Figure 2: Association between adipose tissue and pathophysiology of metabolic syndrome. Chronic systemic inflammation is the main criteria of energy metabolic system disturbances like metabolic syndrome. Obesity is the trigger of this process and adipose tissue is the initiator of this pathophysiology. In obesity state, expansion of adipocytes and its malfunction lead to adipose tissue inflammation, lipolysis and proinflammatory cytokines production and consequently FFA secretion to the circulation. This leads to lipid destination from the adipose tissue to peripheral tissue and sedimentation in these tissues. ER stress, mitochondrial dysfunction, systemic inflammation and FAID are the general outcome of this process. In the normal state, a functional adipose tissue absorbs lipids from the peripheral tissues to storage in its lipid droplets. FFA: Free Fatty Acid; ER: Endoplasmic Reticulum; TNF: Tumor Necrosis Factor