Clinical efficacy of PPAR agonists in the treatment of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) has become a major public health concern. Peroxisome proliferator-activated receptors (PPARs) are nuclear receptor transcription factors. PPARs are categorized into three subtypes: PPARα, β/δ, and γ. Three subtypes of PPARs play crucial roles in lipid and glucose metabolism, inflammation and fibrosis. This review summarizes randomized controlled trials on the use of PPAR agonists in the treatment of NAFLD. PPARα and PPARβ/δ agonists control circulatory lipids well, but they do not yield enough liver benefits. PPARγ agonists, particularly pioglitazone, are recommended for NAFLD treatment. PPARα/γ agonists and PPARα/β/γ agonists are plausible in the treatment of NAFLD. More clinical studies are still in need to properly unveil the efficacy of PPAR agonists in the treatment of NAFLD.