HIF1A and obesity due to melanocortin 4 receptor deficiency: In the presence of obesity, the proinflammatory state in these patients together with intermittent episodes of hypoxia may lead to an enhanced inflammatory response mediated by a positive feedback loop mechanism that implicates HIF-1 and NFκB, which could explain the presence of more severe forms of liver involvement in obesity-related NAFLD in the presence of OSAHS [11].