Viewpoints on the way to the consensus session: where does insulin resistance start? The adipose tissue

Adipose tissue is a heterogeneous organ with respect to embryonic origin, body distribution, and function. In addition to playing a major role in the regulation of nutrient and energy homeostasis, it is involved in the modulation of the immune response, reproductive function, hemostasis, mechanical support, bone mass growth, and thermogenesis. To postulate that insulin resistance starts in adipose tissue, there should be evidence of 1) potential mechanisms for such a causal relationship, 2) the manifestation of such mechanisms in insulinresistant individuals, and 3) their early occurrence in the development of insulin resistance.