low Testosterone associated with insulin resistance, type II diabetes, metabolic syndrome, and increased fat. These will all translate to increased mortality.
acute GC secretion during stress mobilizes peripheral amino acids from muscle as well as fatty acids and glycerol
from peripheral fat stores to provide substrates for glucose synthesis by the liver
chronically elevated GC levels
alter body fat distribution and increase visceral adiposity as well as metabolic abnormalities in a fashion reminiscent of
metabolic syndrome
This local production may
play an important role in the onset of obesity and insulin resistance.
In adipocytes, cortisol inhibits lipid mobilization in the presence of insulin, thus leading to triglyceride accumulation
and retention.
Since the density of GC receptors is higher in intra-abdominal (visceral) fat than in other fat depots, the
activity of cortisol leading to accumulation of fat is accentuated in visceral adipose tissue (24, 158), providing a mechanism by which excessive endogenous or exogenous GC lead to abdominal obesity and IR
obese patients generally have normal or subnormal
plasma cortisol concentrations
This may be explained by an increased intratissular/cellular concentration of cortisol in adipose tissues
Intracellular GC may be produced from recycling of GC metabolites such as cortisone in adipose tissues
Local GC recycling metabolism is mediated by 11β-hydroxysteroid dehydrogenase enzymes (11β-HSD1 and 11β-HSD2
Cortisol also increases 11β-HSD1 expression in human adipocytes
In humans, elevated 11β-HSD1 expression in visceral adipose tissue is also associated with obesity
even if obese patients generally have normal or subnormal plasma cortisol concentrations
(131, 158), triglyceride accumulation in visceral adipose tissue may be due, at least in part, to the local production of GC in insulin-
and GC-responsive organs such as adipose tissue, liver, and skeletal muscle
insulin, in women with PCOS, promotes increased 5-alpha reductase activity. This results in a dysregulated HPA axis, promoting increased cortisol and androgen levels.
obesity and type II diabetes found to be associated with low adiponectin and elevated insulin as found in insulin resistance. This study revealed the inverse relationship of adiponectin and insulin resistance. The interesting thing is that inflammation causes insulin resistance. Here you can see the inflammation-insulin resistance-low adiponectin-obesity-diabetes link.
This study looks at the effects of capsaicin on inflammation and obesity. Capsaicin decreases IL-1B, IL-6, TNF-alpha and MCP-1. This reduces insulin and leptin levels, as well as increase adiponectin activity. This article also briefly discusses curcumin, which has similar activity.
endocannaboid activation associated with inflammation, insulin resistance, and of course obesity. This study was done in mice with a specific Apolipoprotein E deficiency.
Vitamin B12 deficiency will decrease methionine synthase activity, which will result in elevated homocysteine and the risk of DVT increases as a result. In this article, the cause of the vitamin B12 depletion was metformin. Diabetics and those with insulin resistance are already at an increased risk of blood clots.
A subsequent study by Yuan et al. showed that Tnf treatment of 3T3L1 adipocytes induces insulin resistance and that this could be prevented by pretreatment of cells with aspirin
Activation of the Tnf receptor results in stimulation of NFκB signaling via Ikkb
the percentage of macrophages in a given adipose tissue depot is positively correlated with adiposity and adipocyte size
Il-10 is an anti-inflammatory cytokine produced by macrophages and lymphocytes
Il-10 exerts its anti-inflammatory activity by inhibiting Tnf-induced NFκB activation by reducing IKK activity [38]
adipose tissue macrophages are responsible for nearly all adipose tissue Tnf expression and a significant portion of Nos2 and Il6 expression
One theory holds that the expansion of adipose tissue leads to adipocyte hypertrophy and hyperplasia and that large adipocytes outstrip the local oxygen supply leading to cell autonomous hypoxia with activation of cellular stress pathways
The use of the anti-inflammatory compounds, salicylate and its derivative aspirin, for treating symptoms of T2DM dates back over 100 years
elevated levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin (IL-8) have all been reported in various diabetic and insulin resistant states
overnutrition and obesity are often accompanied by elevations in tissue and circulating FFA concentrations, and saturated FFAs can directly activate pro-inflammatory responses
Adipokines such as resistin, leptin and adiponectin, which are secreted by adipocytes, can also affect inflammation and insulin sensitivity
In skeletal muscle insulin promotes glucose uptake by stimulating translocation of the GLUT4 glucose transporter
macrophages are also capable of undergoing a phenotypic switch from an M1 state, which was defined as the “classically activated” pro-inflammatory macrophage, to the M2 state or the “alternatively activated” non-inflammatory cell
saturated fatty acids are the most potent inducers of this inflammatory response
Several inducers of insulin resistance, including FFAs, pro-inflammatory cytokines and oxidative stress, activate the expression of Nos2, the gene that encodes iNOS (reviewed in [33]
Adipose tissue insulin signaling results in decreased hormone sensitive lipase activity and this anti-lipolytic effect inhibits free fatty acid (FFA) efflux out of adipocytes.
In the liver, insulin inhibits the expression of key gluconeogenic enzymes and, therefore, insulin resistance in liver leads to elevated hepatic glucose production
elevated JNK activity in liver, adipose tissue and skeletal muscle of obese insulin resistant mice, and knockout of Jnk1 (Jnk1−/−) leads to amelioration of insulin resistance in high fat diet
Adipose tissue from obese mice contains proportionately more M1 macrophages, whereas, lean adipose tissue contains more M2 macrophages, and increased M1 content positively correlates with inflammation, macrophage infiltration and insulin resistance
C-reactive protein (CRP)
these studies highlight the possibility that increased iNOS activity plays a direct role in the pathogenesis of insulin resistance
the important role of Ikkb in the development of obesity and inflammation-induced insulin resistance.
It is probable that local concentrations of inflammatory mediators, such as FFAs, Tnf or other cytokines/adipokines contribute to this polarity switch
Tnf and other cytokines/chemokines are symptomatic of inflammation, and while they propagate and/or maintain the inflammatory state, they are not the initial cause(s) of inflammation
Tlr4, in particular, is stimulated by lipopolysaccharide (LPS), an endotoxin released by gram-negative bacteria
Tlr4 belongs to the family of Toll-like receptors that function as pattern recognition receptors that guard against microorganismal infections as part of the innate immune system.
Tlr4 stimulation results in the activation of both Ikkb/NFκB and JNK/AP-1 signaling, culminating in the expression and secretion of pro-inflammatory cytokines/chemokines, including, Il1b, IL-6, Tnf, Mcp1, etc. (reviewed in [57
in those with nonalcoholic fatty liver disease, low adiponectin is associated with the insulin resistance, not the NAFLD. But of course, insulin resistance leads to NAFLD
How does inflammation cause insulin resistance? This in-depth paper helps to explain the current understanding.
More and more obesity is part of a growing inflammatory epidemic.