The development of coronary atherosclerosis begins in childhood. A clear relation between diet and cardiovascular disease risk has been demonstrated. Findings from the Bogalusa Heart Study indicate that most children still exceed national recommendations for intake of total and saturated fat. In addition, children's mean total energy intake is greater than energy expenditure, contributing to the high prevalence of obesity beginning in childhood. Even in childhood, obesity often occurs with other risk factors for cardiovascular disease, such as increased blood pressure, adverse changes in serum lipoproteins, and hyperinsulinemia. This clustering of risk factors has been linked to acceleration of atherosclerotic lesions in the coronary arteries of young individuals. Decreasing the incidence of coronary artery disease in mid and late life necessitates healthy habits in nutrition and lifestyle in early life. Public health measures to favorably alter lifestyle can have a major impact on heart disease prevention and should be pursued vigorously.