In particular, 2-hydroxybutyrate, a strong predictor of diabetes risk in the Relationship of Insulin Sensitivity to Cardiovascular Risk study, did not differ by sex.15 We also did not observe a difference in plasma lactate, a marker of insufficient oxidative capacity to meet energy requirements, which was associated with prevalent diabetes in the Atherosclerosis Risk in Communities study.16 We hypothesize that in our cohort, metabolic abnormities had not yet reached a point where fasting energy requirements grossly exceeded oxidative capacity. The gene discussed is INS; the disease is diabetes mellitus.