Adults with type 2 diabetes, obesity, or metabolic syndrome should have non-invasive fibrosis risk assessment in primary care using validated scoring tools (such as FIB-4 or the NAFLD fibrosis score), followed by second-line tests (such as the Enhanced Liver Fibrosis [ELF] blood test or transient elastography) if indicated
Some observational studies suggest that patients with NAFLD who continue using tobacco products may have higher rates of advanced fibrosis compared to non-users with similar metabolic profiles, though the strength of evidence specific to smokeless tobacco remains uncertain
Carlsson and colleagues hypothesised that the effect of nicotine could explain these findings, with experimental studies previously linking nicotine to impaired insulin sensitivity
Oxidative Stress: Tobacco introduces free radicals and toxins that cause oxidative stress, leading to inflammation and cellular damage
Long-term inflammation is also linked to liver scarring and a higher risk of liver disease
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