TNF and obesity due to melanocortin 4 receptor deficiency: Obesity promotes the secretion of interleukin 1, interleukin 6, tumor necrosis factor alpha, and other pro-inflammatory factors that upregulate the IkappaB-kinase/nuclear factor kappa B (IKK/NF-κB) and mitogen-activated protein kinase (MAPK) pathways to induce cell apoptosis and ultimately contribute to myocardial injury [23,24].