The objective of this comprehensive review is to summarize and discuss
the available evidence of how adipose tissue inflammation affects insulin
sensitivity and glucose tolerance. Low-grade, chronic adipose tissue
inflammation is characterized by infiltration of macrophages and other immune
cell populations into adipose tissue, and a shift towards more pro-inflammatory
subtypes of leukocytes. The infiltration of pro-inflammatory cells in adipose
tissue is associated with an increased production of key chemokines such as C-C
motif chemokine ligand 2, pro-inflammatory cytokines including tumor necrosis
factor α and interleukins 1β and 6, as well as reduced expression
of the key insulin sensitizing adipokine, adiponectin. In both rodent models and
humans, adipose tissue inflammation is consistently associated with excess fat
mass and insulin resistance. In humans, associations with insulin resistance are
stronger and more consistent for inflammation in visceral as opposed to
subcutaneous fat. Further, genetic alterations in mouse models of obesity that
reduce adipose tissue inflammation are – almost without exception -
associated with improved insulin sensitivity. However, a dissociation between
adipose tissue inflammation and insulin resistance can be observed in very few
rodent models of obesity as well as in humans following bariatric surgery- or
low-calorie diet-induced weight loss, illustrating that the etiology of insulin
resistance is multifactorial. Taken together, adipose tissue inflammation is a
key factor in the development of insulin resistance and type 2 diabetes in
obesity, along with other factors that likely include inflammation and fat
accumulation in other metabolically active tissues.