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Hypertrophied adipose tissue contributes to an inflammatory state through four mechanisms: (1) altered adipokine secretion, specifically increased pro-inflammatory leptin and reduced anti-inflammatory adiponectin; (2) release of free fatty acids that induce systemic inflammation; (3) increased endoplasmic reticulum stress triggered by adipocyte expansion, leading to oxidative stress and inflammation; and (4) increased inflammatory gene expression and immune cell activation in hypoxic regions.

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