Adipose tissue macrophage populations and inflammation are associated with systemic inflammation and insulin resistance in obesity

Am J Physiol Endocrinol Metab. 2021 Jul 1;321(1):E105-E121. doi: 10.1152/ajpendo.00070.2021. Epub 2021 May 17.


Obesity is accompanied by numerous systemic and tissue-specific derangements, including systemic inflammation, insulin resistance, and mitochondrial abnormalities in skeletal muscle. Despite growing recognition that adipose tissue dysfunction plays a role in obesity-related disorders, the relationship between adipose tissue inflammation and other pathological features of obesity is not well-understood. We assessed macrophage populations and measured the expression of inflammatory cytokines in abdominal adipose tissue biopsies in 39 nondiabetic adults across a range of body mass indexes (BMI 20.5-45.8 kg/m2). Skeletal muscle biopsies were used to evaluate mitochondrial respiratory capacity, ATP production capacity, coupling, and reactive oxygen species production. Insulin sensitivity (SI) and β cell responsivity were determined from test meal postprandial glucose, insulin, c-peptide, and triglyceride kinetics. We examined the relationships between adipose tissue inflammatory markers, systemic inflammatory markers, SI, and skeletal muscle mitochondrial physiology. BMI was associated with increased adipose tissue and systemic inflammation, reduced SI, and reduced skeletal muscle mitochondrial oxidative capacity. Adipose-resident macrophage numbers were positively associated with circulating inflammatory markers, including tumor necrosis factor-α (TNFα) and C-reactive protein (CRP). Local adipose tissue inflammation and circulating concentrations of TNFα and CRP were negatively associated with SI, and circulating concentrations of TNFα and CRP were also negatively associated with skeletal muscle oxidative capacity. These results demonstrate that obese humans exhibit increased adipose tissue inflammation concurrently with increased systemic inflammation, reduced insulin sensitivity, and reduced muscle oxidative capacity and suggest that adipose tissue and systemic inflammation may drive obesity-associated metabolic derangements.NEW AND NOTEWORTHY Adipose inflammation is proposed to be at the nexus of the systemic inflammation and metabolic derangements associated with obesity. The present study provides evidence to support adipose inflammation as a central feature of the pathophysiology of obesity. Adipose inflammation is associated with systemic and peripheral metabolic derangements, including increased systemic inflammation, reduced insulin sensitivity, and reduced skeletal muscle mitochondrial respiration.

Keywords: adipose tissue resident macrophages; inflammation; insulin sensitivity; mitochondria; obesity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Abdominal Fat / chemistry
  • Abdominal Fat / metabolism
  • Abdominal Fat / pathology*
  • Adult
  • Biomarkers / analysis
  • Body Mass Index
  • C-Reactive Protein / analysis
  • Cell Count
  • Cytokines / analysis
  • Female
  • Gene Expression
  • Humans
  • Inflammation / genetics
  • Inflammation / pathology*
  • Insulin Resistance*
  • Macrophages / pathology*
  • Male
  • Middle Aged
  • Mitochondria, Muscle / metabolism
  • Obesity / pathology*
  • Obesity / physiopathology
  • Oxygen Consumption
  • Tumor Necrosis Factor-alpha / blood


  • Biomarkers
  • Cytokines
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein