Also, obesity is associated with nonalcoholic fatty liver disease (NAFLD), a condition that is accompanied by a decrease in the hepatic activity of peroxisome proliferator-activated receptor alpha (PPAR-alpha), which, in turn, is directly related to HOMA-IR and increases the pro-lipogenic status of the liver [44,45]. Here, PPARA is linked to obesity due to melanocortin 4 receptor deficiency.