Background: The disparity in the prevalence of cardiovascular disease and type 2 diabetes between African Americans and whites has been well established, and ethnic differences in several risk factors for these diseases are evident in childhood. Objective: The current study explored whether dietary factors explain ethnic differences in serum lipids and insulin profiles in children, independent of body composition and social class background. Design: The sample included 95 African American and white children (mean age: 10.0 y). Macronutrient and food group intakes were derived from three 24-h recalls. Cardiovascular disease and type 2 diabetes risk were determined on the basis of total cholesterol, triacylglycerol, insulin sensitivity (S(i)), and acute insulin response (AIR). Data were analyzed by using t tests, analysis of covariance, and multiple regression. Results: African American children had lower triacylglycerol (P < 0.01), lower S(i) (P < 0.001), and higher AIR (P < 0.001) than whites. Intake of fruit and vegetables was significantly higher, and dairy intake lower, in African American than in white children after adjustment for social class and total energy intake. Several direct relations were observed between diet and insulin action: carbohydrate and fruit intakes were positively associated with S(i) (P = 0.02), and vegetable intake was negatively associated with AIR (P = 0.01). However, neither macronutrient nor food group intake accounted for the ethnic differences in triacylglycerol and AIR. Conclusions: The African American children in our sample showed a greater disease risk than did the white children, even after body composition, social class background, and dietary patterns were adjusted for.