TNF and obesity due to melanocortin 4 receptor deficiency: The specific manifestations of visceral adipose tissue (VAT) inflammation are increased levels of pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-6 Hotamisligil et al. (1993), Kern et al. (2001), and decreased levels of anti-inflammatory cytokines IL-10 and IL-4 in obesity-related IR patients (Esposito et al., 2003).