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This pattern is particularly alarming in individuals with existing metabolic risk factors or liver disease, where dual use may exacerbate hepatic steatosis, inflammation, and fibrosis

What is already known Tobacco smokers often develop non-alcoholic fatty liver disease (NAFLD), a range of liver conditions related to the accumulation of liver fat in people who drink little or no alcohol, which can lead to liver scarring and cancer

Mitochondrial dysfunction and oxidative stress in the pathogenesis of alcohol- and obesity-induced fatty liver diseases

Lee YC, Cohet C, Yang YC, Stayner L, Hashibe M, Straif K