Meda dhatu

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Meda dhatu is the body component which indicates fat in general and adipose tissue in particular.[1] Its important function is to oleate or lubricate (snehana). [2](SAT-B.435)
It is present in two forms:

  1. Fixed or bounded form is observed as stored fats in adipocytes.
  2. The free form is observed as circulating lipids like lipoproteins or free fatty acids.[3]

Contributors
Section/Chapter/topic Sharira / Dhatu / Meda Dhatu
Authors Deole Y.S., Anagha S.,
Reviewed by Basisht G.
Affiliation Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar
Correspondence email: carakasamhita@gmail.com
Publisher Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication: June 4, 2020
DOI 10.47468/CSNE.2020.e01.s09.016

Etymology, derivation and meanings

The word "meda" is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness.

The literary meanings of word meda are as follows:[4]

1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibers, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them.

In physiology, its proper seat is said to be the abdomen.

2. Morbid or unnatural obesity.

3. In general, obesity or fat in the body is denoted by the word meda.[5]

Panchabhautika constitution and properties

Meda dhatu has dominance of prithvi, jala and agni mahabhuta.

It possesses properties like unctuousness (snigdha) and heaviness(guru).[6]

Physiological aspects

Formation and metabolism

Meda dhatu is formed from the unctuous portion of mamsa dhatu by action of factors responsible for metabolism of meda(medadhatvagni).[Cha. Sa Chikitsa Sthana 15/29-30]

There are two forms of meda dhatu in body:

1. Structural component (poshya meda dhatu): It is the form,that is stored in the layer of meda (medodhara kala). It is also called fixed or stored fat(baddha medas). This portion is located mainly in the omentum. This form is responsible for the nutrition of meda dhatu itself in case of starvation.

2. Circulating component (poshaka meda dhatu): This form is circulated with nutrient fluid or plasma (rasa dhatu) and blood(rakta). It is free and unbound (abaddha medas). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.Nidana Sthana 4/7]

Metabolic by-products and waste products (Upadhatu and mala)

During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. Chikitsa Sthana 15/17]. Sweat and sebum are formed during this process as waste products (mala). [Cha.Sa. Chikitsa Sthana 15/18].

Quantity

The total quantity of meda dhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. Sharira Sthana 7/15]

Time span

The meda dhatu is formed on the 4th day from the nutrient fluid (ahara rasa). [Cha.Sa. Chikitsa Sthana 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]

Characteristics of best quality of adipose tissue (meda sara )

The person endowed with best quality of meda dhatu has significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.Vimana Sthana 8/106]

Channels of transportation and transformation of meda dhatu (medovaha srotas)

The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. Vimana Sthana 5/8]

Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. Sharira Sthana 9/12].

Vagbhata added mamsa dhatu to the origin with kidneys (vrikka).[A.S.Sharira Sthana 6/26]

Considering the above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment.

The following structures can be considered as components of the transportation and transformation system of meda dhatu.

Layer of meda dhatu (medodhara kala)

It is the layer of fat present in the abdominal cavity, small bones and long bones. In the abdominal cavity, it is present in the form of visceral fats. Meda dhatu present in the long and big bones is known as marrow (majja).That present inside the small bones is termed as red marrow (sarakta meda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. Sharira Sthana 4/13]

Role of meda dhatu in embryonic development

During embryo-genesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism(agni)that makes them elastic and smooth. Ligaments(snayu) are formed after the strong action of factors responsible for metabolism(agni) that makes them hard. [Su. Sa. Sharira Sthana 4/29-30]

The kidneys (vrikka) are formed from the unification of the essence of blood tissue(rakta dhatu)and adipose tissue (meda dhatu).The testis(vrishana) are formed from the unification of the essence of adipose tissue (meda dhatu),muscle tissue (mamsa dhatu), blood tissue (rakta dhatu) and kapha dosha. [Su. Sa. Sharira Sthana 4/31]

Functions

Meda dhatu is responsible for functions of lubrication(sneha), sweating (sweda), stability (dridhatwam), and nourishment of bone tissue(asthipushti). [Su. Sa. Sutra Sthana 15/5]

Importance in diagnosis

Causes of vitiation

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by the sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food, and alcoholic drinks. [Cha. Sa. Vimana Sthana 5/16]

Abnormal states

The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

Decrease of meda dhatu

Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. Sutra Sthana 17/66], [Su. Sa. Sutra Sthana 15/9]

Increase of meda dhatu

The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]

Clinical features of vitiation

  • Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. Sutra Sthana 28/15]
  • The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.Chikitsa Sthana 6/13-14]
  • The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.Sutra Sthana 21/3]
  • When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.Sharira Sthana 9/12]

Role of meda dhatu as vitiated factor in diseases

Meda dhatu is involved in the pathogenesis of the following diseases:

  • Obstinate urinary diseases including diabetes (Prameha)[Cha. Sa. Nidana Sthana 4/8]
  • vitiligo (Shwitra) [Cha. Sa. Chikitsa Sthana 7/174]
  • swelling (Shotha) [Cha. Sa. Chikitsa Sthana 12/94]
  • Anaemia(Pandu)[Cha.Sa. Chikitsa Sthana 16/6]
  • Disorders of thigh and hip (Urusthambha) [Cha. Sa. Chikitsa Sthana 27/14]
  • Obesity (Sthaulya)[Cha. Sa. Sutra Sthana 21/5-8]
  • Vitiated dosha located in the channels of transport of medadhatu (medovahasrotas)cause quaternary fever (chaturthaka jwara).[Cha. Sa. Chikitsa Sthana 3/66]
  • The clinical features of fever due to vitiation of meda dhatu by pitta dosha (medadhatugata jwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. Chikitsa Sthana 3/79].
  • When vitiated vata is located in mamsa and meda dhatu, it manifests by producing symptoms like heaviness of the body, pricking pain, and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. Chikitsa Sthana 28/32].
  • When the vata is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. Chikitsa Sthana 28/66].
  • Obesity (Sthaulya) is defined as an excessive increase of meda and mamsa dhatu in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. Sutra Sthana 21/5-9].

Importance of concept in the preservation of health and prevention

Meda dhatu provides unctuousness to all body components. Unctuousness is the essential property of the essence of all seven dhatu (ojas). It is related to vitality and immunity of the body. [Cha.Sa. Chikitsa Sthana 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.Sutra Sthana 22/11] These are important in various physiological processes and functions of the body.

Management

  • Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.Sutra Sthana22]

The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. Sutra Sthana 21/21-22]

  • Food and drinks that alleviate vata dosha and reduce kapha dosha and meda dhatu (fat),
  • Therapeutic enema processed with drugs of sharply acting, dry and hot properties,
  • Dry powder massage (udwartana),
  • Use of guduchi (Tinospora cordifolia Miers), musta (Cyperusrotundus Linn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belerica Roxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey.
  • The condition of fever due to pitta dosha in mamsa dhatu and meda dhatu is managed by therapeutic purgation (virechana) and fasting (upavasa). [Cha. Sa. Chikitsa Sthana 3/316].
  • The treatment measures for vata located in meda dhatu are therapeutic purgation (virechana), evacuative enema(basti) and palliative measures(shamana). [Cha. Sa. Chikitsa Sthana 28/93].

Contemporary approach

  • In conventional physiology, the concept of meda dhatu is perceived in view of adipose tissue, fats, and lipids. [7] Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.[8]

Origin and formation

Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.[9] Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy.[10] Adipocytes are derived from mesenchymal stem cells through adipogenesis.

There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.[11] The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.

The third but poorly understood marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cells expand in states of low bone density but additionally expands in the setting of obesity.[12]

Embryonic development

Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle, or bone. The fibroblast are preadipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6

Quantity and measurement

The total weight of fat in an average human adult measures about 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show a fourfold increase in size before dividing and increasing the absolute number of fat cells present.[13]

Functions

Storage of fat

The fat is stored in the body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.[14]

Generation of heat

The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.[11]

Adaptation

The fat cells tend to increase in size to store more fat in case needed. This expansion of fat mass leads to obesity.

Investigations

The levels of meda dhatu can be investigated through various assessment parameters like:

  1. Body mass index
  2. Waist: hip ratio
  3. Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
  4. Estimation of total cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
  5. Serum insulin

Role of adipocytes in causing obesity and diabetes

From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation of meda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha).

This patho-physiology can be linked as follows:

Excess nutrition leads to the expansion of fat mass and an increase in the size of adipocytes (hypertrophy).[15] This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance.[16] Insulin plays a major role in fat production in adipocytes, synthesis of unsaturated fatty acids, and stimulating lipogenesis. It also plays a role in the uptake of glucose by muscles.[17] The malfunctioning of insulin in turn leads to diabetes.

Current researches

An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individuals showed significantly positive relationship with values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high-density lipoproteins), comparatively low values of LDL (low-density lipoproteins), and serum cholesterol.[18]

List of theses

Very few research works have been carried out on fundamental approach towards the concept of meda dhatu.

Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and the effect of Ayurveda therapies in their management.

Hyperlipidemia and dyslipidemia are two other disorders related to meda dhatu.

1. Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar

2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar

4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.

6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar.

7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With Medoghna Rasayana Vati, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effect Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of Triphaladi Vati and Shilajitwadi Vati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.

12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, I.P.G.T. & R.A., Jamnagar.

13. Yogesh K Patil (2010) : A Comparative Study of Nyagrodhadi Vati and Gokshuradi Guggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

14.Falguni S Patel (2010) :A Clinical Study of Tryushnadhya Lauha Vati in the Management of Sthaulya w.s.r. to Obesity, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

16.Kanwar S Singh(2011) : Study on Apathyanimittaja Prameha (Type 2 Diabetes) and its Management with Saptarangyadi Ghana vati (A Clinico-Experimental study), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in Apathya Nimittaja Prameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

19.Chitra Devi Sharma (2013) : Comparative Study of Asanadi yoga Vati and Shilajitwadi Vati in the management of Madhumeha w.s.r. to Diabetes mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

20.MalivadShila (2014) : A Comparative Study of Vidangadi Lauh and Triphaladi Vati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

21.Jatin M Vyas (2014) : A Comparative Study of Bilvadi Panchmool Ghana vati and Navaka Guggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,I.P.G.T. & R. A., Jamnagar.

22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadi guggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

23. Bhushan Bhav Ram Prakash Niranjan (2014) : Management of Apathyanimittaja Prameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

More information

Related Chapters

Vividhashitapitiya Adhyaya, Snehadhyaya, Langhanabrimhaniya Adhyaya, Ashtauninditiya Adhyaya, Santarpaniya Adhyaya Grahani Chikitsa,Prameha Nidana,Prameha Chikitsa

Related articles

External links

Adipocyte, fat cells

Abbreviations

  • SAT = Standard Ayurveda Terminology
  • Cha. = Charak
  • Su. = Sushruta
  • Sha. =Sharangadhara
  • Sa. = Samhita
  • A. = Ashtanga
  • S. = Sangraha

References from Charak Samhita

The list of references for meda dhatu in Charak Samhita can be seen here.

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References

  1. ↑ Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020
  2. ↑ Available from http://namstp.ayush.gov.in/#/sat
  3. ↑ Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19
  4. ↑ Sanskriti Jha and Srujan Jha. Amarkosha.
  5. ↑ Monier-Williams Sanskrit-English Dictionary, 1899, [Cologne record ID = 167817] [Printed book page 832 , 3], https://www.sanskrit-lexicon.unikoeln.de/scans/MWScan/2014/web/webtc/indexcaller.php
  6. ↑ Bhavaprakasha, purva khanda, Garbhaprakarana 207
  7. ↑ Vandana Verma, Sonam Agrawal, & Sangeeta Gehlot. (2020). Exploration of Ayurveda blueprint on clinical physiology of Meda (adipose tissue) and Majja Dhatu (bone marrow) in context to obesity. International Journal of Research in Pharmaceutical Sciences, 11(1), 358-367. https://doi.org/10.26452/ijrps.v11i1.1830
  8. ↑ Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346
  9. ↑ Available from https://embryology.med.unsw.edu.au/embryology/index.php/Adipose_Tissue_Development cited on 18/05/2020
  10. ↑ Birbrair A, Zhang T, Wang ZM, Messi ML, Enikolopov GN, Mintz A, Delbono O (August 2013). "Role of pericytes in skeletal muscle regeneration and fat accumulation". Stem Cells and Development. 22 (16): 2298–314. doi:10.1089/scd.2012.0647. PMC 3730538. PMID 23517218
  11. ↑ 11.0 11.1 Available from https://en.wikipedia.org/wiki/Adipocyte#cite_note-Birbrair_2298%E2%80%932314-1
  12. ↑ Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J (August 2017). "Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice". Journal of Bone and Mineral Research. 32 (8): 1692–1702. doi:10.1002/jbmr.3159. PMC 5550355. PMID 28436105
  13. ↑ Robert P (2001). Fat: fighting the obesity epidemic. Oxford [Oxfordshire]: Oxford University Press. pp. 68. ISBN 978-0-19-511853-7
  14. ↑ KAvailable from https://en.wikipedia.org/wiki/Adipocyte#cite_note-:0-3 cited on 18/05/2020
  15. ↑ Bluher M (June 2009). "Adipose tissue dysfunction in obesity". Experimental and Clinical Endocrinology & Diabetes. 117 (6): 241–50. doi:10.1055/s-0029-1192044. PMID 19358089
  16. ↑ Kahn SE, Hull RL, Utzschneider KM (December 2006). "Mechanisms linking obesity to insulin resistance and type 2 diabetes". Nature. 444 (7121): 840-6. doi:10.1038/nature05482. PMID 17167471
  17. ↑ Kahn BB, Flier JS (August 2000). "Obesity and insulin resistance". The Journal of Clinical Investigation. 106 (4): 473–81. doi:10.1172/JCI10842. PMC 380258. PMID 10953022
  18. ↑ Najneen M. Bhaldar et al,An Observational Study of Medadhatu Sarata w.s.r. to Lipid Profile, International Journal of Research & Review , Vol.5; Issue: 10; October 2018
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