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      The Contents of Herbal and Dietary Supplements Implicated in Liver Injury in the United States Are Frequently Mislabeled

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          Abstract

          The U.S. Drug Induced Liver Injury Network assayed the contents of herbal and dietary supplements collected from patients enrolled into its prospective study. The aim was to determine the accuracy of product labels, and to identify known hepatotoxins. Using high‐performance liquid chromatography coupled with mass spectrometry to assay 272 product, 51% were found to be mislabeled; that is, to have chemical contents that did not match the label. Appearance enhancement, sexual performance, and weight loss products were most commonly mislabeled. Whether the mislabeling contributed to liver injury is under study; however, the high mislabeling rate underscores the need for more stringent regulation of supplements.

          Abstract

          Herbal and dietary supplements can cause liver injury. The precise cause for injury due to supplements is difficult to determine, as this studies shows that labels are largely unreliable.

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          Most cited references4

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          Trends in Dietary Supplement Use Among US Adults From 1999-2012.

          Dietary supplements are commonly used by US adults; yet, little is known about recent trends in supplement use.
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            Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network.

            The Drug-Induced Liver Injury Network (DILIN) studies hepatotoxicity caused by conventional medications as well as herbals and dietary supplements (HDS). To characterize hepatotoxicity and its outcomes from HDS versus medications, patients with hepatotoxicity attributed to medications or HDS were enrolled prospectively between 2004 and 2013. The study took place among eight U.S. referral centers that are part of the DILIN. Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (15.5%) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. Hepatotoxicity caused by HDS was evaluated by expert opinion. Demographic and clinical characteristics and outcome assessments, including death and liver transplantation (LT), were ascertained. Cases were stratified and compared according to the type of agent implicated in liver injury; 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7% to 20% (P < 0.001) during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in any fatalities or LT. The remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and, more frequently, led to death or transplantation, compared to injury from medications (13% vs. 3%; P < 0.05).
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              Nutrition Business Journal’s Supplement Business Report 2015

              (2015)
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                Author and article information

                Contributors
                NavarroV@einstein.edu
                Journal
                Hepatol Commun
                Hepatol Commun
                10.1002/(ISSN)2471-254X
                HEP4
                Hepatology Communications
                John Wiley and Sons Inc. (Hoboken )
                2471-254X
                03 April 2019
                June 2019
                : 3
                : 6 ( doiID: 10.1002/hep4.v3.6 )
                : 792-794
                Affiliations
                [ 1 ] Department of Digestive Disease and Transplantation Einstein Healthcare Network Philadelphia PA
                [ 2 ] National Center for Natural Products Research, the University of Mississippi University MS
                [ 3 ] Liver Diseases Branch National Institute of Diabetes and Digestive and Kidney Diseases Bethesda MD
                [ 4 ] Department of Medicine Keck School of Medicine of the University of Southern California Los Angeles CA
                [ 5 ] University of Michigan Medical School Ann Arbor MI
                [ 6 ] Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
                Author notes
                [*] [* ] Address Correspondence and Reprint Requests to:

                Victor J. Navarro, M.D.

                Department of Digestive Disease and Transplantation

                Albert Einstein Medical Center

                Suite 505 Klein

                5501 Old York Road

                Philadelphia, PA, 19141

                E‐mail: NavarroV@ 123456einstein.edu

                Article
                HEP41346
                10.1002/hep4.1346
                6545864
                31168513
                fd9307ee-50c5-4c2f-b4c1-ad675b8964de
                © 2019 The Authors. Hepatology Communications published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 22 October 2018
                : 17 December 2018
                Page count
                Figures: 0, Tables: 1, Pages: 3, Words: 1803
                Funding
                Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
                Award ID: UO1 DK083027
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                hep41346
                June 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:03.06.2019

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