Cardiovascular disease (CVD) risk factors can be identified in children and tracked over time. We studied 519 children (mean age, 3.9 years) and reevaluated CVD risk factors 4 years later. Baseline and follow-up (FU) measures included height, weight, body mass index (BMI), blood pressure level, blood lipid values, and 24-hour dietary intake. Nutritional predictors of CVD risk factors (lipid levels and BMI) were identified using regression analysis at follow-up. Energy intake at baseline and FU, as well as increasing BMI over time, were directly associated with total cholesterol levels. Dietary intake of monounsaturated fat and dietary fiber were significant predictors of total cholesterol level at follow-up (inverse associations). Increasing BMI, waist circumference at FU, and intake of sucrose at FU were inversely associated with high-density lipoprotein cholesterol levels at FU. Waist circumference and BMI at FU were associated with higher triglyceride levels, while percent energy from monounsaturated fat was associated with lower values. This study provides further evidence that dietary intake influences CVD risk factors in childhood.