Hormonal
Pathological adipose tissue expansion driven by adipocyte hypertrophy leads to local hypoxia, which triggers a fibrotic response and chronic inflammation, ultimately resulting in systemic insulin resistance.
Not all fat gain leads to metabolic disease. The key is how your body handles the expansion. If your fat cells grow too large (hypertrophy) without creating new blood vessels, they become hypoxic and inflamed, causing insulin resistance. Encouraging 'healthy' expansion (hyperplasia/new cell creation) through gradual weight management may help preserve metabolic health, whereas rapid, massive fat cell enlargement is the primary driver of pathology.
In contrast, pathological expansion of AT can be described by rapid growth of the fat pad through enlargement of existing fat cells, a high degree of macrophage infiltration, limited vessel development, and massive fibrosis... Such pathological expansion is associated with chronic inflammation, which ultimately results in the development of systemic insulin resistance.
Why this rating
Based on a comprehensive review of multiple human and rodent studies, though it is a review rather than a single primary trial.
Source
Adipose tissue remodeling and obesity
Kai Sun et al. · Journal of Clinical Investigation · 2011
DOI 10.1172/jci45887
More from this paper
- Macrophage infiltration into adipose tissue is a critical mediator of obesity-induced insulin resistance, and their removal can restore insulin sensitivity.Good
- Acute weight loss or fasting triggers a transient, physiological influx of macrophages into adipose tissue to clear lipid droplets from dead adipocytes, which is a healthy adaptive response distinct from chronic pathological inflammation.Moderate
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