To the Editor. —
In their article describing tracking of cholesterol levels in school-age children, Lauer and Clarke1 provided no data describing the dietary intake of their subjects and how changes in dietary intake during the study period may have influenced total blood cholesterol levels over time.The link between diet and coronary artery disease received increasing attention by the mass media during the study period (1971 through 1986), and recommendations to reduce consumption of total fat, saturated fat, and cholesterol were widely disseminated. Indeed, a recent analysis2 of 171 studies completed in the United States showed a steady decline in total and saturated fat consumption from the middle 1960s to 1984, while polyunsaturated fatty acid intake increased. The subjects followed up in the Lauer and Clarke study were told their blood cholesterol values. That knowledge may have given those with high values an incentive to make dietary
Shannon B, Tershakovec AM, Cortner JA. Cholesterol Screening of Children. JAMA. 1991;265(24):3247–3248. doi:10.1001/jama.1991.03460240042020
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