Recently, the high responsiveness of omental adipocytes to positive lipolytic stimuli has been clearly demonstrated in women. We conclude that adipose tissue fatty acid release, storage capacity, and secreted cytokines may all be involved in the etiology of the metabolic syndrome. The anatomical location of visceral adipocytes close to the liver, combined with possible depot-specific alterations in various adipo-cyte or adipose tissue features likely play critical roles in this process. This highly complex etiology is concordant with the heterogeneous clinical manifestations of the metabolic syndrome, and suggests possible interindividual variability in the extent to which each pathophysiological mechanism is involved.

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