Adipose Tissue: What Role Does It Play In Diabetes?

Body fat, also known as Adipose tissue is a loose connective tissue composed of adipocytes. Tissues are a group of cells together that have a similar structure and work together.

Body fat is connective tissue. Subcutaneous adipose tissue is below the skin’s surface on the entire body. Subcutaneous fat surrounds vital organs such as the heart, liver, nerves, and bone marrow.

As this type of adipose tissue growth occurs, it grows outside of the other vascular tissues. Fat tissue growth continues into adulthood and needs vascularization to support it. Once organ development ends in adulthood, adipose tissue can continue to expand. 

In obese individuals, it has increased up to 40%. Visceral fat found within the abdominal cavity surrounds vital organs. Visceral adipose tissue termed as an “active fat.” Specific compounds in active fat increase the likelihood of disease development.

Visceral fat measurement marks the risk for disease development. Completing disease risk assessments includes measuring your waist size. If you are female and your waist is 35 inches or greater, or as a male 40 inches or more, you are at risk. A BMI of 30 or higher, which is a measurement of body fat, determines obesity. 

Communication within the cell determines the type of fat tissue developed. During Lipolysis, a lipid triglycerides change into glycerol and three fatty acids. This process mobilizes stored energy in fat adipocytes during fasting or exercise. Lipolysis begins with the signal from several hormones.

These include: glucagon, epinephrine, norepinephrine, growth hormone, atrial natriuretic peptide, brain natriuretic peptide, and cortisol. Adipose tissues deliver fatty acids to the liver. Lipoprotein lipase then provides essential assistance for the transfer of triglycerides from the lipoproteins in your blood to your fatty tissues, heart, and muscles.

As defects in lipolysis occur, we can pinpoint the dynamic that leads to type 2 diabetes development.  

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Types of Adipose Tissue

White adipose tissue surrounds organs. It provides cushioning to the kidneys and the lymph glands. White adipocytes make up White fat. White adipocytes store energy as a single lipid droplet. Too much white fat is indicative of obesity. 

An Adipose Tissue Mass connects organs and tissues and is an insulator against cold. When these tissues form, new blood vessels form from existing ones. The splitting of the vascular growth causes tissue dysfunction. The new adipose tissue that forms prevents new healthy formations from occurring. 

Brown and Beige Adipose tissue both function to generate body heat. The name of these fat derives from the amount of blood vessels present. The adipose cells in Brown adipose tissue contain more vessels than white fat. Brown fat is often found in the neck and back. Beige Adipose tissue differs from white and brown fat.

The beige adipocytes have varying lipid sizes and are in greater proportion than white fat. Both beige and brown fat has shown to have a great effect on the body’s ability to burn calories.

Over the last decade, Harvard researchers have looked into manipulations of these tissues. There is great potential using this research to combat the current obesity issue. 

Function of Adipose Tissue

The function of brown adipose tissue is to transfer energy from food into heat. Brown adipocytes store energy in many small lipid droplets. The mechanism to produce heat triggered by being cold and producing a shiver. The heat produced can cause metabolic efficiency. 

Brown fat is often referred to as the good fat because its mechanism is to burn. There is some research indicating the use of brown fat to combat metabolic issues. Total body fat adds to insulin resistance versus total body fat. 

Besides its protective function, adipose tissue is recognized as a major endocrine organ. Research has shown that adipose tissue is, in fact, a metabolic organ that plays a hormonal role in the body. The Endocrine system is a system of glands that make hormones. The endocrine system regulates body processes.

Processes include reproduction, metabolism, and blood sugar levels. These hormones control your mood, metabolism, organs, reproduction, growth, and development. Hormones produced by Adipose tissue include: leptin, estrogen, resistin, and the cytokine tumor necrosis factor. In recent years, the global obesity epidemic has enhanced interest in adipose tissue biology-Gene expression, hormones, and growth factors that affect adipocyte differentiation

The Endocrine system is also comprised of the thyroid, and parathyroid glands are in your neck. The thymus, the adrenals are on top of your kidneys, and the pancreas is behind your stomach.

Other important glands include the ovaries, testes, pineal, and parathyroid glands. The Pituitary gland is your endocrine system’s master gland. It uses the information it gets from your brain to tell other glands what to do in your body. This gland makes thyroid hormone, which controls your metabolism. 

The Thymus and Adrenal glands are best known for making the hormone adrenaline known as the “fight or flight” hormone. This is called epinephrine. These two glands also make hormones called corticosteroids. They affect your metabolism and sexual function, among other things.

The pancreas is a dynamic endocrine organ. Each gland produces specific hormones that allow cells to “communicate” with each other. It produces digestive enzymes that break down food. It also makes the hormones insulin and glucagon. These ensure you have the right amount of sugar in your bloodstream and your cells. 

How is adiposity associated with Diabetes?

Central adiposity is a fat accumulation around the midsection. Carrying excess weight causes an increased risk of both heart disease and diabetes.

Excess fat can result in a decreased insulin ability to bind to the body’s own insulin receptors. The fat deposits become more likely to store fat as triglycerides. This is what is thought to cause insulin resistance and development of type 2 diabetes.

The formation of adipose tissue is, in part, controlled by the adipose gene. Adipose tissues exert cortisol, a hormone that is part of the “fight or flight” response. The bodies’ Function is affected by stress, and adipose tissue plays a part in this response.

Genetic predisposition and obesity from excess adipose tissue make the development of Type 2 diabetes likely. An increase in visceral fat also increases the likelihood that insulin resistance will occur-low-grade inflammation of endothelial cells in adipose tissue cause Type 2 diabetes.

Type 2 diabetics have a reduced capability to oxidize fat and have a high level of free fatty acids circulation. Reduction in glucose uptake in skeletal muscle causes lipids to accumulate inside the muscle cell. 

Epigenetics is the study between the environment and gene expression. They are dependent on one another. The environment can trigger how the cell functions and can lead to disease. Scientists have identified these changes and help predict the development of type 2 diabetes.

The Extracellular matrix consists of tiny molecules of collagen, enzymes, and glycoproteins. They provide structure and support to surrounding cells. When one experiences prolonged periods of high blood sugar levels, the matrix changes, these changes in the matrix cause fibrosis. Fibrosis affects cardiac function, rhythm, and blood pressure. These changes can further affect the diabetic patient by causing retinopathy and neuropathy. 

Macrophages are a type of white blood cell. They seek out other cells containing unhealthy proteins and destroys them. Inflammation macrophage phenotypes are the result of a cell interacting with its environment. These are inflammation macrophages.

Inflammatory Macrophages are responsible for proinflammatory cytokine secretion. This is linked to the progression of atherosclerosis. High blood sugar levels and the production of reactive cytokines inhibit the macrophages from doing their jobs. This can also lead to issues like kidney disease. 

Diagnosing a metabolic disorder occurs when several disorders of the body’s processes exist. Both Type 1 and Type 2 Diabetes are metabolic disorders. As discussed, there are many causes of the development of metabolic disorders. These include: infections, medications, stress, diet, genetics, and hormonal imbalances.

 Metabolic Syndrome (Syndrome X) occurs by excess consumption of refined carbohydrates. Chronic insulin resistance is directly related to diet-induced inflammation. The syndrome is a cluster of disease symptoms.

The syndrome includes abnormal cholesterol or triglyceride level, abdominal fat, elevated blood pressure, and high blood sugar. In type 2 diabetes, the body doesn’t respond to insulin the way it should or doesn’t make enough. This leads to weight gain and causes the cells to have decreased insulin sensitivity. High blood sugar ensues and decreased glucose tolerance. As this develops, other health concerns emerge. 

When adipose tissue is highly vascularized, it creates inflammation within the fat cell. This cell becomes insulin resistant. Adipose tissue that gives rise to bone marrow is called mesenchymal stem cells (MSC) ­. Mesenchymal cells are key in the immune responseIn research, MSC’s show promise in decreasing the attack on the beta cells in the pancreas. 

In 2017, the American Diabetes Association noted in a report on standards of care that diabetes is a “complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control.”

Medical intervention, along with lifestyle changes, a diabetics lifespan is increased. Tighter blood sugar control ensures better health. Better health means living a longer, more satisfying life. Self-management is crucial and means making small sustainable changes that make a positive impact. 

Reducing the Risk of Diabetes:

  • Control your weight

  • Body Mass Index of <35

  • Eat a well-balanced diet (My Plate

  • Understand what you eat-read food labels

  • Reduce the amount of added sugar intake (Men <9tsp/day, women<6 tsp)

  • Live and Active Lifestyle, exercise 150+ min per week of moderate-intensity exercise

If you have Type 2 diabetes:

  • Moderate weight loss can improve outcomes- consider a 5-7% body weight loss 

  • Dietary changes including reducing sodium and alcohol intake

  • Lifestyle changes include living a more active lifestyle, limit T.V. and screen time

  • Consider exercise like H.I.I.T training. 2 hours of training decreases insulin resistance in overweight adults and decrease adipose tissue 

  • Consume a diet high in Omega 3 fatty acids and DHA. These are anti-inflammatory and lower insulin resistance. Foods high in Omega 3 & DHA include: walnuts, leafy greens, tofu, vegetable oils, and fortified foods.

Learning practical ways to keep diabetes at bay can be crucial to lifelong health. If you have the diagnosis of Type 2 diabetes, forming a close relationship with your medical provider is essential. Along with the diagnosis, many experiences fears.

Addressing mental health and creating a support system is crucial. Many have found it helpful to practice meditation and mindfulness. Having the support of loved ones helping to provide care can increase your life span. Stay educated and informed and ask questions when you don’t understand.

Learning skills (self-care) enables you to be in control of your diabetes. It is vital to understand your blood sugar levels and stay on target. When your numbers are in the target range, you will feel better and have more energy. Reach out for help when needed. Understanding that diabetes is in itself, a stressor can help you take control of your diabetes. 

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  5. Gutierrez, D., Puglisi, M. and Hasty, A., 2009. Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia. Current Diabetes Reports, 9(1), pp.26-32.
  6. Guénantin, A., Briand, N., Capel, E., Dumont, F., Morichon, R., Provost, C., Stillitano, F., Jeziorowska, D., Siffroi, J., Hajjar, R., Fève, B., Hulot, J., Collas, P., Capeau, J. and Vigouroux, C., 2017. Functional Human Beige Adipocytes From Induced Pluripotent Stem Cells. Diabetes, 66(6), pp.1470-1478.
  7. Hampton, T., 2012. “Browning” of White Fat May Help in the Ongoing Fight Against Obesity. JAMA, 308(11), p.1080.
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  9. Sears, B. and Perry, M., 2015. The role of fatty acids in insulin resistance. Lipids in Health and Disease, 14(1).


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