Adipose tissue extension is also associated with enhanced adipose tissue inflammation and hypoxia, promoting recruitment of pro-inflammatory macrophages that secrete cytokines, such as tumor necrosis factor (TNF-α) and Interleukin 6 (IL-6), which, by activating the TNF-α receptor and other cytokine receptors, they worsen insulin resistance [8]. This evidence concerns the gene TNF and Insulin resistance.