Hormonal
High intra-abdominal fat (IAF) is the primary determinant of an atherogenic lipoprotein profile (increased triglycerides, LDL, ApoB; decreased HDL), whereas insulin resistance contributes independently only to VLDL cholesterol.
Focus on reducing visceral fat rather than just total body weight. Even if you are 'lean' by BMI, high abdominal fat (measurable by CT or inferred by waist circumference) is strongly linked to bad cholesterol profiles. Lifestyle changes that reduce visceral fat (caloric restriction, exercise) improve lipid profiles, likely by reducing IAF and improving insulin sensitivity.
Thus an atherogenic lipoprotein profile appears to be the result primarily of an increase in IAF, perhaps via insulin resistance.
Why this rating
Large cohort (n=196), rigorous measurement (CT for fat, minimal model for SI, DGUC for lipids), but cross-sectional design limits causal inference.
Source
The Atherogenic Lipoprotein Profile Associated With Obesity and Insulin Resistance Is Largely Attributable to Intra-Abdominal Fat
Delma Nieves et al. · Diabetes · 2003
DOI 10.2337/diabetes.52.1.172
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