The Triumvirate of Adiposopathy: A Literature Review and Proposal of the Claros Pathophysiological Model

Obesity is currently considered as the 21st century epidemic. The accelerated increase in prevalence and mortality due to cardiovascular diseases establishes a historical precedent as a global public health problem. The increased incidence of obesity and obesity-associated chronic diseases (coronary heart disease, cancer, diabetes), together with the frequent finding of these conditions in the clinic, urgently call for studies aiming to identify possible pathophysiologic connections among these conditions. Obesity is often seen only as an imbalance between caloric intake and energy expenditure. On the other hand, numerous neuroendocrine factors are responsible for the regulation of energy metabolism. In addition, body metabolism is also affected by the autocrine, paracrine, and endocrine activity of organokines. Thus, the understanding signaling pathways, action and regulation of organokines could lead to a comprehensive approach to obesity, which in turn may unravel new indicators of adiposopathy, that are not necessarily associated solely to body weight or evident excess of fatty tissue. Herein we propose a pathophysiological model, which we refer to as the triumvirate of adiposopathy, involving the alteration of organokine balance (myokines, hepatokines, and adipokines) and that takes into account signaling pathways that are common to pro-inflammatory states such as insulin resistance and endothelial damage, emphasizing in adiposopathy and obesity, aiming to achieve the early identification of cardiometabolic risk, and thus positively impact the risk of morbimortality associated with adiposity.