The efficacy of an innovative home-based, physician-initiated parent-child autotutorial nutrition education program (PCAT) and of standard nutrition counseling for hypercholesterolemic children were evaluated. Two-hundred-sixty-one 3.9-9.9 year old children with elevated LDL cholesterol(LDL-C) levels were randomly assigned to one of the nutrition interventions, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). The change in knowledge of heart healthy foods, dietary intake, and (for the At-Risk groups only) blood lipid levels were evaluated at 3, 6 and 12 months post-baseline. The PCAT group exhibited a significant initial increase in knowledge of heart healthy foods, which was fully retained. The PCAT and Counseling groups lowered their total fat and saturated fat intake throughout the year. The PCAT group's decrease in LDL-C level at 3 months reached borderline significance, when compared to the At-Risk Control group. This trial demonstrated that knowledge and dietary change can be affected and retained via an innovative home-based nutrition intervention for children, though some form of ongoing intervention may be necessary to produce lasting decreases in LDL-C level.