TNF and obesity due to melanocortin 4 receptor deficiency: Nevertheless, TNF-α increase was not statistically changed, whereas other markers of inflammation (i.e., macrophage marker CD68, chemokines monocyte chemoattractant protein-1 and macrophage inflammatory protein-1alpha) were found at variance in the group of patients with high fat liver, supporting the hypothesis that in obesity an increased inflammatory status impacts directly on ceramide level.