PPARA and Insulin resistance: Some researchers also believe that PFAS have structural homology with some fatty acids in the human body, which increases the expression of genes related to fatty acid oxidation and causes oxidative stress in the body, thereby aggravating insulin resistance (38) It has also been suggested that the effects of PFOS/PFOA on cholesterol and lipid homeostasis may be mediated by activation of the peroxisome proliferator activated receptor alpha (PPARα) pathway or inhibition of hepatocyte nuclear factor 4-alpha (HNF4α) protein expression (39, 40).