A UN agency says North Koreans are experiencing their worst food shortages since the famine of the late 1990s.
According to the World Food Programme, as many as six million people are in urgent need of food aid.
Most households have cut their food intake and more people are scavenging for wild foods such as grasses and berries.
North Korea has relied on foreign food aid for years, but recent flooding and poor harvests have made things worse.
Rising fuel prices and a drop in aid from South Korea have also contributed to the shortages.
WFP's top official in North Korea, Jean-Pierre de Margerie, said in Beijing that an assessment by the agency last month found millions of North Koreans were "slipping toward precarious hunger levels".
The last time the situation was so bad was in the late 1990s when an estimated one million people starved to death after natural disasters and government mismanagement devastated the economy.
The WFP assessment found that almost three-quarters of families had reduced their food intake and an increasing number of malnourished children were being admitted to hospital.
The UN agency says $US20 million is needed to help people get by until the autumn harvest.
Foreign Affairs Minister Winston Peters announced this week that New Zealand will give $NZ500,000 to help North Korea deal with food shortages.
Mr Peters said food prices have tripled in the past year after a significant proportion of the country's crops were destroyed in floods in August.
The aid will go to the World Food Programme, and follows $500,000 given via the International Red Cross after the floods.