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How/what little food they have! They suffer from malnutrition because they eat little food.

How/what few books she has! She knows so little because she reads few books.

I wonder whether to use how or what in these two sentences.

I guess both work: What little food they have! = How little food they have! Just like, What a beautiful girl she is! = How beautiful a girl she is!

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Little and few are quantifiers. Now

Quantifiers are adjectives and adjectival phrases that give approximate or specific answers to the questions "How much?" and "How many?" (Source)

Among the meanings of the adverb how, Cambridge mentions:

to what amount or degree

What is never used for quantities or amounts. In exclamations it is rather used to express emotions or opinions about qualities, as in

What a little house they have!

Note that what is used as a determiner before a Noun Phrase (Adj+Noun), and it requires the article a/an before the adjective:

We can use what in exclamations to express a strong feeling or opinion. In this case, we use what as a determiner before a noun or before a/an (+ adjective) + noun (Cambridge)

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    Careful. You need to use "what little" for quantities or amounts, as: (Correct:) "The people on the island ate what little food they had". (Incorrect:) "The people ate how little food they had." Aug 18, 2021 at 11:09
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    @whiskeychief Not in exclamations though... In your sentence "what" means "whatever", it does not enhance quantity.
    – fev
    Aug 18, 2021 at 11:12
  • @fev Hi, I still don't know which to choose in my two sentences where I deliberately distinguished "a little" and "little", "a few" and "few".
    – joy2020
    Aug 19, 2021 at 3:07

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