2.2. The development of adipocyte hypertrophy and hypoxia in adipose tissue inflammation

Adipose tissue can respond rapidly and dynamically to alterations in nutrient deprivation and excess through adipocyte hypertrophy and hyperplasia [15]. Especially in morbid obesity, in contrast to adipose tissue expansion in health obesity consisting of an enlargement of adipose tissue through effective recruitment of adipogenic precursor cells to the adipogenic programs, the pathogenic adipose tissue expansion consists of massive enlargement of existing adipocytes and limited angiogenesis and ensuring hypoxia [16]. For instance, adipocytes become hypertrophic during the development of obesity, and their size increases up to 140–180 μm in diameter, but the diffusion limit of oxygen is at most 100 μm [17]. On the other hand, it is possible that the blood supply to adipocytes may be reduced during the progressive adipocyte enlargement with consequent hypoxia [18].
