These findings suggest that, in this relatively healthy population, smoking cessation and light-to-moderate drinking may reduce the risk of HCC.

These findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.

Background and Aims Nonalcoholic fatty liver disease (NAFLD) encompasses a range of conditions, from simple steatosis to nonalcoholic steatohepatitis. Studies in the United States have reported an increased mortality risk among individuals with NAFLD; therefore, the population attributable fractions (PAFs) for mortality were examined. Approach and Results A total of 12,253 adult individuals with ultrasound assessment of NAFLD from the Third National Health and Nutrition Examination Survey and mortality follow‐up through 2015 were included in the analysis. Cox proportional hazard regression was used to estimate multivariable‐adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for NAFLD in association with all‐cause and cause‐specific mortality. Overall, sex‐ and race/ethnicity‐specific PAFs and 95% CIs were estimated. In the current study, presence of NAFLD was associated with a 20% increased risk of all‐cause mortality (HR, 1.20; 95% CI, 1.08, 1.34). The overall PAF for all‐cause mortality associated with NAFLD was 7.5% (95% CI, 3.0, 12.0). The PAF for diabetes‐specific mortality was 38.0% (95% CI, 13.1, 63.0) overall, 40.8% (95% CI, 2.1, 79.6) in men, and 36.8% (95% CI, 6.6, 67.0) in women. The PAF for liver disease (LD)‐specific mortality was notably higher in men (68.3%; 95% CI, 36.3, 100.0) than women (3.5%; 95% CI, −39.7, 46.8). In the race‐specific analysis, the PAFs of NAFLD for all‐cause mortality (9.3%; 95% CI, 4.0, 14.6) and diabetes‐specific mortality (44.4%; 95% CI, 10.8, 78.0) were significantly greater than zero only for whites. Conclusions In the United States, approximately 8% of all‐cause mortality and more than one‐third of LD‐ and diabetes‐specific deaths are associated with NAFLD. With these high percentages, efforts are needed to reduce the burden of NAFLD in the United States.

Background Marijuana has been reported to have several effects on the male reproductive system. Marijuana has previously been linked to reduced adult testosterone, however, a study in Denmark reported increased testosterone concentrations among marijuana users. This study was performed to estimate the effect of marijuana use on testosterone in U.S. males. Methods Data on serum testosterone, marijuana use and covariates for 1577 men from the 2011–2012 U.S. National Health and Nutrition Examination Survey (NHANES) were analyzed. Information on marijuana use was collected by a self-administered computer-assisted questionnaire. Serum testosterone was determined using isotope dilution liquid chromatography tandem mass spectrometry. The effects of marijuana use on serum testosterone concentrations were examined by frequency, duration, and recency of use. Adjusted means and 95% confidence intervals (CI) of serum testosterone across levels of marijuana use were estimated using multiple linear regression weighted by the survey weights. Results The majority (66.2%) of the weighted study population reported ever using marijuana with 26.6% reporting current marijuana use. There was no difference in serum testosterone between ever users (adjusted mean = 3.69 ng/mL, 95% CI: 3.46, 3.93) and never users (adjusted mean = 3.70 ng/mL, 95% CI: 3.45, 3.98) upon multivariable analysis. However, serum testosterone was inversely associated with time since last regular use of marijuana (p-value for trend = 0.02). When restricted to men aged 18 – 29 years, this relationship strengthened (p-value for trend < 0.01) and serum testosterone was also inversely associated with time since last use (p-value for trend < 0.01), indicating that recency of use, and not duration or frequency, had the strongest relationship with testosterone levels. Discussion Serum testosterone concentrations were higher in men with more recent marijuana use. Studies are needed to determine the extent to which circulating testosterone concentrations mediate the relationship of marijuana use to male reproductive outcomes.

Objective To clarify risk factors for rare vulvar neoplasms. Methods Within the NIH-AARP Study, among 201,469 women interviewed in 1995–1996 and followed for a mean of 13.8 years, there were 370 diagnoses of incident vulvar neoplasms, including 170 invasive and 198 vulvar intraepithelial neoplasms grade 3 (VIN3). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated via multivariate logistic regression for various demographic, reproductive and lifestyle factors, with separate consideration of relations according to invasiveness, histology and age at diagnosis. Results Consistent with descriptive data, we found non-white women at lower risks of vulvar neoplasia than white women (HR=0.59, 95% CI 0.36–0.95). Significant risk factors for VIN3included being divorced/separated (HR vs. currently married=1.77, 95% CI 1.24–2.51), a current cigarette smoker (3.88, 95% CI 2.64–5.72), a user of oral contraceptives (1.46, 95% CI 1.06–2.01), or a current user of menopausal hormones (1.73, 95% CI 1.24–2.41). Significant risk factors for invasive cancers were being obese (HR for BMI ≥30 vs. <25=1.62, 95% CI 1.10–2.40) or a current smoker (1.86, 95% CI 1.21–2.87). Cigarette smoking was a risk factor mainly for neoplasms shown in other investigations to be HPV-related, namely VIN3 and invasive squamous cell cancers (SCCs) occurring in the younger stratum of cases. In contrast, obesity was primarily associated with the development of invasive SCCs. Conclusions Our results support that vulvar neoplasia is a heterogeneous disease. VIN3 demonstrated risk factors consistent with an HPV-related etiology, while invasive cancers were additionally affected by obesity, suggesting that further attention should focus on the role of chronic inflammatory conditions.