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The primary risk factors for NAFLD include obesity (particularly central adiposity), type 2 diabetes mellitus , insulin resistance , dyslipidaemia (abnormal cholesterol levels), and metabolic syndrome

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Smoking may exacerbate the pathogenic effects of alcohol on the liver, implying that the combined exposure to both substances leads to more severe liver damage than either factor alone [77]

This biological link is supported by common underlying pathways, such as hepatic and systemic insulin resistance, atherogenic lipid profiles, hypertension, and increased expression of pro-atherogenic, pro-coagulant, and pro-inflammatory factors [75]

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