Larger waist-circumference, as a marker of obesity, was more prevalent in subjects with CU, and significantly associated with IgE, Eosinophilic Cationic Protein (ECP) and Tumor Necrosis Factor-a (TNF-a) levels (117), while a postive association between CU and obesity was shown in a large population-based Italian study (adjusted HR 1.40,95% CI 1.17–1.67) (108). Here, TNF is linked to obesity due to melanocortin 4 receptor deficiency.