TNF and obesity due to melanocortin 4 receptor deficiency: In this sense, the excess of adipose tissue (perivisceral fat) accumulated in the abdominal region, unlike subcutaneous tissue, is metabolically active and releases several adipokines, such as TNFα, MCP-1, IL-6, TGF-β, PAI-1, and leptin, among others, which have been postulated to be the link between obesity and the pathophysiology of MS [60].