Dietary modification can lower lipid levels in children, but will such modification, or therapeutic intervention, lower the probability of developing future coronary heart disease? The answer is still not in, as Dr Glueck well knows. "...diet-heart trials have not unequivocally proved or disproved the underlying hypothesis that cholesterol-lowering leads to reduced incidence of atherosclerotic disease." Moreover, "there is no evidence, either observational or experimental, that conclusively demonstrates a causative relationship between dietary fat per se and human and atherosclerotic disease."1

Faced with an unproved hypothesis pediatricians have four choices: (1) make no recommendation regarding diet changes; (2) Advocate a prudent diet to all families; (3) Screen for hypercholesterolemia and recommend diet changes and other measures to those with high levels; (4) Intervene, either by screening or by diet modification without screening, in only those children with a strong family history of coronary heart disease.

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