2.3. The hypothesis and evidence about the effect of adipocyte hypertrophy and hypoxia on the development of adipose tissue inflammation and insulin resistance

Recent studies have demonstrated that adipose tissue during the development of morbid obesity is characterized by adipocyte hypertrophy followed by hypoxia, immune cell infiltration, and pro-inflammatory adipocytokines during progress of chronic inflammation. In addition, the concomitant development of reduced blood flow perfusion, lipotoxicity, and adipocyte cell death would also further deteriorate the progress of adipose tissue inflammation (Figure 1).
