INS and obesity due to melanocortin 4 receptor deficiency: In obesity metabolic changes in AT result in altered secretion of hormones and cytokines such as TNF-α, IL-6, leptin, resistin, adiponectin, etc. Increased levels of adipocyte derived cytokines impairs the insulin sensitivity and enhances the recruitment and activation of pro-inflammatory immune cells in the vasculature which contribute in the development of arterial stiffness [75].