In EMS horses, adipocytes hypertrophy has been associated with increased expression of leptin and the inflammatory cytokines tumor necrosis factor (TNF)-α, IL1β and monocyte chemoattractant protein (MCP)-1 and typical fasting hyperinsulinemia, evoking the close relationship between flawed adipose tissue dynamics and insulin resistance progression (Reynolds et al., 2019). Here, TNF is linked to hyperinsulinism.