Steatosis and hepatic IR are closely associated but it is still poorly understood whether it is steatosis which causes IR, or vice versa. It is clear however that steatosis and IR usually precede inflammation, fibrosis, and cirrhosis of the liver.
Up-regulation of PPAR-alpha is protective against steatohepatitis and inhibits HCV replication.
PPARα was also reported to be down-regulated by HCV in the liver of infected patients [88, 89]. Since PPARα blocks the replication and production of infectious viral particles, its downregulation likely confers a replicative advantage to the virus in spite of the resulting metabolic disorders for the host cells [90, 91].
PPAR-alpha is upregulated by intracellular peroxidation of DHA, by carbohydrate restriction, and by fasting, as well as by the flavanone naringenin, an antioxidant found in grapefruit, oranges and tomatoes.
From this we might be able to construct a diet that prevents or reverses fatty liver, and thus prevents its sequellae: