The report by Lifshitz and Moses1 in this issue of AJDC demonstrates the potential problems accompanying well-intentioned pediatric advice without adequate follow-up. The particular data also deal with an important medical problem of our time for which we do not yet have rigorous or near-rigorous scientific data to guide our actions.
The problem may be stated as pertaining to what measures should be taken in childhood to prevent coronary artery disease in adult life. The evidence of a close association of increased cholesterol levels (specifically, low-density lipoprotein [LDL] levels) with increased risk and incidence of coronary artery disease in adult life is strong. The evidence that fatty streaks in the aorta are sometimes found at the end of childhood is indisputable. That fatty streaks may progress to fibrous plaque, which in turn may progress to atheromatous lesions, is generally accepted. It is also known that fatty streaks and fibrous lesions
FINBERG L. Dietary Advice: Responsibility for Monitoring. Am J Dis Child. 1989;143(5):531. doi:10.1001/archpedi.1989.02150170029012
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