PPARGC1A and obesity due to melanocortin 4 receptor deficiency: It is plausible that PPARGC1A levels and PPARGC1A gene polymorphisms could be associated with cardiac function, as PPARGC1A is an important regulator of metabolic pathways, and as heart failure and diastolic dysfunction can be caused by metabolic disturbances, such as diabetes and insulin resistance [40-42], obesity [8,9] and hypertension [1].