LEP and obesity due to melanocortin 4 receptor deficiency: In addition, obesity may also induce chronic low-grade inflammation resulting in an alteration of local and systemic levels of cytokines (e.g., interleukin-6, C-reactive protein) and adipokines (e.g., leptin, adiponectin) [48], which may play a role in bladder carcinogenesis to bladder cancer mortality [49, 50].