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In dependent smokers, the urge to smoke cigarettes correlates with a low blood nicotine level, as though smoking were a means to achieve certain nicotine level, reap the rewarding feeling associated with nicotine and avoid withdrawals [22]

Summary: There is currently no established direct causal link between chewing tobacco and fatty liver disease based on available clinical evidence

However, less is known about these risk factors in African Americans who are disproportionately affected. Participants self-reported their cigarette smoking status through a questionnaire at baseline