The controversial findings on visfatin levels as a result of obesity and metabolic syndrome, suggest that an increased [82], a decreased [83,84], or unchanged level of visfatin-induced endothelial angiogenesis occurs through mediating VEGF, MMP, MAPK and PI3K/Akt signaling pathways [85]. This evidence concerns the gene NAMPT and obesity due to melanocortin 4 receptor deficiency.