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Central obesity is associated with insulin resistance and elevated levels of FFAs. As illustrated in slide 23, FFAs can reduce insulin-mediated glucose disposal under experimental conditions. However, it remains to be determined whether increased FFAs cause insulin resistance or vice versa in obese subjects. In either case, insulin resistance and elevated FFAs stimulate hepatic apolipoprotein B secretion and increase hepatic lipase activity. This enzyme catalyzes the removal of lipids from LDL and HDL, which makes them smaller and more dense. In turn, these effects lead to hypertriglyceridemia, production of small, dense LDL particles, and reduced HDL2-cholesterol levels. This dyslipidemic pattern, which has been termed the atherogenic lipoprotein phenotype, is also characteristic of that found in type 2 diabetes. Brunzell JD, et al. Diabetes Care. 1999;22(suppl 3):C10-C13.