Obesity and cardiometabolic risk

Abstract

Adipose tissue releases a number of biologically active molecules that are thought to have a causative role in the pathogenesis of insulin resistance and vascular disease. Serum free fatty acids (FFAs) are generated by lipolysis (breakdown of stored triglycerides). They are increased in obese individuals as a result of increased adipose tissue mass. FFAs induce insulin resistance, possibly by competing with glucose as an energy substrate and by having an inhibitory effect on insulin signaling. The liver takes up FFAs to synthesise triglycerides and packages them with proteins to form very low density lipoprotein (VLDL). FFAs therefore mediate the association between obesity and hepatic steatosis ('fatty liver') and with hypertriglyceridaemia. High serum triglycerides, in turn, result in small dense LDL and low LDL. These lipid abnormalities help explain the association between obesity and cardiovascular disease.