TNF and obesity due to melanocortin 4 receptor deficiency: Macrophages are considered to be a major source of proinflammatory mediators [34], and levels of proinflammatory adipokines including interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), and tumor necrosis factor-α (TNF-α) are elevated in obesity and are connected with IR directly [35].