Adipose tissue dysfunction Working with collaborators as part of ongoing genetic studies, the investigators have identified several genetic variations (DNA changes) associated with insulin resistance, and believe some of these genetic variants operate primarily through adipose tissue "dysfunction". Adipose tissue dysfunction is a relatively new concept and has resulted from detailed physiological studies that have revealed that obese individuals have larger fat cells, more inflamed fat tissue (often infiltrated with macrophages) poorer adipose tissue blood flow pre/post meal, and differential expression of genes involved in these processes (Alkhouli 2013). The failure of adipocytes, resulting in a limited capacity to take up free fatty acids (FFA), predispose to ectopic fat depositions which is a deposition of lipids in sites such as the liver, muscle with more omental tissue similar to subjects with lipodystrophy.