Herbal, dietary supplements-induced liver injury common in young women

Herbal and dietary supplements (HDS) may cause liver damage, which frequently occurs as hepatocellular injury, a study has found. Furthermore, this hepatotoxicity affects mostly young women and could potentially increase the risk of death or liver transplantation.

The study used data from the Latin America-Drug Induced Liver Injury (LATINDILI) Network and included 29 cases of HDS hepatotoxicity reported over 9 years. These cases were evaluated against 322 drug-induced liver injury (DILI) cases due to conventional drugs and 16 due to anabolic steroids.

Among DILI cases, 8 percent were attributed to HDS. There was a notable increasing trend in HDS-hepatotoxicity over time (p=0.04). These events were frequently associated with Camellia sinensis, Herbalife products, and Garcinia cambogia, mostly used for weight loss.

The mean age of the affected patients was 45 years, and 66 percent were women. Hepatotoxicity occurred after a median of 31 days of HDS use. Typical presentations were hepatocellular injury (83 percent) and jaundice (66 percent). Five patients (17 percent) developed acute liver failure.

Compared with those who developed liver injury due to conventional medications and anabolic steroids, patients with HDS-induced hepatotoxicity had the highest levels of aspartate and alanine transaminase (p=0.008 and p=0.021, respectively), had higher frequency of accidental re-exposure to the culprit HDS (14 percent vs 3 percent vs 0 percent; p=0.026), and had more severe and fatal/liver transplantation outcome (21 percent vs 12 percent vs 13 percent; p=0.005).

Compared to other DILI cohorts, relatively fewer patients who developed HDS hepatotoxicity in Latin America were hospitalized (41 percent).