TNF and metabolic syndrome: Furthermore, obesity and metabolic syndrome bring about a state of metabolic inflammation in which damaged hypertrophic, hyperplastic, and hypoxic adipocytes provoke the accentuated production and release of inflammatory cytokines like interleukins 1, 6, and 23 (IL-1, IL-6, and IL-23); tumor necrosis factor-alpha (TNF-α); transforming growth factor-β (TGF-β) [37,40]; and adipokines and promote macrophage polarization toward the M1 proinflammatory phenotype [37,38].