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193,194 Fetuin-A inhibits glucose-stimulated insulin secretion and, in conjunction with non-esterified fatty acids (NEFAs), activates Toll-like receptor 4-mediated proinflammatory pathways in adipocytes and macrophages

Because fumarate is a direct, naturally occurring intermediate in the Krebs cycle, this specific form provides a powerful dual-action benefit

Furthermore, obese mice's white adipose tissue had considerably lower transcript levels and antioxidant enzyme activity than control mice, including catalase and dismutase

The circulating FFAs are increased in subjects with obesity, which can induce insulin resistance in the liver and contribute to NAFLD development [28]