PPARA and metabolic dysfunction-associated steatotic liver disease: The sirtuins with greatest association to nonalcoholic fatty liver disease development are SIRT1 and SIRT3. Recent evidence showed that SIRT1 is an important piece in lipid homeostasis in the liver, and it is an agonist ligand of peroxisome proliferator-activated receptor alpha (PPAR), promoting oxidative activity in lipids.