Breakfast is important

November 2012  Volume 161  Number 5

Breakfast is important — Stephen R. Daniels, MD, PhD

ADHD in former preterms — Alan H. Jobe, MD, PhD

Lipids and lipoproteins in adolescents with prediabetes — Stephen R. Daniels, MD, PhD

Copyright ª 2012 by Mosby Inc.

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here has been longstanding concern that skipping meals may be a potential contributor to the development of obesity. This is particularly true for children and adolescents who skip breakfast. In the clinical setting, it is common to hear patients with obesity report that they never eat breakfast. This seems to be associated with greater hunger and greater caloric consumption later in the day. In this issue of The Journal, Freitas J unior et al report on glucose and lipid levels in obese children and adolescents in Brazil. The authors found that skipping breakfast was associated with higher fasting blood glucose, triglycerides, and low density lipoprotein cholesterol compared with those who did not skip breakfast. These findings suggest that skipping breakfast may have metabolic implications beyond increased hunger. Counseling about lifestyle interventions should include emphasis on the importance of not skipping meals and the fact that skipping meals is not a good behavioral strategy to reduce calorie intake. Article page 871<

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umerous reports identify preterm infants as a high-risk group for attention and learning problems with attention deficit/hyperactivity disorder (ADHD)-type symptoms. Attention requires multiple integrated brain activities that include information processing, orienting, alerting, executive attention, and working memory. In this issue of The Journal, de Kieviet et al report the parsing of these neurologic functions in a cohort of 7.5-year-old preterm former infants in comparison with normal term infants to identify abnormalities that contribute to attention deficits. The former preterm infants had decreased visuospatial working memory and increased lapses of attention, compared with the term control group. These abnormalities correlated highly with parent and teacher assessments of inattention and were the elements that contributed to the attention problems. Perhaps specific training in these domains could blunt the adverse effects of inattention on children born preterm. Article page 824<

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here is concern in both adults and adolescents about diabetes as a cardiovascular disease risk equivalent. This means that the risk for cardiovascular disease in a patient with diabetes is similar to that in patients with already extant cardiovascular disease. There also is concern that clustering of traditional cardiovascular disease risk factors leads to accelerated atherosclerosis. In this issue of The Journal, Magge et al report on the lipoprotein profile of obese adolescents with prediabetes. The authors found that those with prediabetes (impaired fasting glucose) had higher concentrations of small low-density lipoprotein (LDL) particles and smaller LDL particle size, as well as higher concentration of small high-density lipoprotein (HDL) particles and smaller HDL particle size compared with youth with a normal concentration of glucose normoglycerinic youth. These results demonstrate that obese adolescents with prediabetes already have a more atherogenic lipoprotein profile. This emphasizes the need for early intervention to prevent obesity and for those who are obese to prevent the development of prediabetes. Article page 881<

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