Childhood

 A child typically refers to a human being in the stage of life between  infancy and adolescence, roughly from ages one to twelve years old. This  developmental period encompasses significant growth, maturation, and  learning across physical, cognitive, social, and emotional domains.  Children are characterized by their curiosity, imagination, energy, and  capacity for learning. They undergo rapid physical development,  including gains in height, weight, and motor skills, as well as  cognitive development marked by advancements in language,  problem-solving, memory, and attention. Socially, children form  relationships with family members, peers, and other adults, learning  social norms, cooperation, empathy, and emotional regulation. The child  stage is also a critical period for education and skill acquisition, as  children attend school and engage in formal learning activities to  acquire knowledge, develop academic skills, and explore their interests.  Overall, childhood is a time of immense growth, exploration, and  development, laying the foundation for future health, well-being, and  success. 

 Chronic Diseases: Conditions such as asthma, diabetes, epilepsy, cystic fibrosis, and sickle cell disease that require ongoing management and may impact daily functioning, quality of life, and long-term health outcomes.

• Developmental Disorders: Neurodevelopmental conditions such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), learning disabilities, and intellectual disabilities that affect cognitive, social, and adaptive functioning and may require specialized interventions and support.
• Mental Health Disorders: Conditions such as anxiety disorders, depression, disruptive behavior disorders, and mood disorders that affect children's emotional well-being, behavior, and social interactions, often requiring therapeutic interventions and support from mental health professionals.
• Infectious Diseases: Common childhood illnesses such as upper respiratory infections (colds), gastrointestinal infections (stomach flu), strep throat, ear infections, and viral exanthems (e.g., chickenpox, measles), which can cause symptoms such as fever, cough, diarrhea, rash, and general malaise.
• Accidental Injuries: Injuries resulting from falls, sports-related accidents, burns, drowning, poisoning, or other accidents, which are common among children due to their active lifestyles, curiosity, and lack of awareness of danger.

 Traditionally hyperinsulinemia, insulin resistance, and metabolic syndrome are not  typically implicated in the major disorders of children such as chronic  diseases, developmental disorders, mental health disorders, infectious  diseases, or accidental injuries.   These metabolic abnormalities are more  commonly associated with conditions that develop later in life,  particularly in adulthood, and are influenced by factors such as  genetics, lifestyle, and environmental exposures. However, this situation is changing with more and more  youngsters exhibiting the same modern chronic conditions as their parents .  Promoting  healthy metabolic habits from an early age is essential for reducing the  risk of metabolic disorders in adulthood. This includes an appropriate  diet, regular physical activity, adequate sleep, and limiting  exposure to environmental toxins. Additionally, addressing chronic  diseases, developmental disorders, mental health concerns, and promoting  injury prevention strategies are crucial for supporting the overall  health and well-being of children. Regular pediatric check-ups and  monitoring growth, development, and overall well-being are essential for  identifying and addressing any potential health concerns in children. 

Pediatric cancer refers to cancers that occur in children and adolescents. While cancer is relatively rare in children compared to adults, it remains a significant cause of illness and death in this age group. Pediatric cancers differ from adult cancers in various ways, including the types of cancers that are most common, their causes, and how they respond to treatment.

Some common types of pediatric cancer include:

1. Leukemia: Leukemia is the most common type of cancer in children, accounting for about one-third of all childhood cancer cases. It affects the blood and bone marrow, where abnormal white blood cells multiply rapidly, interfering with the production of normal blood cells.
2. Brain and central nervous system (CNS) tumors: Brain tumors are the second most common type of pediatric cancer. They can arise from various parts of the brain and spinal cord and can be benign or malignant.
3. Neuroblastoma: Neuroblastoma is a cancer that develops from immature nerve cells, most commonly occurring in the adrenal glands (located on top of the kidneys). It primarily affects infants and young children.
4. Wilms tumor: Wilms tumor is a type of kidney cancer that primarily affects young children, usually between the ages of 2 and 5 years old.
5. Lymphoma: Lymphoma is a cancer of the lymphatic system, which includes the lymph nodes, spleen, thymus, and bone marrow. The two main types of lymphoma in children are Hodgkin lymphoma and non-Hodgkin lymphoma.
6. Rhabdomyosarcoma: Rhabdomyosarcoma is a type of soft tissue sarcoma that arises from muscle cells. It can occur in various parts of the body, including the head and neck, urinary tract, and extremities.

The exact causes of pediatric cancer are not always known, but they can involve a combination of genetic factors, environmental exposures, and other risk factors. Treatment for pediatric cancer typically involves a combination of therapies, including surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. The prognosis for pediatric cancer varies depending on factors such as the type and stage of cancer, the age of the child, and the response to treatment. Advances in research and treatment have led to significant improvements in survival rates for many types of pediatric cancer in recent decades.

The relationship between hyperinsulinemia, insulin resistance, metabolic syndrome, and cancer, especially in pediatric cases, is an area of ongoing research. While much of the understanding comes from studies in adults, similar mechanisms are believed to operate in pediatric populations. Here's how these metabolic abnormalities may be involved in pediatric cancer:

1. Hyperinsulinemia: Elevated insulin levels, known as hyperinsulinemia, can promote cell growth and proliferation. In pediatric cancer, hyperinsulinemia may contribute to tumor development and progression by providing a growth-promoting environment. Insulin can stimulate the insulin-like growth factor 1 (IGF-1) pathway, which plays a crucial role in cell growth and survival. Elevated levels of IGF-1 can promote the growth of cancer cells. Additionally, hyperinsulinemia can contribute to an inflammatory state, which can further support tumor growth.
2. Insulin Resistance: Insulin resistance occurs when cells in the body become less responsive to insulin, requiring higher levels of insulin to maintain normal blood sugar levels. Insulin resistance is closely linked to obesity and metabolic syndrome. In pediatric cancer, insulin resistance may create an environment conducive to tumor growth. Insulin resistance is associated with dysregulation of various metabolic pathways, including increased inflammation and altered lipid metabolism, which can promote cancer progression. Additionally, insulin resistance can lead to compensatory hyperinsulinemia, further exacerbating the growth-promoting effects of insulin.
3. Metabolic Syndrome: Metabolic syndrome is characterized by a cluster of conditions, including central obesity, insulin resistance, high blood pressure, and dyslipidemia. Metabolic syndrome is associated with an increased risk of various cancers, including pediatric cancers. The underlying mechanisms linking metabolic syndrome to cancer risk likely involve chronic inflammation, oxidative stress, hormonal dysregulation, and altered metabolism of glucose and lipids, all of which can promote tumor growth and progression. In pediatric populations, metabolic syndrome may contribute to an increased risk of developing certain types of cancer and may also influence treatment outcomes.

Overall, while more research is needed to fully understand the role of hyperinsulinemia, insulin resistance, and metabolic syndrome in pediatric cancer, it is clear that these metabolic abnormalities can create an environment that promotes tumor growth and progression. Managing these metabolic abnormalities through lifestyle modifications, such as maintaining a healthy weight, exercising regularly, and adopting a balanced diet, may help reduce the risk of pediatric cancer and improve treatment outcomes.

1. Almutairi, H. et al. (2023) ‘Safety, feasibility, and effectiveness of ketogenic diet in  paediatric patients with brain tumours: A systematic revie’. Available  at: https://doi.org/10.22541/au.168743885.54780069/v1.
2. Nebeling  LC, Lerner E. Implementing A Ketogenic Diet Based on Medium-chain  Triglyceride Oil in Pediatric Patients with Cancer. Journal of the  American Dietetic Association. 1995;95(6):693-697. doi:10.1016/S0002-8223(95)00189-1 ABSTRACT
3. Perez  A, Louw E van der, Nathan J, et al. Ketogenic diet treatment in diffuse  intrinsic pontine glioma in children: Retrospective analysis of  feasibility, safety, and survival data. Cancer Reports. n/a(n/a):e1383. doi:https://doi.org/10.1002/cnr2.1383 PDF
4. Nebeling  LC, Miraldi F, Shurin SB, Lerner E. Effects of a ketogenic diet on  tumor metabolism and nutritional status in pediatric oncology patients:  two case reports. Journal of the American College of Nutrition.  1995;14(2):202-208. doi:10.1080/07315724.1995.10718495 ABSTRACT
5. Diorio  C, Kelly KM, Afungchwi GM, Ladas EJ, Marjerrison S. Nutritional  traditional and complementary medicine strategies in pediatric cancer: A  narrative review. Pediatr Blood Cancer. 2020;67 Suppl 3:e28324. doi:10.1002/pbc.28324

 "The increase in serum uric acid showed a positive statistical  correlation with insulin resistance and it is associated with and  increased risk of insulin resistance in obese children and adolescents. "

   " Insulin resistance is highly prevalent in obese children and  adolescents. The onset of Impaired Glucose Tolerance  is associated with the development of  severe hyperinsulinemia as there are no predictive cutpoint values of  insulin resistance or insulin sensitivity indexes for IGT, and neither  fasting blood glucose nor insulin levels nor HOMA-IR or HOMA %B are  effective screening tools; an OGTT is required in all subjects at high  risk. Longitudinal studies are needed to identify the metabolic  precursors and the natural history of the development of type 2 diabetes  in these patients. "

"High levels of serum uric acid, UAR, UCR, and UHR were associated with obesity. Furthermore, we found that uric acid, UAR, and UHR were positively correlated with insulin resistance".

Introduction: Childhood overweight and obesity are major public health challenges, with Malta having one of the highest prevalences among European countries. The COVID-19 pandemic may further worsen this epidemic. The food and physical activity environments impact children's behaviours. This study looks at barriers to maintain a healthy weight, responsibility to address obesity, and assesses parental support for 22 policies aimed at addressing childhood obesity. Public support for policy is key because it influences which policies are adopted and their success. 

Methods: A cross-sectional, paper-based, quantitative survey was conducted amongst parents of primary school-aged children in Malta in 2018-2019. Ethical approval was obtained. Statistical analysis was performed using SPSS. 

Results: 1,169 parents participated. The food environment was more commonly identified as a barrier to maintain a healthy weight than the physical activity environment. Parents were least supportive of taxation policies, and most in favour of increasing spaces available for safe physical activity (94.0%), followed by providing free weight management services for children (90.8%). The level of support varied significantly by various socio-demographic/economic characteristics; parents with a higher educational level were significantly more supportive of most policies. Most findings were consistent with the international literature. 

Conclusions: Most policies supported are trans-sectoral; a health-in-all policies approach is needed to address the obesogenic environment. The strong public support identified for several policies should embolden policymakers to consider policy options that were not previously considered. 

 Asthma is the most frequent chronic disease in childhood. Chest  tightness, cough, wheezing and dyspnoea during or after exercise may be  unique manifestations of asthma in up to 90% of subjects. Physical  activity may be reduced by uncontrolled asthma symptoms and parental  beliefs, impairing physical fitness of asthmatic children. Clinicians  working in the field of allergy are aware of evidence supporting the  benefits of physical activity for patients with asthma. Treatment of  asthma is required in order to obtain its control and to avoid any  limitation in sports and active play participation. As exercise  performance in children with controlled asthma is not different from  that of healthy controls, any exercise limitation cannot be accepted.  Overweight and obesity may interfere with asthma and exercise, leading  to dyspnoea symptoms. Evidences on the effect of insulin resistance on  airway smooth muscle and on bronchial hyperactivity are presented.  CONCLUSION: Exercise is part of the strategy to obtain the best control  of asthma in childhood, but we have to optimise the asthma control  therapy before starting exercise programming. Furthermore, it is crucial  to give best attention on the effects of obesity and insulin  resistance, because they could in turn influence patients' symptoms.     

   Dietary habits in developing countries are characterized in the last decades by low intake of fruits, vegetables, and high consumption of sweetened drinks. Most of the evidence linking carbohydrate intake and asthma comes from children over 6 years of age. The aim of this study was to examine the association of macronutrient intake with the severity of wheezing exacerbation in children aged 2 to 6 years Methods. We performed a prospective cohort study that included all children aged 2 to 6 years hospitalized by a wheezing exacerbation in two tertiary centers in Rionegro, Colombia. Dietary data were collected using a food frequency questionnaire (FFQ) validated in the Colombian population. Gina classification of acute wheezing in children 5 years and younger was to define the severity of the wheezing Results During the study period, 228 cases of patients with wheezing exacerbation were included. Wheezing severity was dose-dependently associated with protein and carbohydrate-rich intake. The variables included in the multivariable analysis included reactive C protein, smoking at home, atopic dermatitis, protein, and carbohydrate-rich food intake Conclusion High carbohydrate-rich food intake was associated with severity of wheezing exacerbation adjusted by other known risk factors such as atopic, smoking, and reactive C protein. Also, we found a negative association of severity of wheezing exacerbation with high protein-rich food intake adjusted by the factors mentioned above. This evidence should motivate the development of public health policies to control the consumption of sugar-rich products in children under 6 years of age.