Pathogenesis and Clinical Features of Obesity and Insulin Resistance

The etiology of obesity is not simple as multiple genetic and environmental factors, first of which is an increasingly sedentary lifestyle, play interacting roles. It is well recognized that persons with obesity carry a high risk of insulin resistance and its metabolic complications, such as impaired glucose tolerance, type 2 diabetes, hyperlipidemia and hypertension, and a significantly increased risk of atherothrombotic cardiovascular disease. Recent data have shown that not only generalized obesity, but rather ectopic fat accumulation, is associated with the risk of comorbidity. This article focuses on the clinical evidence related to the impact of regional adiposity on insulin resistance, with particular attention to central obesity, including fat accumulation in insulin sensitive organs, such as liver, muscle and heart, and the recent interest in adipokines.