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. 2015 Nov 13;7(11):9453–9474. doi: 10.3390/nu7115475

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© 2015 by the authors; licensee MDPI, Basel, Switzerland.

This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).

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Imbalance in lipid metabolism causes increased efflux of FFA to adipose tissue. Reduced free fatty acids (FFA) utilization and β-oxidation and increased lipogenic and lipolytic pathways lead to overflow of FFA in the circulation. Adipose tissue activates adipogenesis and increases the number of adipocytes becoming hyperplastic or enlarges adipocyte size becoming hypertrophic. Hyperplastic adipose tissue is normally metabolically healthy while hypertrophic adipose tissue is characterized by dysfunctional adipocytes, insulin resistance, hypoxia and inflammation.