A group of 56 hypercholesterolemic and normocholesterolemic men and women were given approximately 700 mg a day of egg yolk cholesterol In a double-blind, crossover study while they were on a background diet containing approximately 30% of energy as fat. Overall there was a 0.23 mmol/l rise In plasma cholesterol (3.7%, p<0.001) after 4 weeks, a 0.19 mmol/l rise in low density lipoprotein (LDL) cholesterol (4.9%, p=0.002), and a 0.07 mmol/l rise In high density lipoprotein (HDL) cholesterol (5.4%, p<0.001). Plasma trlglycerides fell by 0.07 mmol/l (5.1%). Normocholesterolemic Individuals (plasma cholesterol <5.2 mmol/l) experienced small, nonsignificant rises of 0.06, 0.02, and 0.05 mmol/l In total, LDL, and HDL cholesterol, respectively. Hypercholesterolemic sub|ects were classified on the basis of their response to a low fat diet. Diet-sensitive sub|ects were defined by a > 10% fall In plasma cholesterol on a 25% fat, low cholesterol (<200 mg/day) diet These individuals were found to be more responsive to the effect of dietary cholesterol than were dlet-insensltlve subjects; the respective changes In the two groups were rises of 0. A n increase in dietary cholesterol produces a small, but significant, increase in plasma cholesterol in most large experimental groups, but there is great individual variability.1 -8 The response to a change in saturated fat intake tends to be much larger than the response to dietary cholesterol, and although individual variability occurs, few people are truly unresponsive. 9 -13 McNamara et al. 13 in an extensive trial of free-living subjects, found that 70% of people could effectively compensate for an increase in dietary cholesterol by down-regulating cholesterol synthesis. A similar proportion of metabolic "compensators" had earlier been reported by Nestel and Poyser.14 In the former study, only 10% of the individuals had a significant (10%) increase in plasma cholesterol, and these individuals failed to downregulate cholesterol synthesis and tended to have high cholesterol absorption rates. A possible genetic basis has been suggested by Kesaniemi et al. 16 who demonstrated that subjects with the E4 allele for apolipoprotein (apo) E had a higher fractional cholesterol absorption From the CSIRO Division of Human Nutrition, Adelaide, South Australia.This work was partly supported by the National Heart Foundation of Australia and the Egg Industry Research Council of Australia.Address for reprints: Dr. P.J. Nestel, CSIRO Division of Human Nutrition, Kintore Avenue, Adelaide SA 5000, Australia.Received August 3, 1989; revision accepted December 11, 1989. than did subjects with the E2 allele. Individuals carrying an apo E4 allele had a much higher low density lipoprotein (LDL) cholesterol concentration than did those with the E2 allele. 16 Katan et al. 17 have recently shown that there may be a correlation between sensitivity to changes in dietary saturated fat intake and sensitivity to dietary cholesterol in normocholesterolemic individuals. However, hypercholesterolemic ind...