Individuals with mental retardation (MR) have elevated cardiovascular disease (CVD) risk factor components of the insulin resistance syndrome (IRS). Purpose The purpose of this project was to identify the association between recommended behaviors (physical activity and dietary intake) and elevated CVD risk factors components of the IRS in adults with MR. Methods Established clinical cutoff points were used to identify subjects with hyperinsulinemia (≥ 15 μU/mL, Despres et al., 1996), borderline high triglycerides (TG)(≥ 200mg/dL, NCEP, 1994), low high-density lipoprotein cholesterol (HDL-C) (< 35mg/dL-men, NCEP, 1994/ < 50mg/dL-women, Miller Bass et al., 1993), borderline hypertension (≥ 140/90mmHg, JNC, 1997), abdominal obesity (abdominal sagittal diameter > 25cm, Pouliot et al., 1994), leisure time physical activity (LTPA) (≥ moderate intensity LTPA ≥ 5x's/week, Pate et al., 1995), below average dietary fat intake (≤ 35% fat, Block et al., 1992), and fruit and vegetable intake (≥ 5/day, NCEP, 1994) in 145 non-diabetic adults with mild MR who reside in community settings. Logistic regression was used to determine separate odds ratios (OR) for elevated CVD risk factors components of the IRS for those with recommended LTPA, below average fat intake, and recommended fruit and vegetable intake, compared to those with less than recommended LTPA, above average fat intake, and below recommended fruit and vegetable intake after adjusting for age, gender, Down syndrome, smoking, resident type, and medication use, Results OR (95% Confidence Interval)TableAdults with MR who participated in at least the recommended LTPA or who consumed below average fat intake were approximately one-third as likely to have hyperinsulinemia and abdominal obesity as compared to adults with MR who participated in less than the recommended LTPA or who consumed above average fat intake independent of age, gender, Down syndrome, smoking, resident type, and medication use. Conclusions The protective findings of LTPA and lower fat intake against hyperinsulinemia suggest that all adults with MR residing in community settings should participate in moderate to vigorous LTPA at least five times per week and consume a diet of 35% or less to potentially lower their risk for CVD. Supported by the John C. Erkkila, MD Endowment for Health and Human Performance, the Arc of Washington Trust Fund, RRTC # H133B980046, NIDRR # H133P000005