The underlying pathophysiology of the metabolic syndrome is the subject of debate, with both insulin resistance and obesity considered as important factors. We evaluated the differential effects of insulin resistance and central body fat distribution in determining the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. In addition, we determined which NCEP criteria were associated with insulin resistance and central adiposity. The subjects, 218 healthy men (n ‫؍‬ 89) and women (n ‫؍‬ 129) with a broad range of age (

This study provides evidence for sex differences in the progression to cognitive impairment in PD, while specific cognitive features become more important indicators of progression with impending conversion to PDD.

Objective-This study was undertaken to determine if insulin resistance without and with obesity influences LDL response to dietary cholesterol and saturated fat. Methods and Results-We fed 0, 2, and 4 egg yolks per day to 197 healthy subjects in a 4-week, double-blind, randomized, crossover design. Subjects were dichotomized on body mass index (Ͻ27.5 and Ն27.5 kg/m 2 ) and insulin sensitivity (insulin-sensitivity index Ն4.2ϫ1.0 Ϫ4 and Ͻ4.2ϫ1.0 Ϫ4 min Ϫ1 U/mL), yielding insulin-sensitive (IS, nϭ65), insulinresistant (IR, nϭ75), and obese insulin-resistant (OIR, nϭ58) subjects. Mean fasting baseline LDL cholesterol (LDL-C) levels were higher in IR and OIR subjects (3.44Ϯ0.67 and 3.32Ϯ0.80 mol/L) than in IS subjects (2.84Ϯ0.75 mmol/L) (PϽ0.001). Progressive triglyceride elevations and HDL-C decreases were seen across the 3 groups. Ingesting 4 eggs daily yielded significant LDL-C increases of 7.8Ϯ13.7% (IS) and 3.3Ϯ13.2% (IR) (both PϽ0.05) compared with 2.4Ϯ12.6% for OIR (NS). HDL-C increases were 8.8Ϯ10.4%, 5.2Ϯ10.4%, and 3.6Ϯ9.4% in IS, IR, and OIR, respectively (all PϽ0.01). Conclusions-Insulin resistance without and with obesity is associated with elevated LDL-C as well as elevated triglyceride and low HDL-C. The elevated LDL-C cannot be explained by dietary sensitivity, because the LDL-C rise with egg feeding is less in IR persons regardless of obesity status, probably attributable to diminished cholesterol absorption. The results suggest that dietary management of insulin resistance and obesity can focus more on restricting calories and less on restricting dietary fat. (Arterioscler Thromb Vasc