Infants

 Infants, typically defined as children from birth to one year old,  represent a critical stage of human development characterized by rapid  growth, maturation, and adaptation to extrauterine life. During this  period, infants undergo significant physical, cognitive, and  socio-emotional development, transitioning from dependence on the  mother's body for sustenance and protection to independent functioning.  Infants experience rapid gains in weight, length, and head circumference  as they grow and develop muscles, bones, organs, and sensory systems.  They acquire fundamental skills such as sucking, swallowing, grasping,  rolling, sitting, and eventually crawling and walking, reflecting the  maturation of neurological pathways and motor control. Infants also  engage in early social interactions, vocalizations, and emotional  expressions, laying the foundation for future social and cognitive  development. Nutrition, sleep, physical activity, sensory stimulation,  and responsive caregiving are essential factors influencing infant  health, growth, and development during this critical period. 

• Neonatal Jaundice: A common condition characterized by yellowing of the skin and eyes due to elevated levels of bilirubin, often resolving without intervention but requiring monitoring to prevent complications such as kernicterus.
• Respiratory Distress Syndrome (RDS): A breathing disorder in premature infants characterized by insufficient surfactant production, leading to difficulty breathing, oxygen deficiency, and potential respiratory failure.
• Sudden Infant Death Syndrome (SIDS): The sudden and unexplained death of an apparently healthy infant, typically occurring during sleep, with risk factors including prone sleeping position, maternal smoking, and soft bedding.
• Failure to Thrive (FTT): Inadequate weight gain or growth in infants due to various factors such as insufficient nutrition, feeding difficulties, gastrointestinal disorders, or underlying medical conditions.
• Gastroesophageal Reflux Disease (GERD): A digestive disorder characterized by frequent regurgitation or vomiting, irritability, feeding difficulties, and poor weight gain due to stomach acid reflux into the esophagus.
• Developmental Dysplasia of the Hip (DDH): Abnormal development or instability of the hip joint, which may lead to hip dislocation or dysplasia if not detected and treated early.
• Congenital Heart Defects: Structural abnormalities of the heart present at birth, ranging from minor defects to severe conditions requiring surgical intervention, affecting oxygenation, circulation, and overall health..

Hyperinsulinemia, insulin resistance, and metabolic syndrome are less commonly implicated in disorders of infants up to one year old due to their developmental stage and limited exposure to metabolic risk factors. However, in rare cases where infants may be affected by metabolic abnormalities, these conditions could potentially contribute to certain disorders through indirect mechanisms:

• Neonatal Jaundice: Hyperinsulinemia or metabolic disturbances in the infant may affect bilirubin metabolism and clearance, potentially exacerbating neonatal jaundice.
• Respiratory Distress Syndrome (RDS): Maternal diabetes or gestational diabetes mellitus (GDM) may increase the risk of RDS in infants due to altered surfactant production and lung development.
• Failure to Thrive (FTT): Metabolic abnormalities in infants, such as congenital metabolic disorders or malabsorption syndromes, may contribute to failure to thrive through impaired nutrient absorption or utilization.
• Congenital Heart Defects: Maternal diabetes or obesity, both associated with metabolic syndrome, may increase the risk of congenital heart defects in infants through mechanisms such as altered cardiac development or vascular dysfunction.

Overall, while direct implications of hyperinsulinemia, insulin resistance, and metabolic syndrome on infant disorders are rare, addressing maternal metabolic health before and during pregnancy is crucial for reducing the risk of certain neonatal conditions and optimizing infant health and development.

• While obesity in infants is less common compared to adults, it is still a growing concern globally, particularly in regions with high rates of maternal obesity and unhealthy infant feeding practices.
• According to the World Health Organization (WHO), childhood obesity rates have been rising steadily in recent years, including in infants and young children.
• In 2016, an estimated 41 million children under the age of five were overweight or obese worldwide, with the prevalence of obesity increasing in both developed and developing countries.
• In Europe, obesity among infants is also a growing issue, reflecting the broader trend of increasing childhood obesity rates in the region.
• Data from the WHO European Childhood Obesity Surveillance Initiative (COSI) indicates that obesity rates among infants and young children vary across European countries but have been generally increasing over the years.
• Factors contributing to obesity in infants in Europe include maternal obesity, inappropriate infant feeding practices, high intake of sugary and processed foods, and sedentary lifestyles.
• Specific data on the prevalence of obesity among infants in Malta may not be readily available.
• However, given the overall rising trend of obesity in Malta and Europe, it's likely that obesity rates among infants in Malta are also increasing.
• Early childhood obesity in Malta is a concern as it can lead to long-term health problems, including obesity-related chronic diseases later in life.

Now, let's discuss the impact of obesity in infants:

d.

The impact of obesity in infants can have significant short-term and long-term health consequences, including:

1. Increased Risk of Chronic Diseases:
   
   • Obesity in infants is associated with an increased risk of developing chronic diseases later in life, such as type 2 diabetes, cardiovascular diseases, and metabolic disorders.
   • Early exposure to excess weight and adiposity can predispose infants to metabolic disturbances, insulin resistance, and dyslipidemia, which may persist into adulthood.

1. Early Onset of Obesity-related Conditions:
   
   • Infants with obesity are at risk of experiencing early onset of obesity-related conditions, including insulin resistance, hypertension, and dyslipidemia, which can have implications for their long-term health and well-being.
   • These conditions may contribute to the development of cardiovascular disease risk factors at a young age, potentially leading to premature morbidity and mortality.

1. Growth and Developmental Delays:
   
   • Obesity in infants may lead to growth and developmental delays, including delays in motor skill development, cognitive function, and overall physical growth.
   • Excess weight and adiposity can strain the infant's musculoskeletal system, impacting mobility, coordination, and overall physical development.

1. Respiratory Problems:
   
   • Infants with obesity are at increased risk of respiratory problems, including asthma and sleep apnea, which can impair breathing and disrupt sleep patterns.
   • Respiratory problems can affect the infant's overall health and quality of life, potentially leading to complications such as recurrent respiratory infections and compromised respiratory function.

1. Psychological and Social Consequences:
   
   • Obesity in infants may have psychological and social consequences, including poor self-esteem, social stigma, and negative body image.
   • Social stigma related to obesity can lead to feelings of isolation, discrimination, and reduced quality of life for the infant and their family.

Overall, addressing obesity in infants is essential to mitigate the risk of chronic diseases, promote healthy growth and development, and improve long-term health outcomes. Early intervention through promoting healthy infant feeding practices, encouraging physical activity, and creating supportive environments for healthy behaviors is crucial for preventing and managing obesity in infants.

 Prevalence of Obesity in Infants: Obesity in infants is a growing concern worldwide, reflecting the  broader trend of increasing childhood obesity rates. While obesity rates  in infants may be lower compared to older age groups, recent studies  suggest a rising prevalence of obesity among infants. Factors  contributing to this trend include changes in maternal diet and  lifestyle, early introduction of high-calorie foods, and decreased  physical activity. Specific prevalence data for infant obesity may vary  by region and country, but the overall trend highlights the importance  of early intervention and preventive measures to address obesity in  infancy. 

 Obesity in infants can have significant health implications, affecting  both short-term and long-term outcomes. Infants with obesity are at  increased risk of developing metabolic disorders, such as insulin  resistance and dyslipidemia, early in life. Additionally, obesity in  infancy may lead to developmental delays, including delays in motor  skill development and cognitive function. Long-term consequences of  infant obesity include an increased risk of childhood obesity and  associated health problems later in life. Addressing obesity in infancy  through promoting healthy feeding practices, encouraging physical  activity, and creating supportive environments is crucial for mitigating  these health risks and promoting optimal growth and development. 

Type 2 diabetes in infants, also known as early-onset or neonatal  diabetes, is relatively rare but has been reported in some cases. While  specific prevalence data for type 2 diabetes in infants may be limited,  the overall prevalence of diabetes in children under the age of one is  low compared to older age groups. However, with the rising prevalence of  obesity and gestational diabetes in mothers, the risk of type 2  diabetes in infants may increase. Early detection and management of  diabetes in infants are essential for preventing complications and  optimizing long-term health outcomes. 

 Type 2 diabetes in infants can have serious health consequences,  including metabolic disturbances, growth delays, and neurological  complications. Infants with diabetes may require intensive medical  management, including insulin therapy and dietary modifications, to  maintain blood glucose levels within a healthy range. Uncontrolled  diabetes in infancy can lead to short-term complications such as  hypoglycemia, hyperglycemia, and diabetic ketoacidosis, which require  prompt medical attention. Long-term implications of early-onset diabetes  may include an increased risk of obesity, cardiovascular disease, and  other chronic health conditions later in life. Early diagnosis,  comprehensive care, and ongoing monitoring are essential for managing  type 2 diabetes in infants and promoting optimal health outcomes  throughout childhood and beyond. 

Breast milk is the best and principal nutritional source for neonates and infants. It may protect infants against many metabolic diseases, predominantly obesity and type 2 diabetes. Diabetes mellitus (DM) is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood. Breastfeeding protects against infant mortality and diseases, such as necrotizing enterocolitis, diarrhoea, respiratory infections, viral and bacterial infection, eczema, allergic rhinitis, asthma, food allergies, malocclusion, dental caries, Crohn's disease, and ulcerative colitis. It also protects against obesity and insulin resistance and increases intelligence and mental development. Gestational diabetes has short and long-term impacts on infants of diabetic mothers (IDM). Breast milk composition changes in mothers with gestational diabetes.

 Most of the literature agreed on the beneficial effects of breast milk  for both the mother and the infant in the short and long terms.  Breastfeeding protects mothers with gestational diabetes against obesity  and type 2 DM. Despite some evidence of the protective effects of  breastfeeding on IDM in the short and long term, the evidence is not  strong enough due to the presence of many confounding factors and a lack  of sufficient studies.      

Objectives: To compare the lipid profiles of exclusively breastfed and mixed-fed term healthy infants in the first 6 months of life. 

Design: Prospective comparative study. 

Setting: Study was carried out in a tertiary care hospital. 

Subjects: Four hundred consecutive term healthy infants, 200 on exclusive breastfeeding (group 1) and 200 receiving mixed feeding (group 2) were recruited at 14 weeks of age. At 6 months, 149 and 150 mother-infant pairs were followed up in groups 1 and 2, respectively. 

Methods: Anthropometric measures of the mother and baby were recorded. Serum lipid levels of the mother and babies were determined at 14 weeks. Babies were followed up till 6 months and their lipid levels were determined again at 6 months. Statistical analysis was carried out using SPSS. 

Results: Two groups were comparable in birth weight and maternal characteristics (P>0.05). Weight and head circumference were significantly more in the breastfed group at 14 weeks as well as at 6 months (P<0.001). Mean total cholesterol (TC) was 205.27+/-47.31 and 176.55+/-32.01 mg/dl in groups 1 and 2, respectively at 14 weeks (CI=20.77-36.66, P<0.001). At 6 months TC was 192.79+/-40.52 and 161.05+/-22.53 mg/dl in the two groups (CI=24.26-39.22, P<0.001). Change in total cholesterol from 14 weeks to 6 months was also significant in both groups (P<0.001). Low-density lipoprotein cholesterol (LDL-C) and triglycerides were significantly higher in the breastfed groups at 14 weeks and 6 months. The high-density lipoprotein cholesterol (HDL-C)/LDL-C significantly improved at 6 months in exclusively breastfed group (P=0.045). A positive correlation was found only at 14 weeks between mother's TC and baby's TC (r=0.332), mother's LDL-C with baby's LDL-C (r=0.223) in mixed fed group. 

Conclusion: Breastfed babies have significantly higher TC and LDL-C compared to mixed fed babies in the first 6 months of life with improving HDL-C/LDL-C ratio at 6 months.  

 "We included 17 studies with 18 estimates of the relationship between breastfeeding and performance in intelligence tests. .."Breastfeeding is related to improved performance in intelligence tests. A positive effect of breastfeeding on cognition was also observed in a randomised trial. 

This suggests that the association is causal .    

 " The most commonly  used infant formulas contain purified cow's milk whey and casein as a  protein source, a blend of vegetable oils as a fat source, lactose as a  carbohydrate source, a vitamin-mineral mix, and other ingredients  depending on the manufacturer. 

 Vegetable  oils used as a source of fat in infant formula include palm  oil, palm  kernel oil, rapeseed oil, coconut oil, sunflower oil or other   individual oils or blended mixes. Whilst most infant milks use a blend   of vegetable oils, the specific oils used may vary as worldwide 

    "However, levels of linoleic acid (LA) were  negatively associated with  motor and cognitive scores, independently of  breastfeeding duration.  Children breastfed with the highest levels of  LA tended to score closer  to the never breastfed children than children  breastfed with the lowest  levels of LA.     

Conclusion: Our findings suggest that too high levels of LA in colostrum are associated with poorer child development at 2 and 3 yr.     

 LA  levels in colostrum are strongly connected to maternal intake. Where do  these mothers get linoleic acid in the diet?   Vegetable ( seed)  oils  are certainly the highest source.  Oils like canola (21% LA), soybean  (55% LA), corn (56% LA), peanut (30% LA), sunflower (70% LA), safflower  (78% LA),  

 "Colostrum linoleic acid (LA) levels were  negatively associated with  Verbal IQ (-0.6 [-1.1, 0.0] points per 1%  level increase). Children  exposed to colostrum high in LA and low in  docosahexaenoic acid (DHA)  had lower IQs than those exposed to  colostrum high in DHA (3.0 [0.5,  5.5] points) and those exposed to  colostrum low in LA and DHA (4.4 [1.6,  7.3] points). Finally, the  association between breastfeeding duration  and child IQ was stronger  when LA levels were high.      

 LA  levels in colostrum are strongly connected to maternal intake. Where do  these mothers get linoleic acid in the diet?   Seed oils are certainly  the highest source.  Oils like canola (21% LA), soybean (55% LA), corn  (56% LA), peanut (30% LA), sunflower (70% LA), safflower (78% LA). 

 DHA-rich food sources include human milk, ( though less when mum eats above oils)  cold water fatty fishes such as salmon, tuna, sardines and mackerel. Other sources include seafood like oysters and shrimps 

Congenital hyperinsulinism (CHI) is a rare genetic disorder characterized by dysregulated insulin secretion from the pancreas, leading to persistent hypoglycemia (low blood sugar levels) in newborns and infants.

In individuals with congenital hyperinsulinism, the beta cells of the pancreas produce and release too much insulin, causing blood sugar levels to drop excessively. This can lead to various symptoms such as seizures, developmental delays, and in severe cases, brain damage or even death if not promptly diagnosed and treated.

There are two main types of congenital hyperinsulinism:

1. Focal CHI: This form of the disorder involves abnormal development of a small area (focal lesion) within the pancreas where excessive insulin is produced. Surgical removal of the affected portion of the pancreas is often curative.
2. Diffuse CHI: In this form, abnormal insulin secretion occurs throughout the entire pancreas. It is usually managed with medications to suppress insulin secretion, dietary adjustments, and in some cases, may require partial or total removal of the pancreas.

Congenital hyperinsulinism is typically diagnosed through blood tests measuring glucose and insulin levels during episodes of hypoglycemia. Treatment involves maintaining adequate blood sugar levels while minimizing insulin secretion. This may include frequent feedings, continuous glucose infusions, medications, and in severe cases, surgical intervention.

Due to its rarity and potential severity, congenital hyperinsulinism often requires specialized care from healthcare providers experienced in its diagnosis and management. Early diagnosis and appropriate treatment are crucial for minimizing the risk of complications and ensuring the best possible outcomes for affected individuals

" Ketogenic diet: CHI typically deprives the brain of  both its main and alternative energy sources, being glucose and ketone  bodies respectively. During the suckling period, ketone bodies  constitute the main energy substrate for the brain. However, in the  adult brain glucose is the main energy source (166). An increase in the ketone body concentration increases their oxidation rate in the brain (167,168).  Thus, ketogenic diets have been used as an adjunctive therapeutic  option in refractory epilepsy and in experimental models of ischemia and  excitotoxicity (169).  HH induces severe neuroglycopenia and also inhibits gluconeogenesis,  glycogenolysis, lipolysis and, eventually, fatty acid oxidation which  results in suppressed ketone body synthesis. This makes the brain more  vulnerable to the neurological insult of hypoglycaemia. Maiorana et al (170)  reported a trial ketogenic diet administered to a child with CHI due to  a spontaneous GCK activating mutation and recurring hypoglycaemic  episodes, despite medical therapy. After the first six months, the  patient was free of epileptic seizures, with normalization of EEG and  showed a marked recovery in psychological development and QoL (170).  Although this treatment requires further investigation these initial  findings suggest that a ketogenic diet could have a neuroprotective  effect in selected cases of CHI. "

Congenital hyperinsulinism (CHI) is a rare genetic disorder characterized by dysregulated insulin secretion from the pancreas, leading to persistent hypoglycemia (low blood sugar levels) in newborns and infants.

In individuals with congenital hyperinsulinism, the beta cells of the pancreas produce and release too much insulin, causing blood sugar levels to drop excessively. This can lead to various symptoms such as seizures, developmental delays, and in severe cases, brain damage or even death if not promptly diagnosed and treated.

There are two main types of congenital hyperinsulinism:

1. Focal CHI: This form of the disorder involves abnormal development of a small area (focal lesion) within the pancreas where excessive insulin is produced. Surgical removal of the affected portion of the pancreas is often curative.
2. Diffuse CHI: In this form, abnormal insulin secretion occurs throughout the entire pancreas. It is usually managed with medications to suppress insulin secretion, dietary adjustments, and in some cases, may require partial or total removal of the pancreas.

Congenital hyperinsulinism is typically diagnosed through blood tests measuring glucose and insulin levels during episodes of hypoglycemia. Treatment involves maintaining adequate blood sugar levels while minimizing insulin secretion. This may include frequent feedings, continuous glucose infusions, medications, and in severe cases, surgical intervention.

Due to its rarity and potential severity, congenital hyperinsulinism often requires specialized care from healthcare providers experienced in its diagnosis and management. Early diagnosis and appropriate treatment are crucial for minimizing the risk of complications and ensuring the best possible outcomes for affected individuals