cemetery of Isola Sacra, Rome, Italy.” Journal of Archaeological Science 31: 259–272. 1016/j.jas.2003.08.008

Reitsema, Laurie J. 2013. “Beyond Diet Reconstruction: Stable Isotope Applica-tions to Human Physiology, Health, and Nutrition.” American Journal of Human Biology 25, no. 4: 445–456. https://doi. org/10.1002/ajhb.22398

Rigotti, Nancy A., Samuel R. Nussbaum, David B. Herzog, and Robert M. Neer. 1984. “Osteoporosis in Women with Anorexia Nervosa.” New England Journal of Medicine 311: 1601–1606. https://doi/ 10.1056/NEJM198412203112503

Rissech, Carme, Aniol Pujol, Neil Christie, Lluis Lloveras, Michael P. Richards, and Benjamin T. Fuller BT. 2016. “Isotopic Reconstruction of Human Diet at the Roman Site (1st–4th c. AD) of Carrer Ample 1, Barcelona, Spain.” Journal of Archaeological Science: Reports 9: 366–374. 08.020

Rizzoli, René, and Jean-Phillipe Bonjour. 2004. “Dietary Protein and Bone Health.” Journal of Bone and Mineral Research 19, no. 4: 527–531. JBMR.040204

Roberts, Charlotte, and Keith Manchester. 2005. The Archaeology of Disease. 3rd ed. Ithaca NY: Cornell University Press.

Robertson, Kimberly L., Joshua F. Yarrow, Neil E. Rowland, and John Krigbaum. 2018. “A Rodent Model of Caloric Restriction Using Bone Mass, Microarchi-tecture, and Stable Isotope Ratios: Impli-cations for Revealing Chronic Food Insuf-ficiency in Archaeological Populations.” STAR: Science and Technology of Archae-ological Research 3: 100–111. https://doi. org/10.1080/20548923.2018.1431863

Santarpia, Lidia, Franco Contaldo, and Fabrizio Pasanisi. 2011. “Nutritional Screening and Early Treatment of Malnu-trition in Cancer Patients.” Journal of Cachexia, Sarcopenia and Muscle 2, no. 1: 27–35.

Scharlotta, Ian, Olga I. Goriunova, and Andrzej Weber. 2013. “Micro-Sampling of Human Bones for Mobility Studies: Diagenetic Impacts and Potentials for Elemental and Isotopic Research.” Jour¬nal of Archaeological Science 40, no. 12: 4509–4527. 2013.07.014

Scorrano, Gabriele, Mauro Brilli, Cristina Martínez-Labarga, Francesca Guistini, Elsa Pacciani, Filberto Chilleri, Franco Scaldaferri, et al. 2014. “Paleodiet Recon-struction in a Woman with Probable Celiac Disease: A Stable Isotope Analysis of Bone Remains from the Archaeological Site of Cosa (Italy).” American Journal of Physical Anthropology 154, no. 3: 349–356.

Scott, Amy B., and Robert D. Hoppa. 2015. “A Re-Evaluation of the Impact of Radio-graphic Orientation on the Identification and Interpretation of Harris Lines.” Amer-ican Journal of Physical Anthropology 156: 141–147. ajpa.22635

Sealy, Judith, Richard Armstrong, and Carmel Schrire. 1995. “Beyond Lifetime Aver¬ages: Tracing Life Histories through Isotopic Analysis of Different Calcified Tissues from Archaeological Human Skel¬etons.” Antiquity 68: 290–300. https://doi. org/10.1017/S0003598X00064693

Seeman, Ego. 2003. “Reduced Bone Formation and Increased Bone Resorption: Rational Targets for the Treatment of Osteoporosis.” Osteoporosis International 14, no. S3: S2–S8. 1007/s00198-002-1340-9

Sen, Amartya. 1981. Poverty and Famines: An Essay on Entitlement and Deprivation. Oxford: Clarendon Press.

Smoliner, Christine, Kristina Norman, Karl-Heinz Wagner, Wolfgang Hartig, Herbert Lochs, NS Matthias Pirlich. 2009. “Malnutrition and Depression in the Insti-tutionalised Elderly.” British Journal of Nutrition 102: 1663–1667. 10.1017/S0007114509990900

Soyka, Leslie A., Steven Grinspoon, Lynne L. Levitsky, David B. Herzog, and Anne Klibanksi. 1999. “The Effects of Anorexia Nervosa on Bone Metabolism in Female Adolescents.” Journal of Clinical Endo-crinology & Metabolism 84, no. 12: 4489–4496. 6207

Suter, Susanne, Matthias Harders, Christina Papageorgopoulou, Gisela Kuhn, Gábor Székely, and Frank J. Rühli. 2008. “Tech-nical Note: Standardized and Semiauto-mated Harris Lines Detection.” American Journal of Physical Anthropology 137, no. 3: 362–366. 20901

Taylor, Andrew K., Weiping Cao, Keypur P. Vora, Juan De La Cruz, Wun-Ju Shieh, Sherif R. Zaki, Jaqueline M. Katz, Suryaprakash Sambhar, and Shivaprakash N. Gangappa. 2013. “Protein Energy Malnutrition Decreases Immunity and Increases Susceptibility to Influenza Infection in Mice.” The Journal of Infec-tious Diseases 207: 501–510. https://doi. org/10.1093/infdis/jis527

Ubelaker, Douglas H., and Haley Khosrow-shahi. 2019. “Estimation of Age in Foren-sic Anthropology: Historical Perspective and Recent Methodological Advances.” Forensic Science Research 4: 1–9. https://doi/10.1080/20961790.2018.1549711

Van der Merwe, Nikolaas J. 1982. “Carbon Isotopes, Photosynthesis, and Archaeol-ogy: Different Pathways of Photosynthesis Cause Characteristic Changes in Carbon Isotope Ratios that Make Possible the Study of Prehistoric Human Diets.” Amer¬ican Scientist 70, no. 6: 596–606.

Verbruggen, L. A., M. Bruyland, and M. Shahabpour. 1993. “Osteomalacia in a Patient with Anorexia Nervosa.” The Journal of Rheumatology 20, no. 3: 512–517.

Vidal, Maritza, Ross J. Thibodaux, Luis Fernando Vidal Neira, and Osvaldo Daniel Messina. 2019. “Osteoporosis: A Clinical and Pharmacological Update.” Clinical Rheumatology 38: 385–395. https://doi. org/10.1007/s10067-018-4370-1

Waterlow, J. C. 1972. “Classification and Definition of Protein-Calorie Malnutri¬tion.” British Medical Journal 3: 566–569.

Waters-Rist, Andrea L., Vladamir I. Bazaliiskii, Andrzej W. Weber, and M. Anne Katzenberg. 2011. “Infant and Child Diet in Neolithic Hunter-Fisher-Gatherers from Cis-Baikal, Siberia: Intra-Long Bone Stable Nitrogen and Carbon Isotope Ratios. American Journal of Physical Anthropol-ogy 146: 225–241. 1002/ajpa.21568

Watkins, Susan C., and Jane Menken. 1985. “Famines in Historical Perspective.” Population and Development Review 11: 647–675.

Webb, Patrick, Gunhild A. Stordalen, Sudhvir Singh, Ramani Wijensinha-Bettoni, Prakash Shetty, and Anna Lartey. 2018. “Hunger and malnutrition in the 21st century.” The British Medical Journal 361: k2238.

Weisz, George M., and William R. Albury. 2013. “Osteoporosis in Survivors of Early Life Starvation.” Australian Journal of Primary Health 19: 3–6. https://doi. org/10.1071/PY12004

White, Christine D., T. Douglas Price, and Fred J. Longstaffe. 2007. “Residential Histories of the Human Sacrifices at the Moon Pyramid, Teotihuacan.” Ancient Mesoamerica 18: 159–172. https://doi. org/10.1017/S0956536107000119

Wood, James W., George R. Milner, Henry C. Harpending, and Kenneth M. Weiss. 1992. “The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samples.” Current Anthropology 33, no. 4: 343–370.

World Health Organization (WHO). 2018. “Malnutrition.” Retrieved from

Zuckerman, Molly K., Kristin N. Harper, and George J. Armelagos. 2016. “Adapt or Die: Three Case Studies in which the Failure to Adopt Advances from Other Fields Has Compromised Paleopathology.” Interna¬tional Journal of Osteoarchaeology 26, no. 3: 375–383. oa.2426

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2020 Rachel Simpson