The primary goal for pediatric dietary guidelines is to provide nutrients to support optimal growth and development at different ages from infancy through the end of adolescence. Over the past 15 years increasing attention has been directed toward developing nutrition recommendations that may lower the risk of chronic illness later in life. Recent evidence supports earlier studies that demonstrate that atherogenesis begins in childhood, is an evolving process and is influenced by environmental factors. As a result, in part, because of nutritional recommendations to lower the fat content of the diet, total fat and saturated fat as a percentage of total energy intake have declined in the diet of children and adolescents over the past 20 years. At the same time there has been no increase in the prevalence of growth failure; children, in fact, are heavier than their counterparts of 15 years ago. With a decrease in dietary fat, the mean serum cholesterol of the population as a whole has decreased steadily over the past 20 years. Children can safely eat a lower fat diet in which fat contributes 30% of total energy and saturated fat < 10% of total energy.