TNF and metabolic syndrome: The decline in estrogen further leads to elevated pro-inflammatory adipocytokines (TNF-α, IL-6), increased low-density lipoprotein (LDL), and heightened triglyceride levels, all of which elevate the risk of cardiovascular disease and metabolic syndrome (MetS) (Abildgaard et al., 2021; Alves et al., 2025) (Figure 4).