TNF and Insulin resistance: In addition to adipocyte-derived factors, increased release of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and additional products of macrophages and other cells that populate adipose tissue also plays a role in the development of cardiovascular and metabolic risk including insulin resistance [99,100].