TNF and obesity due to melanocortin 4 receptor deficiency: Importantly, emerging evidence indicates that BMI may mediate these associations through two interconnected pathways: (1) inflammation of visceral adipose tissue leading to the overproduction of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), thereby enhancing systemic urate synthesis [13]; (2) obesity-induced insulin resistance resulting in reduced renal clearance of urate [14].