“…Healthy adipose tissue expansion is that of hyperplasia and adaptation; maintaining vascularization, increasing insulin sensitivity partly through adiponectin release, and allowing storage of triglycerides in a ‘healthy’ fashion, ready for release whenever energy is required [ 149 ]. However, in case of chronic overfeeding and obesity, adipose tissue does not only undergo physiologic hyperplasia, but it also hypertrophies [ 150 ]. Hypertrophic adipocytes do not store energy efficiently, but rather they are overloaded with triglycerides and excessively large cytoplasmic lipid droplets, and upon closer investigation, these enlarged adipocytes have inadequate vascularization, deteriorated mitochondrial oxygen use, hypoxia despite increased hypoxia-inducible factor 1-alpha (HIF1α), and as a result substantially increased reactive oxygen species (ROS) production, lipid peroxidation, and tissue fibrosis [ 149 , 150 , 151 , 152 ].…”