TNF and obesity due to melanocortin 4 receptor deficiency: Moreover, it is known that EF secretes inflammation-related materials such as tumor necrosis factor-alpha (TNF-α), interleukine-6 (IL-6), free fatty acids (FFA), plasminogen activator inhibitor-1 (PAI-1) and adiponectin into blood vessels, especially the coronary arteries, thereby influencing diabetes, obesity, and dyslipidemia [23].