There is an increase in the release of pro-inflammatory adipokines including leptin, insulin-like growth factor-1 (IGF-1), angiopoietin-like-protein-4 (ANGPTL4), MCP-1, IL-8, IL-6, IL-1β, PAI-1, MIP-2 (CXCL2), TIMP and vascular endothelial growth factor (VEGF) in response to adipocyte cellular stress and hyperinsulinemia [72,73,74,75,76,77]. Here, ANGPTL4 is linked to hyperinsulinism.